TY - JOUR AU - Baretta, Dario AU - Rüttimann, Lynn Carole AU - Amrein, Alexandra Melanie AU - Inauen, Jennifer PY - 2025/4/24 TI - Promoting Hand Hygiene During the COVID-19 Pandemic: Randomized Controlled Trial of the Optimized Soapp+ App JO - JMIR Mhealth Uhealth SP - e57191 VL - 13 KW - COVID-19 KW - hand hygiene KW - behavior change technique KW - Multiphase Optimization Strategy KW - randomized controlled trial KW - smartphone apps KW - mobile phones N2 - Background: The adoption of protective behaviors represents a crucial measure to counter the spread of infectious diseases. The development of effective behavior change techniques therefore emerged as a public health priority during the COVID-19 pandemic, but randomized controlled trials (RCTs) testing such interventions during the pandemic were scarce. We conducted a Multiphase Optimization Strategy to develop, optimize, and evaluate a smartphone app, Soapp+, to promote hand hygiene during the COVID-19 pandemic. Objective: This RCT aims to evaluate the efficacy of the Soapp+ app (intervention group) targeting motivation and habit compared to a simplified version of the app mainly delivering hand hygiene information (active control group). We hypothesize that, compared to the control group, the intervention group will show greater improvements in hand hygiene behavior and behavioral determinants post intervention and at a 6-month follow-up. Methods: We conducted an RCT from March 2022 to April 2023, recruiting 193 adults living in Switzerland online. Following baseline assessment, the intervention lasted 32 days, followed by a postintervention assessment and a 6-month follow-up. The primary outcome was the change in hand hygiene behavior from pre- to postintervention and preintervention to follow-up. Hand hygiene was assessed with electronic diaries. The intervention group received content incorporating various behavior change techniques designed to address key motivational and volitional determinants of hand hygiene behavior (eg, skills, knowledge, intention, attitudes toward hand hygiene, risk perception, outcome expectancies, self-efficacy, action planning, coping planning, action control, habit). In contrast, the active control group was exposed to behavior change techniques targeting only a subset of these determinants (ie, skills, knowledge, and intention). The delivery of the intervention content was fully automated. Group differences were tested using an intention-to-treat approach with the nonparametric Wilcoxon rank sum test. Results: Of the 193 randomized participants, 146 completed the first hand hygiene diary preintervention and were included in the main analysis. The mean age was 41 (SD 17) years, and 69.2% (n=101) were women. The main analysis revealed significant superiority of the intervention compared to controls in the change in hand hygiene pre-post intervention (W=2034; P<.04; effect size r=0.17) and between preintervention and follow-up (W=2005; P<.03; effect size r=0.18). Regarding behavioral determinants, the change in coping planning pre-post intervention (W=3840; P=.03, effect size r=0.16) was significantly greater in the intervention group using Soapp+ compared to controls. Conclusions: Soapp+ was developed through a rigorous experimental method during the ongoing COVID-19 pandemic. The RCT provided evidence for the efficacy of Soapp+ to promote hand hygiene in the context of a pandemic. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/study/NCT04830761 UR - https://mhealth.jmir.org/2025/1/e57191 UR - http://dx.doi.org/10.2196/57191 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57191 ER - TY - JOUR AU - O'Connor, Karen AU - Weissenbacher, Davy AU - Elyaderani, Amir AU - Lautenbach, Ebbing AU - Scotch, Matthew AU - Gonzalez-Hernandez, Graciela PY - 2025/4/22 TI - Patient-Related Metadata Reported in Sequencing Studies of SARS-CoV-2: Protocol for a Scoping Review and Bibliometric Analysis JO - JMIR Res Protoc SP - e58567 VL - 14 KW - SARS-CoV-2 KW - COVID-19 KW - genomic epidemiology KW - GISAID KW - GenBank KW - sequence records KW - patient-related metadata KW - scoping review KW - protocol N2 - Background: There has been an unprecedented effort to sequence the SARS-CoV-2 virus and examine its molecular evolution. This has been facilitated by the availability of publicly accessible databases, such as the GISAID (Global Initiative on Sharing All Influenza Data) and GenBank, which collectively hold millions of SARS-CoV-2 sequence records. Genomic epidemiology, however, seeks to go beyond phylogenetic (the study of evolutionary relationships among biological entities) analysis by linking genetic information to patient characteristics and disease outcomes, enabling a comprehensive understanding of transmission dynamics and disease impact. While these repositories include fields reflecting patient-related metadata for a given sequence, the inclusion of these demographic and clinical details is scarce. The current understanding of patient-related metadata in published sequencing studies and its quality remains unexplored. Objective: Our review aims to quantitatively assess the extent and quality of patient-reported metadata in papers reporting original whole genome sequencing of the SARS-CoV-2 virus and analyze publication patterns using bibliometric analysis. Finally, we will evaluate the efficacy and reliability of a machine learning classifier in accurately identifying relevant papers for inclusion in the scoping review. Methods: The National Institutes of Health?s LitCovid collection will be used for the automated classification of papers reporting having deposited SARS-CoV-2 sequences in public repositories, while an independent search will be conducted in MEDLINE and PubMed Central for validation. Data extraction will be conducted using Covidence (Veritas Health Innovation Ltd). The extracted data will be synthesized and summarized to quantify the availability of patient metadata in the published literature of SARS-CoV-2 sequencing studies. For the bibliometric analysis, relevant data points, such as author affiliations, citation metrics, author keywords, and Medical Subject Headings terms will be extracted. Results: This study is expected to be completed in early 2025. Our classification model has been developed and we have classified publications in LitCovid published through February 2023. As of September 2024, papers through August 2024 are being prepared for processing. Screening is underway for validated papers from the classifier. Direct literature searches and screening of the results began in October 2024. We will summarize and narratively describe our findings using tables, graphs, and charts where applicable. Conclusions: This scoping review will report findings on the extent and types of patient-related metadata reported in genomic viral sequencing studies of SARS-CoV-2, identify gaps in the reporting of patient metadata, and make recommendations for improving the quality and consistency of reporting in this area. The bibliometric analysis will uncover trends and patterns in the reporting of patient-related metadata, including differences in reporting based on study types or geographic regions. The insights gained from this study may help improve the quality and consistency of reporting patient metadata, enhancing the utility of sequence metadata and facilitating future research on infectious diseases. Trial Registration: OSF Registries osf.io/wrh95; https://doi.org/10.17605/OSF.IO/WRH95 International Registered Report Identifier (IRRID): DERR1-10.2196/58567 UR - https://www.researchprotocols.org/2025/1/e58567 UR - http://dx.doi.org/10.2196/58567 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58567 ER - TY - JOUR AU - Liebst, Suonperä Lasse AU - Bernasco, Wim AU - Ejbye-Ernst, Peter AU - van Herwijnen, Nigel AU - van der Veen, Thomas AU - Koelma, Dennis AU - Snoek, M. Cees G. AU - Lindegaard, Rosenkrantz Marie PY - 2025/4/17 TI - Association Between Social Distancing Compliance and Public Place Crowding During the COVID-19 Pandemic: Cross-Sectional Observational Study Using Computer Vision to Analyze Surveillance Footage JO - JMIR Public Health Surveill SP - e50929 VL - 11 KW - social distancing KW - compliance KW - crowding KW - urban public spaces KW - computer vision KW - surveillance footage KW - COVID-19 pandemic N2 - Background: Social distancing behavior has been a critical nonpharmaceutical measure for mitigating the COVID-19 pandemic. For this reason, there has been widespread interest in the factors determining social distancing violations, with a particular focus on individual-based factors. Objective: In this paper, we examine an alternative and less appreciated indicator of social distancing violations: the situational opportunity for maintaining interpersonal distance in crowded settings. This focus on situational opportunities is borrowed from criminology, where it offers an alternative to individual-based explanations of crime and rule violations. We extend this approach to the COVID-19 pandemic context, suggesting its relevance in understanding distancing compliance behavior. Methods: Our data comprise a large collection of video clips (n=56,429) from public places in Amsterdam, the Netherlands, captured by municipal surveillance cameras throughout the first year of the pandemic. We automatized the analysis of this footage using a computer vision algorithm designed for pedestrian detection and estimation of metric distances between individuals in the video still frames. This method allowed us to record social distancing violations of over half a million individuals (n=539,127) across more and less crowded street contexts. Results: The data revealed a clear positive association between crowding and social distancing violations, evident both at the individual level and when aggregated per still frame. At the individual level, the analysis estimated that each additional 10 people present increased the likelihood of a distancing violation by 9 percentage points for a given pedestrian. At the aggregated level, there was an estimated increase of approximately 6 additional violations for every 10 additional individuals present, with a very large R² of 0.80. Additionally, a comparison with simulation data indicated that street spaces should, in principle, provide sufficient room for people to pass each other while maintaining a 1.5-meter distance. This suggests that pedestrians tend to gravitate toward others, even when ample space exists to maintain distance. Conclusions: The direct positive relationship between crowding and distancing violations suggests that potential transmission encounters can be identified by simply counting the number of people present in a location. Our findings thus provide a reliable and scalable proxy measure of distancing noncompliance that offers epidemiologists a tool to easily incorporate real-life behavior into predictive models of airborne contagious diseases. Furthermore, our results highlight the need for scholars and public health agencies to consider the situational factors influencing social distancing violations, especially those related to crowding in public settings. UR - https://publichealth.jmir.org/2025/1/e50929 UR - http://dx.doi.org/10.2196/50929 ID - info:doi/10.2196/50929 ER - TY - JOUR AU - Nian, Hui AU - Bai, Yu AU - Yu, Hua PY - 2025/4/8 TI - Assessing the Causal Association Between COVID-19 and Graves Disease: Mendelian Randomization Study JO - JMIR Form Res SP - e66003 VL - 9 KW - Graves disease KW - COVID-19 KW - Mendelian randomization KW - causal relationship KW - autoimmune disease N2 - Background: Graves disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism and autoantibodies. The COVID-19 pandemic has raised questions about its potential relationship with autoimmune diseases like GD. Objective: This study aims to investigate the causal association between COVID-19 and GD through Mendelian randomization (MR) analysis and assess the impact of COVID-19 on GD. Methods: We conducted an MR study using extensive genome-wide association study data for GD and COVID-19 susceptibility and its severity. We used stringent single nucleotide polymorphism selection criteria and various MR methodologies, including inverse-variance weighting, MR-Egger, and weighted median analyses, to assess causal relationships. We also conducted tests for directional pleiotropy and heterogeneity, as well as sensitivity analyses. Results: The MR analysis, based on the largest available dataset to date, did not provide evidence supporting a causal relationship between COVID-19 susceptibility (odds ratio [OR] 0.989, 95% CI 0.405?2.851; P=.93), COVID-19 hospitalization (OR 0.974, 95% CI 0.852?1.113; P=.70), COVID-19 severity (OR 0.979, 95% CI 0.890?1.077; P=.66), and GD. Tests for directional pleiotropy and heterogeneity, as well as sensitivity analyses, supported these findings. Conclusions: This comprehensive MR study does not provide sufficient evidence to support a causal relationship between COVID-19 and the onset or exacerbation of GD. These results contribute to a better understanding of the potential association between COVID-19 and autoimmune diseases, alleviating concerns about a surge in autoimmune thyroid diseases due to the pandemic. Further research is warranted to explore this complex relationship thoroughly. UR - https://formative.jmir.org/2025/1/e66003 UR - http://dx.doi.org/10.2196/66003 ID - info:doi/10.2196/66003 ER - TY - JOUR AU - Mathew, Jenny AU - Pagliaro, A. Jaclyn AU - Elumalai, Sathyanarayanan AU - Wash, K. Lauren AU - Ly, Ka AU - Leibowitz, J. Alison AU - Vimalananda, G. Varsha PY - 2025/3/27 TI - Developing a Multisensor-Based Machine Learning Technology (Aidar Decompensation Index) for Real-Time Automated Detection of Post?COVID-19 Condition: Protocol for an Observational Study JO - JMIR Res Protoc SP - e54993 VL - 14 KW - Aidar Decompensation Index KW - AIDI KW - biophysical biomarkers of worsening health KW - biosensor-based physiological monitoring KW - cardiorespiratory, metabolic, renal, and neurological complications after COVID-19 KW - early warning signs of clinical decompensation KW - long COVID KW - noninvasive monitoring of physiology KW - postacute sequelae of COVID-19 KW - PACS KW - rapid assessment tool KW - risk triaging related to long COVID N2 - Background: Post?COVID-19 condition is emerging as a new epidemic, characterized by the persistence of COVID-19 symptoms beyond 3 months, and is anticipated to substantially alter the lives of millions of people globally. Patients with severe episodes of COVID-19 are significantly more likely to be hospitalized in the following months. The pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiovascular and pulmonary diseases, which are common among those at risk of severe disease. Objective: This study aims to use a single, integrated device?MouthLab, which measures 10 vital health parameters in 60 seconds?and a cloud-based proprietary analytics engine to develop and validate the Aidar Decompensation Index (AIDI), to predict decompensation in health among patients who previously had severe COVID-19. Methods: Overall, 200 participants will be enrolled. Inclusion criteria are patients in the US Department of Veterans Affairs health care system; ?severe? COVID-19 infection during the acute phase, defined as requiring hospitalization, within 3-6 months before enrollment; aged ?18 years; and having 1 of 6 prespecified chronic conditions. All participants will be instructed to use the MouthLab device to capture daily physiological data and complete monthly symptom surveys. Structured data collection tables will be developed to extract the clinical characteristics of those who experience decompensation events (DEs). The performance of the AIDI will depend on the magnitude of difference in physiological signals between those experiencing DEs and those who do not, as well as the time until a DE (ie, the closer to the event, the easier the prediction). Information about demographics, symptoms (Medical Research Council Dyspnea Scale and Post-COVID-19 Functional Status Scale), comorbidities, and other clinical characteristics will be tagged and added to the biomarker data. The resultant predicted probability of decompensation will be translated into the AIDI, where there will be a linear relationship between the risk score and the AIDI. To improve prediction accuracy, data may be stratified based on biological sex, race, ethnicity, or underlying clinical characteristics into subgroups to determine if there are differences in performance and detection lead times. Using appropriate algorithmic techniques, the study expects the model to have a sensitivity of >80% and a positive predicted value of >70%. Results: Recruitment began in January 2023, and at the time of manuscript submission, 204 patients have been enrolled. Publication of the complete results and data from the study is expected in 2025. Conclusions: The focus on identifying predictor variables using a combination of biosensor-derived physiological features should enable the capture of heterogeneous characteristics of complications related to post?COVID-19 condition across diverse populations. Trial Registration: ClinicalTrials.gov NCT05220306; https://clinicaltrials.gov/study/NCT05220306 UR - https://www.researchprotocols.org/2025/1/e54993 UR - http://dx.doi.org/10.2196/54993 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54993 ER - TY - JOUR AU - Kerr, Gabriele AU - Greenfield, Geva AU - Li, Edmond AU - Beaney, Thomas AU - Hayhoe, J. Benedict W. AU - Car, Josip AU - Clavería, Ana AU - Collins, Claire AU - Gusso, Gustavo AU - Hoffman, D. Robert AU - Jimenez, Geronimo AU - Koskela, H. Tuomas AU - Laranjo, Liliana AU - Lingner, Heidrun AU - Memarian, Ensieh AU - Nessler, Katarzyna AU - Petek, Davorina AU - Tsopra, Rosy AU - Majeed, Azeem AU - Neves, Luisa Ana PY - 2025/3/19 TI - Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study JO - J Med Internet Res SP - e65147 VL - 27 KW - digital health KW - primary care KW - telemedicine KW - virtual consultation KW - healthcare delivery KW - online consultation KW - primary care physician KW - upper-middle income KW - upper-middle income countries KW - high-income countries KW - online survey KW - chi-squared test KW - remote healthcare KW - video consultation KW - chat consultation KW - telephone consultations KW - digital technology KW - virtual care KW - teleconsultation KW - telehealth KW - remote consultation N2 - 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 UR - https://www.jmir.org/2025/1/e65147 UR - http://dx.doi.org/10.2196/65147 UR - http://www.ncbi.nlm.nih.gov/pubmed/40105882 ID - info:doi/10.2196/65147 ER - TY - JOUR AU - Alexander, D. Jordan AU - Duffy, A. Kelly AU - Freis, M. Samantha AU - Chow, Sy-Miin AU - Friedman, P. Naomi AU - Vrieze, I. Scott PY - 2025/3/17 TI - Investigating the Magnitude and Persistence of COVID-19?Related Impacts on Affect and GPS-Derived Daily Mobility Patterns in Adolescence and Emerging Adulthood: Insights From a Smartphone-Based Intensive Longitudinal Study of Colorado-Based Youths From June 2016 to April 2022 JO - J Med Internet Res SP - e64965 VL - 27 KW - adolescence KW - emerging adulthood KW - intensive longitudinal assessment KW - COVID-19 KW - affect KW - GPS KW - mobility patterns KW - smartphone data KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - adolescents KW - teens KW - teenagers KW - mobility KW - apps KW - smartphones KW - intensive longitudinal panel studies KW - emotional well-being KW - well-being KW - daily routines KW - affect survey N2 - Background: The onset of the COVID-19 pandemic in early 2020 introduced unprecedented disruptions impacting the emotional well-being and daily routines of US youths. However, the patterns and persistence of these impacts over the pandemic?s multiyear course remain less well understood. Objective: This study examined longitudinal changes in affect and daily mobility patterns observed in adolescence and young adulthood from June 2016 to April 2022. The study aimed to quantify changes in youths? mood and daily routines following the pandemic?s onset and in response to local COVID-19 case rates as well as the persistence of these effects over the pandemic?s multiyear course. Methods: Colorado-based adolescent and young adult twins (N=887; n=479, 54% female; meanage 19.2, SDage 1.5 years on January 01, 2020) participating in the CoTwins study between June 2016 and April 2022 were followed via a smartphone app, which recorded persistent GPS location data and, beginning in February 2019, administered an abbreviated Positive and Negative Affect Schedule every 2 weeks. Nonlinear trajectories in affect and daily mobility over time and in response to local COVID-19 counts were modeled via generalized additive mixed models, while the magnitude and persistence of pandemic-related changes were quantified via linear mixed effects regressions. Results: Between January and April 2020, participants experienced a 28.6% decline in daily locations visited (from 3.5 to 2.5; SD 0.9) and a 60% reduction in daily travel distance (from 20.0 to 8.0 km; SD 9.4). Mean positive affect similarly declined by 0.3 SD (from 3.0 to 2.79; SD 0.6), while, correspondingly, mean negative affect increased by 0.3 SD (from 1.85 to 2.10; SD 0.6). Though mobility levels partially recovered beginning in the summer of 2020, daily locations visited remained slightly below 2019 levels through the study?s conclusion in April 2022 (standardized ?=?0.10; P<.001). Average positive affect similarly remained slightly below (standardized ?=?0.20; P<.001) and negative affect slightly above (standardized ?=0.14; P=.04) 2019 levels through April 2022. Weekly county-level COVID-19 transmission rates were negatively associated with mobility and positive affect and positively with negative affect, though these effects were greatly weakened later in the pandemic (eg, early 2022) or when transmission rates were high (eg, >200 new cases per 100,000 people per week). Conclusions: Findings demonstrate large initial declines in daily mobility, a moderate decline in positive affect, and a moderate increase in negative affect following the pandemic?s onset in 2020. Though most effects attenuated over time, affect and mobility levels had not recovered to prepandemic levels by April 2022. Findings support theories of hedonic adaptation and resiliency while also identifying lingering emotional and behavioral consequences. The study highlights both youth?s resiliency in adapting to major stressors while also underscoring the need for continued support for youth mental health and psychosocial functioning in the pandemic?s aftermath. UR - https://www.jmir.org/2025/1/e64965 UR - http://dx.doi.org/10.2196/64965 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64965 ER - TY - JOUR AU - Arifi, Dorian AU - Resch, Bernd AU - Santillana, Mauricio AU - Guan, Wendy Weihe AU - Knoblauch, Steffen AU - Lautenbach, Sven AU - Jaenisch, Thomas AU - Morales, Ivonne AU - Havas, Clemens PY - 2025/1/30 TI - Geosocial Media?s Early Warning Capabilities Across US County-Level Political Clusters: Observational Study JO - JMIR Infodemiology SP - e58539 VL - 5 KW - spatiotemporal epidemiology KW - geo-social media data KW - digital disease surveillance KW - political polarization KW - epidemiological early warning KW - digital early warning N2 - Background: The novel coronavirus disease (COVID-19) sparked significant health concerns worldwide, prompting policy makers and health care experts to implement nonpharmaceutical public health interventions, such as stay-at-home orders and mask mandates, to slow the spread of the virus. While these interventions proved essential in controlling transmission, they also caused substantial economic and societal costs and should therefore be used strategically, particularly when disease activity is on the rise. In this context, geosocial media posts (posts with an explicit georeference) have been shown to provide a promising tool for anticipating moments of potential health care crises. However, previous studies on the early warning capabilities of geosocial media data have largely been constrained by coarse spatial resolutions or short temporal scopes, with limited understanding of how local political beliefs may influence these capabilities. Objective: This study aimed to assess how the epidemiological early warning capabilities of geosocial media posts for COVID-19 vary over time and across US counties with differing political beliefs. Methods: We classified US counties into 3 political clusters, democrat, republican, and swing counties, based on voting data from the last 6 federal election cycles. In these clusters, we analyzed the early warning capabilities of geosocial media posts across 6 consecutive COVID-19 waves (February 2020-April 2022). We specifically examined the temporal lag between geosocial media signals and surges in COVID-19 cases, measuring both the number of days by which the geosocial media signals preceded the surges in COVID-19 cases (temporal lag) and the correlation between their respective time series. Results: The early warning capabilities of geosocial media data differed across political clusters and COVID-19 waves. On average, geosocial media posts preceded COVID-19 cases by 21 days in republican counties compared with 14.6 days in democrat counties and 24.2 days in swing counties. In general, geosocial media posts were preceding COVID-19 cases in 5 out of 6 waves across all political clusters. However, we observed a decrease over time in the number of days that posts preceded COVID-19 cases, particularly in democrat and republican counties. Furthermore, a decline in signal strength and the impact of trending topics presented challenges for the reliability of the early warning signals. Conclusions: This study provides valuable insights into the strengths and limitations of geosocial media data as an epidemiological early warning tool, particularly highlighting how they can change across county-level political clusters. Thus, these findings indicate that future geosocial media based epidemiological early warning systems might benefit from accounting for political beliefs. In addition, the impact of declining geosocial media signal strength over time and the role of trending topics for signal reliability in early warning systems need to be assessed in future research. UR - https://infodemiology.jmir.org/2025/1/e58539 UR - http://dx.doi.org/10.2196/58539 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58539 ER - TY - JOUR AU - Cintora-Sanz, María Ana AU - Horrillo-García, Cristina AU - Quesada-Cubo, Víctor AU - Pérez-Alonso, María Ana AU - Gutiérrez-Misis, Alicia PY - 2025/1/16 TI - Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e66179 VL - 11 KW - acute respiratory failure KW - COVID-19 KW - chronic obstructive respiratory insufficiency KW - congestive heart failure KW - bronchospasm KW - emergency medical services costs KW - ambulances KW - SARS-CoV-2 KW - coronavirus KW - respiratory KW - pulmonary KW - pandemic KW - economic impact KW - observational KW - Madrid KW - community KW - medical records KW - health records KW - medical advanced life support KW - ALS KW - acute pulmonary edema KW - chronic obstructive pulmonary disease KW - COPD KW - prevalence N2 - Background: Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid?s medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Objectives: Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. Methods: A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. Results: The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07% in 2014; it decreased to 0.03% in 2020. CHF followed at 0.06% in 2014 and 0.03% in 2020. APE had a prevalence of 0.01% in 2014, decreasing to 0.005% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of ?2,726,893 (which equals to US $2,864,628). Conclusions: COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was ?58,791,031 (US $61,832,879). UR - https://publichealth.jmir.org/2025/1/e66179 UR - http://dx.doi.org/10.2196/66179 ID - info:doi/10.2196/66179 ER - TY - JOUR AU - Crawford, Allison AU - Kirvan, Anne AU - Sanches, Marcos AU - Gambin, Amanda AU - Canso, Denise AU - Serhal, Eva PY - 2025/1/3 TI - The Virtual Client Experience Survey for Mental Health and Addictions: Revalidation of a Survey to Measure Client and Family Experiences of Virtual Care JO - J Med Internet Res SP - e49844 VL - 27 KW - virtual care KW - digital health KW - mental health KW - client satisfaction KW - health care quality KW - Virtual Client Experience Survey KW - telehealth KW - telemedicine KW - eHealth N2 - Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients? perspectives on virtual mental health care quality will be critical to informing future policies and practices. Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care. Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach ? coefficient. Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an ? lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001). Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances. UR - https://www.jmir.org/2025/1/e49844 UR - http://dx.doi.org/10.2196/49844 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752192 ID - info:doi/10.2196/49844 ER - TY - JOUR AU - Voit, Florian AU - Erber, Johanna AU - Egert-Schwender, Silvia AU - Hanselmann, Michael AU - Laxy, Michael AU - Kehl, Victoria AU - Hoffmann, Dieter AU - Jeske, D. Samuel AU - Michler, Thomas AU - Protzer, Ulrike AU - Kohlmayer, Florian AU - Schmid, M. Roland AU - Spinner, D. Christoph AU - Weidlich, Simon PY - 2024/12/11 TI - Implementation and User Satisfaction of a Comprehensive Telemedicine Approach for SARS-CoV-2 Self-Sampling: Monocentric, Prospective, Interventional, Open-Label, Controlled, Two-Arm Feasibility Study JO - JMIR Form Res SP - e57608 VL - 8 KW - telemedicine KW - self-sampling KW - SARS-CoV-2 KW - user satisfaction KW - user KW - implementation KW - acute respiratory syndrome KW - respiratory syndrome KW - coronavirus KW - monocentric KW - prospective KW - interventional KW - open-label KW - two-arm feasibility study KW - innovative KW - application KW - healthcare KW - treatment KW - mobile phone KW - pandemic control KW - health care N2 - Background: The universal availability of smartphones has created new opportunities for innovative telemedicine applications in health care. The COVID-19 pandemic has heightened the demand for contactless health care services, making SARS-CoV-2 polymerase chain reaction (PCR) testing a crucial component of pandemic containment. Objective: This feasibility study aimed to examine a comprehensive telemedicine approach for SARS-CoV-2 testing, focusing on the practicality, user satisfaction, and economic implications of self-sampling guided by a telemedicine platform. Methods: The study process involved shipping self-sampling kits, providing instructions for at-home sample collection, processing biomaterials (swabs and capillary blood), communicating test results, and providing interoperable data for clinical routine and research through a medical mobile app. A total of 100 individuals were randomly assigned to either the conventional health care professional (HCP)?performed SARS-CoV-2 testing group (conventional testing group, CG) or the telemedicine-guided SARS-CoV-2 self-sampling approach (telemedicine group, TG). Feasibility of the TG approach, user satisfaction, user-centered outcomes, and economic aspects were assessed and compared between the groups. Results: In the TG group, 47 out of 49 (95%) individuals received a self-sampling kit via mail, and 37out of 49 (76%) individuals successfully returned at least one sample for diagnostics. SARS-CoV-2 PCR tests were conducted in 95% (35/37) of TG cases compared with 88% (44/50) in the CG. Users in the TG reported high satisfaction levels with ease of use (5.2/7), interface satisfaction (5.2/7), and usefulness (4.3/7). A microcosting model indicated a slightly higher cost for the TG approach than the CG approach. The TG demonstrated the potential to facilitate interoperable data transmission by providing anonymized, standardized datasets for extraction using Health Level 7-Fast Healthcare Interoperability Resources. This supports the national COVID-19 Data Exchange Platform and facilitates epidemiological evaluation based on the German COVID Consensus dataset. Conclusion: These preliminary findings suggest that a telemedicine-based approach to SARS-CoV-2 testing is feasible and could be integrated into existing hospital data infrastructures. This model has the potential for broader application in medical care, offering a scalable solution that could improve user satisfaction and treatment quality in the future. Trial Registration: Deutsches Register Klinischer Studien (DRKS) DRKS00027093; https://www.drks.de/search/de/trial/DRKS00027093 UR - https://formative.jmir.org/2024/1/e57608 UR - http://dx.doi.org/10.2196/57608 ID - info:doi/10.2196/57608 ER - TY - JOUR AU - Wu, A. Scott AU - Soetikno, G. Alan AU - Ozer, A. Egon AU - Welch, B. Sarah AU - Liu, Yingxuan AU - Havey, J. Robert AU - Murphy, L. Robert AU - Hawkins, Claudia AU - Mason, Maryann AU - Post, A. Lori AU - Achenbach, J. Chad AU - Lundberg, L. Alexander PY - 2024/12/5 TI - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Canada: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e53218 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - Canada KW - pandemic KW - surveillance KW - transmission KW - acceleration KW - deceleration KW - dynamic panel KW - generalized method of moments KW - GMM KW - Arellano-Bond KW - 7-day lag KW - k KW - metrics KW - epidemiology KW - dynamic KW - genomic KW - historical context KW - outbreak threshold N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53218 UR - http://dx.doi.org/10.2196/53218 UR - http://www.ncbi.nlm.nih.gov/pubmed/39471286 ID - info:doi/10.2196/53218 ER - TY - JOUR AU - Torán-Monserrat, Pere AU - Lamonja-Vicente, Noemí AU - Costa-Garrido, Anna AU - Carrasco-Ribelles, A. Lucía AU - Quirant, Bibiana AU - Boigues, Marc AU - Molina, Xaviera AU - Chacón, Carla AU - Dacosta-Aguayo, Rosalia AU - Arméstar, Fernando AU - Martínez Cáceres, María Eva AU - Prado, G. Julia AU - Violán, Concepción AU - PY - 2024/11/22 TI - SARS-CoV-2 Infection Risk by Vaccine Doses and Prior Infections Over 24 Months: ProHEpiC-19 Longitudinal Study JO - JMIR Public Health Surveill SP - e56926 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - health care workers KW - cohort KW - extended Cox models KW - coronavirus KW - epidemiology KW - epidemiological KW - risks KW - infectious KW - respiratory KW - longitudinal KW - vaccines KW - vaccination KW - vaccinated N2 - 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 UR - https://publichealth.jmir.org/2024/1/e56926 UR - http://dx.doi.org/10.2196/56926 ID - info:doi/10.2196/56926 ER - TY - JOUR AU - O'Dwyer, Brynn AU - Jaana, Mirou AU - Hui, Charles AU - Chreim, Samia AU - Ellis, Jennifer PY - 2024/11/5 TI - Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study JO - JMIR Public Health Surveill SP - e64270 VL - 10 KW - COVID-19 KW - surveillance KW - technology KW - digital contact tracing KW - qualitative KW - hospitals KW - Reach, Effectiveness, Adoption, Implementation, and Maintenance framework KW - RE-AIM N2 - 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. UR - https://publichealth.jmir.org/2024/1/e64270 UR - http://dx.doi.org/10.2196/64270 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64270 ER - TY - JOUR AU - Hong, Seohyun AU - Son, Yejun AU - Lee, Myeongcheol AU - Lee, Hyuk Jun AU - Park, Jaeyu AU - Lee, Hayeon AU - Dragioti, Elena AU - Fond, Guillaume AU - Boyer, Laurent AU - López Sánchez, Felipe Guillermo AU - Smith, Lee AU - Tully, A. Mark AU - Rahmati, Masoud AU - Choi, Sung Yong AU - Lee, Joo Young AU - Yeo, Geun Seung AU - Woo, Selin AU - Yon, Keon Dong PY - 2024/11/1 TI - Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e56989 VL - 10 KW - COVID-19 KW - influenza KW - South Korea KW - vaccination KW - vaccinations KW - COVID-19 vaccine KW - COVID-19 vaccination KW - SARS-CoV-2 KW - SARS-CoV-2 vaccine KW - pandemic KW - SARS-CoV-2 vaccination KW - vaccine KW - vaccine hesitancy N2 - 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. UR - https://publichealth.jmir.org/2024/1/e56989 UR - http://dx.doi.org/10.2196/56989 ID - info:doi/10.2196/56989 ER - TY - JOUR AU - Dyer, Michael Christopher AU - Negoescu, Alexandra-Teodora AU - Borchert, Matthias AU - Harter, Christoph AU - Kühn, Anne AU - Dambach, Peter AU - Marx, Michael PY - 2024/10/29 TI - Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany JO - Online J Public Health Inform SP - e54578 VL - 16 KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - quarantine KW - contact tracing KW - contact tracing effectiveness KW - demographics KW - mortality KW - case fatality KW - public health surveillance KW - public health systems N2 - 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 F?-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 (F?-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 F?-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. UR - https://ojphi.jmir.org/2024/1/e54578 UR - http://dx.doi.org/10.2196/54578 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54578 ER - TY - JOUR AU - Liu, Min AU - Yuan, Shuo AU - Li, Bingyan AU - Zhang, Yuxi AU - Liu, Jia AU - Guan, Cuixia AU - Chen, Qingqing AU - Ruan, Jiayi AU - Xie, Lunfang PY - 2024/10/28 TI - Chinese Public Attitudes and Opinions on Health Policies During Public Health Emergencies: Sentiment and Topic Analysis JO - J Med Internet Res SP - e58518 VL - 26 KW - public health emergencies KW - nucleic acid testing KW - governance strategies KW - sentiment analysis KW - LDA KW - social media KW - COVID-19 KW - opinion analysis N2 - Background: By the end of 2021, the new wave of COVID-19 sparked by the Omicron variant spread rapidly due to its highly contagious nature, affecting more than 170 countries worldwide. Nucleic acid testing became the gold standard for diagnosing novel coronavirus infections. As of July 2022, numerous cities and regions in China have implemented regular nucleic acid testing policies, which have had a significant impact on socioeconomics and people?s lives. This policy has garnered widespread attention on social media platforms. Objective: This study took the newly issued regular nucleic acid testing policy during the COVID-19 pandemic as an example to explore the sentiment responses and fluctuations of netizens toward new policies during public health emergencies. It aimed to propose strategies for managing public opinion on the internet and provide recommendations for policy making and public opinion control. Methods: We collected blog posts related to nucleic acid testing on Weibo from April 1, 2022, to July 31, 2022. We used the topic modeling technique latent Dirichlet allocation (LDA) to identify the most common topics posted by users. We used Bidirectional Encoder Representations from Transformers (BERT) to calculate the sentiment score of each post. We used an autoregressive integrated moving average (ARIMA) model to examine the relationship between sentiment scores and changes over time. We compared the differences in sentiment scores across various topics, as well as the changes in sentiment before and after the announcement of the nucleic acid price reduction policy (May 22) and the lifting of the lockdown policy in Shanghai (June 1). Results: We collected a total of 463,566 Weibo posts, with an average of 3799.72 (SD 1296.06) posts published daily. The LDA topic extraction identified 8 topics, with the most numerous being the Shanghai outbreak, nucleic acid testing price, and transportation. The average sentiment score of the posts was 0.64 (SD 0.31), indicating a predominance of positive sentiment. For all topics, posts with positive sentiment consistently outnumbered those with negative sentiment (?27=24,844.4, P<.001). The sentiment scores of posts related to ?nucleic acid testing price? decreased after May 22 compared with before (t120=3.882, P<.001). Similarly, the sentiment scores of posts related to the ?Shanghai outbreak? decreased after June 1 compared with before (t120=11.943, P<.001). Conclusions: During public health emergencies, the topics of public concern were diverse. Public sentiment toward the regular nucleic acid testing policy was generally positive, but fluctuations occurred following the announcement of key policies. To understand the primary concerns of the public, the government needs to monitor social media posts by citizens. By promptly sharing information on media platforms and engaging in effective communication, the government can bridge the information gap between the public and government agencies, fostering a positive public opinion environment. UR - https://www.jmir.org/2024/1/e58518 UR - http://dx.doi.org/10.2196/58518 UR - http://www.ncbi.nlm.nih.gov/pubmed/39466313 ID - info:doi/10.2196/58518 ER - TY - JOUR AU - Chen, En-ling AU - Bai, Chyi-Huey AU - Kocis, T. Paul AU - Hwang, Wenke PY - 2024/10/24 TI - The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study JO - JMIR Form Res SP - e60000 VL - 8 KW - name-based rationing system KW - NBRS KW - community pharmacy KW - community pharmacist KW - COVID-19 KW - SARS-CoV-2 KW - KAP KW - knowledge, attitude, and practices KW - public health KW - health emergencies KW - government strategy KW - mobile phone N2 - Background: In Taiwan?s public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. Objective: This study aimed to investigate (1) Taiwanese pharmacists? knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19?related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual?s KAP and corresponding perspectives toward the NBRS. Methods: A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists? KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument?s internal consistency reliability was ascertained using Cronbach ? (0.819), and its content validity was verified by field experts. Results: Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19?related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19?testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. Conclusions: The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan?s COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises. UR - https://formative.jmir.org/2024/1/e60000 UR - http://dx.doi.org/10.2196/60000 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60000 ER - TY - JOUR AU - Lundberg, L. Alexander AU - Soetikno, G. Alan AU - Wu, A. Scott AU - Ozer, A. Egon AU - Welch, B. Sarah AU - Mason, Maryann AU - Murphy, L. Robert AU - Hawkins, Claudia AU - Liu, Yingxuan AU - Moss, B. Charles AU - Havey, J. Robert AU - Achenbach, J. Chad AU - Post, A. Lori PY - 2024/10/23 TI - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Sub-Saharan Africa: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e53409 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - sub-Saharan Africa KW - pandemic KW - surveillance KW - public health KW - COVID-19 transmission KW - speed KW - acceleration KW - deceleration KW - jerk KW - dynamic panel KW - generalized method of moments KW - Arellano-Bond N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53409 UR - http://dx.doi.org/10.2196/53409 UR - http://www.ncbi.nlm.nih.gov/pubmed/39013111 ID - info:doi/10.2196/53409 ER - TY - JOUR AU - Vecino-Ortiz, I. Andres AU - Guzman-Tordecilla, Nicolas Deivis AU - Maniar, Vidhi AU - Agudelo-Londoño, Sandra AU - Franco-Suarez, Oscar AU - Aya Pastrana, Nathaly AU - Rodríguez-Patarroyo, Mariana AU - Mejía-Rocha, Marino AU - Cardona, Jaime AU - Chavez Chamorro, Mariangela AU - Gibson, Dustin PY - 2024/10/17 TI - Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design JO - J Med Internet Res SP - e50184 VL - 26 KW - mobile phone surveys KW - syndromic surveillance KW - COVID-19 KW - public health surveillance KW - IVR KW - interactive voice response KW - survey KW - surveys KW - voice response KW - syndromic KW - surveillance KW - respiratory KW - pandemic KW - SARS-CoV-2 KW - feasibility KW - data collection KW - public health KW - emergency KW - outbreak KW - mobile phone N2 - 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. UR - https://www.jmir.org/2024/1/e50184 UR - http://dx.doi.org/10.2196/50184 UR - http://www.ncbi.nlm.nih.gov/pubmed/39418077 ID - info:doi/10.2196/50184 ER - TY - JOUR AU - Qin, Rundong AU - Feng, Yan AU - Zhang, Huanping AU - Zhao, Beibei AU - Lei, Wei AU - Sun, Hongying AU - Zhi, Lili AU - Zheng, Zhongsheng AU - Wang, Siqin AU - Yu, Yafeng AU - Jiang, Shengxue AU - Liu, Changshan AU - Ma, Xingkai AU - Ma, Hui AU - Wang, Huiying AU - Lin, Hang AU - He, Qiaojie AU - Wu, Lingying AU - Zhai, Yingying AU - Lu, Honglue AU - Chen, Shi AU - Ma, Yan AU - Jin, Xiaohong AU - Deng, Shan AU - Zhong, Nanshan AU - Chen, Ruchong AU - Li, Jing PY - 2024/10/16 TI - Protective Effect of Allergen Immunotherapy in Patients With Allergic Rhinitis and Asthma Against COVID-19 Infection: Observational, Nationwide, and Multicenter Study JO - JMIR Public Health Surveill SP - e50846 VL - 10 KW - allergen immunotherapy KW - COVID-19 KW - antiviral effect KW - allergic rhinitis KW - asthma KW - viral infection KW - allergic disease KW - trajectory KW - questionnaire-based survey KW - clinical evidence N2 - 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. UR - https://publichealth.jmir.org/2024/1/e50846 UR - http://dx.doi.org/10.2196/50846 ID - info:doi/10.2196/50846 ER - TY - JOUR AU - Salisbury, David AU - Lazarus, V. Jeffrey AU - Waite, Nancy AU - Lehmann, Clara AU - Sri Bhashyam, Sumitra AU - de la Cruz, Marie AU - Hahn, Beth AU - Rousculp, D. Matthew AU - Bonanni, Paolo PY - 2024/10/16 TI - COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e57242 VL - 10 KW - COVID-19 KW - discrete choice experiment KW - vaccine hesitancy KW - vaccine side effects KW - SARS-CoV-2 KW - COVID vaccination KW - immunization KW - preference elicitation KW - informed decision-making KW - antivaccine N2 - 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. UR - https://publichealth.jmir.org/2024/1/e57242 UR - http://dx.doi.org/10.2196/57242 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412841 ID - info:doi/10.2196/57242 ER - TY - JOUR AU - Martonik, Rachel AU - Oleson, Caitlin AU - Marder, Ellyn PY - 2024/10/16 TI - Spatiotemporal Cluster Detection for COVID-19 Outbreak Surveillance: Descriptive Analysis Study JO - JMIR Public Health Surveill SP - e49871 VL - 10 KW - COVID-19 KW - cluster detection KW - disease outbreaks KW - surveillance KW - SaTScan KW - space-time surveillance KW - spatiotemporal KW - United States KW - outbreak KW - outbreaks KW - pandemic KW - real-time surveillance KW - detection KW - tool KW - tools KW - effectiveness KW - public health KW - intervention KW - interventions KW - community settings KW - outbreak detection N2 - 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. UR - https://publichealth.jmir.org/2024/1/e49871 UR - http://dx.doi.org/10.2196/49871 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412839 ID - info:doi/10.2196/49871 ER - TY - JOUR AU - Rawat, Kumar Sumit AU - Asati, Anand Ajit AU - Mishra, Nitu AU - Jain, Ashish AU - Ratho, Kanta Radha PY - 2024/10/11 TI - Identification of COVID-19?Associated Hepatitis in Children as an Emerging Complication in the Wake of SARS-CoV-2 Infections: Ambispective Observational Study JO - JMIRx Med SP - e48629 VL - 5 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - liver KW - hepatic KW - hepatitis KW - child KW - children KW - pediatric KW - pediatrics KW - retrospective KW - observational KW - jaundice KW - youth KW - inflammatory KW - inflammation N2 - 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. UR - https://xmed.jmir.org/2024/1/e48629 UR - http://dx.doi.org/10.2196/48629 ID - info:doi/10.2196/48629 ER - TY - JOUR AU - Ashoor, Dana AU - Marzouq, Maryam AU - Fathallah, M-Dahmani PY - 2024/10/10 TI - Comparison of the Neutralization Power of Sotrovimab Against SARS-CoV-2 Variants: Development of a Rapid Computational Method JO - JMIR Bioinform Biotech SP - e58018 VL - 5 KW - in silico KW - anti?SARS-CoV-2 KW - neutralizing antibody KW - Sotrovimab KW - S309 KW - variants KW - SARS-CoV-2 KW - Omicron KW - subvariants KW - computational method KW - monoclonal KW - amino acid KW - protein KW - mutation N2 - 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. UR - https://bioinform.jmir.org/2024/1/e58018 UR - http://dx.doi.org/10.2196/58018 UR - http://www.ncbi.nlm.nih.gov/pubmed/39388246 ID - info:doi/10.2196/58018 ER - TY - JOUR AU - Jiang, Mingyue AU - Jia, Mengmeng AU - Wang, Qing AU - Sun, Yanxia AU - Xu, Yunshao AU - Dai, Peixi AU - Yang, Weizhong AU - Feng, Luzhao PY - 2024/10/9 TI - 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 JO - Interact J Med Res SP - e47370 VL - 13 KW - influenza KW - seasonal variation KW - COVID-19 pandemic KW - stringency index N2 - 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. UR - https://www.i-jmr.org/2024/1/e47370 UR - http://dx.doi.org/10.2196/47370 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382955 ID - info:doi/10.2196/47370 ER - TY - JOUR AU - Kumar, Ashutosh AU - Asghar, Adil AU - Raza, Khursheed AU - Narayan, K. Ravi AU - Jha, K. Rakesh AU - Satyam, Abhigyan AU - Kumar, Gopichand AU - Dwivedi, Prakhar AU - Sahni, Chetan AU - Kumari, Chiman AU - Kulandhasamy, Maheswari AU - Motwani, Rohini AU - Kaur, Gurjot AU - Krishna, Hare AU - Kumar, Sujeet AU - Sesham, Kishore AU - Pandey, N. Sada AU - Parashar, Rakesh AU - Kant, Kamla PY - 2024/10/8 TI - Shift in Demographic Involvement and Clinical Characteristics of COVID-19 From Wild-Type SARS-CoV-2 to the Delta Variant in the Indian Population: In Silico Analysis JO - Interact J Med Res SP - e44492 VL - 13 KW - SARS-CoV-2 KW - COVID-19 KW - epidemiology KW - demographic shift KW - severity of illness KW - variant KW - virus KW - pandemic KW - population studies KW - genomic analysis N2 - Background: The Delta variant (B.1.617.2) was considered the most dangerous SARS-CoV-2 strain; however, in-depth studies on its impact based on demographic and clinical characteristics of COVID-19 are scarce. Objective: We aimed to investigate the shift in demographic and clinical characteristics of the COVID-19 pandemic with the emergence of the SARS-CoV-2 Delta variant compared with the wild-type (WT) strain (B.1). Methods: A cross-sectional study of COVID-19 cases in the Indian population caused by the WT strain (B.1) and Delta variant of SARS-CoV-2 was performed. The viral genomic sequence metadata containing demographic, vaccination, and patient status details (N=9500, NDelta=6238, NWT=3262) were statistically analyzed. Results: With the Delta variant, in comparison with the WT strain, a higher proportion of young individuals (<20 years) were infected (0-9 years: Delta: 281/6238, 4.5% vs B.1: 75/3262, 2.3%; 10-19 years: Delta: 562/6238, 9% vs B.1: 229/3262, 7%; P<.001). The proportion of women contracting infection increased (Delta: 2557/6238, 41% vs B.1: 1174/3262, 36%; P<.001). However, it decreased for men (Delta: 3681/6238, 59% vs B.1: 2088/3262, 64%; P<.001). An increased proportion of the young population developed symptomatic illness and were hospitalized (Delta: 27/262, 10.3% vs B.1: 5/130, 3.8%; P=.02). Moreover, an increased proportion of the women (albeit not men) from the young (Delta: 37/262, 14.1% vs B.1: 4/130, 3.1%; P<.001) and adult (Delta: 197/262, 75.2% vs B.1: 72/130, 55.4%; P<.001) groups developed symptomatic illness and were hospitalized. The mean age of men and women who contracted infection (Delta: men=37.9, SD 17.2 years; women=36.6, SD 17.6 years; P<.001; B.1: men=39.6, SD 16.9 years; women=40.1, SD 17.4 years; P<.001) as well as developing symptoms or being hospitalized (Delta: men=39.6, SD 17.4 years; women=35.6, SD 16.9 years, P<.001; B.1: men=47, SD 18 years; women=49.5, SD 20.9 years, P<.001) were considerably lower with the Delta variant than the B.1 strain. The total mortality was about 1.8 times higher with the Delta variant than with the WT strain. With the Delta variant, compared with B.1, mortality decreased for men (Delta: 58/85, 68% vs B.1: 15/20, 75%; P<.001); in contrast, it increased for women (Delta: 27/85, 32% vs B.1: 5/20, 25%; P<.001). The odds of death increased with age, irrespective of sex (odds ratio 3.034, 95% CI 1.7-5.2, P<.001). Frequent postvaccination infections (24/6238) occurred with the Delta variant following complete doses. Conclusions: The increased involvement of young people and women, the lower mean age for illness, higher mortality, and frequent postvaccination infections were significant epidemiological concerns with the Delta variant. UR - https://www.i-jmr.org/2024/1/e44492 UR - http://dx.doi.org/10.2196/44492 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/44492 ER - TY - JOUR AU - Pokorna, Nikola AU - Palmer, Melanie AU - Pearson, Oliver AU - Beckley-Hoelscher, Nicholas AU - Shearer, James AU - Kostyrka-Allchorne, Katarzyna AU - Robertson, Olly AU - Koch, Marta AU - Slovak, Petr AU - Day, Crispin AU - Byford, Sarah AU - Waite, Polly AU - Creswell, Cathy AU - Sonuga-Barke, S. Edmund J. AU - Goldsmith, Kimberley PY - 2024/10/8 TI - Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e53864 VL - 7 KW - parenting KW - intervention KW - smartphone app KW - randomized controlled trial KW - COVID-19 pandemic KW - moderators KW - conduct problems KW - emotional problems N2 - Background: A smartphone app, Parent Positive, was developed to help parents manage their children?s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children?s emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive?s effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=?0.41, 95% CI ?0.82 to 0.0004; P=.05) or significant (T3: B=?0.76, 95% CI ?1.22 to ?0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive?s potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 UR - https://pediatrics.jmir.org/2024/1/e53864 UR - http://dx.doi.org/10.2196/53864 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378100 ID - info:doi/10.2196/53864 ER - TY - JOUR AU - Hill, Miranda AU - Greene, Meredith AU - Johnson, K. Julene AU - Tan, Y. Judy PY - 2024/10/8 TI - United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study JO - JMIR Form Res SP - e60387 VL - 8 KW - HIV KW - AIDS KW - mental health KW - loneliness KW - older adults KW - music-based interventions KW - technology KW - mobile phone N2 - Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV. UR - https://formative.jmir.org/2024/1/e60387 UR - http://dx.doi.org/10.2196/60387 UR - http://www.ncbi.nlm.nih.gov/pubmed/39378071 ID - info:doi/10.2196/60387 ER - TY - JOUR AU - Lee, Hyunjun AU - Kim, Gul Min AU - Yeom, Woo Sang AU - Noh, Jae Sang AU - Jeong, Yun Cho AU - Kim, Ji Min AU - Kang, Gu Min AU - Ko, Hoon Ji AU - Park, Cheol Su AU - Kweon, Tae Hyeok AU - Sim, Il Sang AU - Lee, Hyun AU - You, Seok Yeon AU - Kim, Seung Jong PY - 2024/10/7 TI - Association Between Ursodeoxycholic Acid and Clinical Outcomes in Patients With COVID-19 Infection: Population-Based Cohort Study JO - JMIR Public Health Surveill SP - e59274 VL - 10 KW - Covid 19 KW - COVID-19 KW - ursodeoxycholic acid KW - population-based cohort study KW - SARS-CoV-2 KW - Coronavirus KW - pandemic KW - population-based KW - retrospective cohort study KW - propensity score KW - UDCA KW - public health KW - common data model KW - clinical KW - severity N2 - 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. UR - https://publichealth.jmir.org/2024/1/e59274 UR - http://dx.doi.org/10.2196/59274 UR - http://www.ncbi.nlm.nih.gov/pubmed/39139026 ID - info:doi/10.2196/59274 ER - TY - JOUR AU - Bjarnadóttir, Vilborg Margrét AU - Anderson, David AU - Anderson, M. Kelley AU - Aljwfi, Omar AU - Peluso, Alina AU - Ghannoum, Adam AU - Balba, Gayle AU - Shara, Nawar PY - 2024/10/3 TI - Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts JO - J Med Internet Res SP - e54991 VL - 26 KW - telehealth utilization KW - health care utilization KW - demographic differences KW - cohort study KW - telehealth KW - COVID-19 KW - telehealth adaption N2 - Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions. UR - https://www.jmir.org/2024/1/e54991 UR - http://dx.doi.org/10.2196/54991 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361360 ID - info:doi/10.2196/54991 ER - TY - JOUR AU - Hirschtick, L. Jana AU - Slocum, Elizabeth AU - Xie, Yanmei AU - Power, E. Laura AU - Elliott, R. Michael AU - Orellana, C. Robert AU - Fleischer, L. Nancy PY - 2024/10/1 TI - Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e55697 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - post-acute COVID-19 syndrome KW - epidemiology KW - surveillance N2 - 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. UR - https://publichealth.jmir.org/2024/1/e55697 UR - http://dx.doi.org/10.2196/55697 ID - info:doi/10.2196/55697 ER - TY - JOUR AU - Musheghyan, Lusine AU - Harutyunyan, M. Nika AU - Sikder, Abu AU - Reid, W. Mark AU - Zhao, Daniel AU - Lulejian, Armine AU - Dickhoner, W. James AU - Andonian, T. Nicole AU - Aslanyan, Lusine AU - Petrosyan, Varduhi AU - Sargsyan, Zhanna AU - Shekherdimian, Shant AU - Dorian, Alina AU - Espinoza, C. Juan PY - 2024/9/30 TI - Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study JO - JMIR Public Health Surveill SP - e57703 VL - 10 KW - COVID-19 KW - remote patient monitoring KW - Armenia KW - web platform KW - home oxygen therapy KW - pandemic KW - global health care KW - low and middle-income countries KW - health care infrastructure KW - Yerevan KW - home monitoring KW - resource-constrained N2 - Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program?s success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments. UR - https://publichealth.jmir.org/2024/1/e57703 UR - http://dx.doi.org/10.2196/57703 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348686 ID - info:doi/10.2196/57703 ER - TY - JOUR AU - Alexandrova-Karamanova, Anna AU - Lauri Korajlija, Anita AU - Halama, Peter AU - Baban, Adriana PY - 2024/9/30 TI - 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 JO - JMIR Res Protoc SP - e57596 VL - 13 KW - COVID-19 survivors KW - severe COVID-19 KW - COVID-19 hospitalization KW - long-term COVID-19 effects KW - post?COVID-19 condition KW - posttraumatic growth KW - coping resources KW - qualitative KW - international KW - Central and Eastern Europe N2 - 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 UR - https://www.researchprotocols.org/2024/1/e57596 UR - http://dx.doi.org/10.2196/57596 UR - http://www.ncbi.nlm.nih.gov/pubmed/39348673 ID - info:doi/10.2196/57596 ER - TY - JOUR AU - Haupt, Robert Michael AU - Yang, Luning AU - Purnat, Tina AU - Mackey, Tim PY - 2024/9/26 TI - Evaluating the Influence of Role-Playing Prompts on ChatGPT?s Misinformation Detection Accuracy: Quantitative Study JO - JMIR Infodemiology SP - e60678 VL - 4 KW - large language models KW - ChatGPT KW - artificial intelligence KW - AI KW - experiment KW - prompt engineering KW - role-playing KW - social identity KW - misinformation detection KW - COVID-19 N2 - Background: During the COVID-19 pandemic, the rapid spread of misinformation on social media created significant public health challenges. Large language models (LLMs), pretrained on extensive textual data, have shown potential in detecting misinformation, but their performance can be influenced by factors such as prompt engineering (ie, modifying LLM requests to assess changes in output). One form of prompt engineering is role-playing, where, upon request, OpenAI?s ChatGPT imitates specific social roles or identities. This research examines how ChatGPT?s accuracy in detecting COVID-19?related misinformation is affected when it is assigned social identities in the request prompt. Understanding how LLMs respond to different identity cues can inform messaging campaigns, ensuring effective use in public health communications. Objective: This study investigates the impact of role-playing prompts on ChatGPT?s accuracy in detecting misinformation. This study also assesses differences in performance when misinformation is explicitly stated versus implied, based on contextual knowledge, and examines the reasoning given by ChatGPT for classification decisions. Methods: Overall, 36 real-world tweets about COVID-19 collected in September 2021 were categorized into misinformation, sentiment (opinions aligned vs unaligned with public health guidelines), corrections, and neutral reporting. ChatGPT was tested with prompts incorporating different combinations of multiple social identities (ie, political beliefs, education levels, locality, religiosity, and personality traits), resulting in 51,840 runs. Two control conditions were used to compare results: prompts with no identities and those including only political identity. Results: The findings reveal that including social identities in prompts reduces average detection accuracy, with a notable drop from 68.1% (SD 41.2%; no identities) to 29.3% (SD 31.6%; all identities included). Prompts with only political identity resulted in the lowest accuracy (19.2%, SD 29.2%). ChatGPT was also able to distinguish between sentiments expressing opinions not aligned with public health guidelines from misinformation making declarative statements. There were no consistent differences in performance between explicit and implicit misinformation requiring contextual knowledge. While the findings show that the inclusion of identities decreased detection accuracy, it remains uncertain whether ChatGPT adopts views aligned with social identities: when assigned a conservative identity, ChatGPT identified misinformation with nearly the same accuracy as it did when assigned a liberal identity. While political identity was mentioned most frequently in ChatGPT?s explanations for its classification decisions, the rationales for classifications were inconsistent across study conditions, and contradictory explanations were provided in some instances. Conclusions: These results indicate that ChatGPT?s ability to classify misinformation is negatively impacted when role-playing social identities, highlighting the complexity of integrating human biases and perspectives in LLMs. This points to the need for human oversight in the use of LLMs for misinformation detection. Further research is needed to understand how LLMs weigh social identities in prompt-based tasks and explore their application in different cultural contexts. UR - https://infodemiology.jmir.org/2024/1/e60678 UR - http://dx.doi.org/10.2196/60678 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60678 ER - TY - JOUR AU - Rahmon, Imme AU - Bosmans, Mark AU - Baliatsas, Christos AU - Hooiveld, Mariette AU - Marra, Elske AU - Dückers, Michel PY - 2024/9/26 TI - COVID-19 Health Impact: A Use Case for Syndromic Surveillance System Monitoring Based on Primary Care Patient Registries in the Netherlands JO - JMIR Public Health Surveill SP - e53368 VL - 10 KW - SARS-CoV-2 KW - epidemic surveillance KW - public health KW - general practice KW - disaster health research N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53368 UR - http://dx.doi.org/10.2196/53368 ID - info:doi/10.2196/53368 ER - TY - JOUR AU - Dziadzko, Mikhail AU - Belhassen, Manon AU - Van Ganse, Eric AU - Heritier, Fabrice AU - Berard, Marjorie AU - Marant-Micallef, Claire AU - Aubrun, Frederic PY - 2024/9/11 TI - Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study JO - JMIR Public Health Surveill SP - e56398 VL - 10 KW - claims data KW - COVID-19 infection KW - France KW - health care resource utilizationuse KW - hospitalization KW - mortality KW - Post-Acute COVID-19 Syndrome KW - PACS KW - analysis KW - COVID-19 KW - health care KW - infection KW - infections KW - pandemic KW - descriptive study KW - resource use KW - outpatient care KW - retrospective KW - cohort study KW - women KW - female KW - females KW - population-based N2 - 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 UR - https://publichealth.jmir.org/2024/1/e56398 UR - http://dx.doi.org/10.2196/56398 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56398 ER - TY - JOUR AU - Sugaya, Nagisa AU - Yamamoto, Tetsuya AU - Suzuki, Naho AU - Uchiumi, Chigusa PY - 2024/9/9 TI - Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study JO - JMIR Public Health Surveill SP - e51653 VL - 10 KW - COVID-19 KW - pandemic KW - loneliness KW - social isolation KW - longitudinal survey KW - epidemiology KW - mental health N2 - Background: Worsening loneliness and social isolation during the COVID-19 pandemic have become serious public health concerns worldwide. Despite previous research reporting persistent loneliness and social isolation under repeated emergency declarations and prolonged pandemics, long-term studies are needed to identify the actual conditions of loneliness and social isolation, and the factors that explain them. Objective: In this study, 3 web-based surveys were conducted at 1-year intervals during the 2 years after the first state of emergency to examine changes in loneliness and social isolation and the psychosocial factors associated with them in the Japanese population. Methods: The first survey (phase 1, May 11-12, 2020) was conducted at the end of the first emergency declaration period, the second survey (phase 2, June 14-20, 2021) was conducted at the end of the third emergency declaration period, and the third survey (phase 3, May 13-30, 2022) was conducted when the state of emergency had not been declared but many COVID-19?positive cases occurred during this period. We collected data on 3892 inhabitants (n=1813, 46.58% women; age: mean 50.3, SD 13.4 y) living in the 4 prefectures where emergency declaration measures were applied in phases 1 and 2. A linear mixed model analysis was performed to examine the association between psychosocial variables as explanatory variables and loneliness scores as the dependent variable in each phase. Results: While many psychosocial and physical variables showed improvement for the 2 years, loneliness, social isolation, and the relationship with familiar people deteriorated, and the opportunities for exercise, favorite activities, and web-based interaction with familiar people decreased. Approximately half of those experiencing social isolation in phase 1 remained isolated throughout the 2-year period, and a greater number of people developed social isolation than those who were able to resolve it. The results of the linear mixed model analysis showed that most psychosocial and physical variables were related to loneliness regardless of the phase. Regarding the variables that showed a significant interaction with the phase, increased altruistic preventive behavior and a negative outlook for the future were more strongly associated with severe loneliness in phase 3 (P=.01 to <.001), while the association between fewer social networks and stronger loneliness tended to be more pronounced in phase 2. Although the interaction was not significant, the association between reduced face-to-face interaction, poorer relationships with familiar people, and increased loneliness tended to be stronger in phase 3. Conclusions: This study found that loneliness and social isolation remained unresolved throughout the long-term COVID-19 pandemic. Additionally, in the final survey phase, these issues were influenced by a broader and more complex set of factors compared to earlier phases. UR - https://publichealth.jmir.org/2024/1/e51653 UR - http://dx.doi.org/10.2196/51653 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250195 ID - info:doi/10.2196/51653 ER - TY - JOUR AU - Zhao, Yusui AU - Xu, Yue AU - Yao, Dingming AU - Wu, Qingqing AU - Chen, Heni AU - Hu, Xiujing AU - Huang, Yu AU - Zhang, Xuehai PY - 2024/8/30 TI - Changes in Infectious Disease?Specific Health Literacy in the Post?COVID-19 Pandemic Period: Two-Round Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e52666 VL - 10 KW - survey KW - infectious disease?specific health literacy KW - COVID-19 KW - health education KW - factors KW - postpandemic N2 - 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 (?²1=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% (?²1=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. UR - https://publichealth.jmir.org/2024/1/e52666 UR - http://dx.doi.org/10.2196/52666 ID - info:doi/10.2196/52666 ER - TY - JOUR AU - Baillet, Maëlle AU - Wathelet, Marielle AU - Lamer, Antoine AU - Frévent, Camille AU - Fovet, Thomas AU - D'Hondt, Fabien AU - Notredame, Charles-Edouard AU - Vaiva, Guillaume AU - Génin, Michael PY - 2024/8/27 TI - Association Between COVID-19 and Self-Harm: Nationwide Retrospective Ecological Spatiotemporal Study in Metropolitan France JO - JMIR Public Health Surveill SP - e52759 VL - 10 KW - self-harm KW - COVID-19 KW - spatiotemporal analysis KW - ecological regression KW - data reuse N2 - 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. UR - https://publichealth.jmir.org/2024/1/e52759 UR - http://dx.doi.org/10.2196/52759 ID - info:doi/10.2196/52759 ER - TY - JOUR AU - Poteat, C. Tonia AU - Reisner, L. Sari AU - Wirtz, L. Andrea AU - Mayo-Wilson, Jennings Larissa AU - Brown, Carter AU - Kornbluh, Wiley AU - Humphrey, Ash AU - Perrin, Nancy PY - 2024/8/26 TI - A Microfinance Intervention With or Without Peer Support to Improve Mental Health Among Transgender and Nonbinary Adults (the Creating Access to Resources and Economic Support Study): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e63656 VL - 13 KW - clinical trial KW - depression KW - anxiety KW - peer support KW - minority stress KW - cash transfer KW - COVID-19 N2 - Background: Transgender and nonbinary (TNB) people experience economic and psychosocial inequities that make them more likely to be subject to financial and mental health harms exacerbated by the COVID-19 pandemic. Sustainable, multilevel interventions are needed to address these harms. The onset of the COVID-19 pandemic galvanized many TNB-led organizations to provide emergency financial and peer support for TNB people negatively impacted by the pandemic. However, the efficacy of these interventions has not been evaluated. The Creating Access to Resources and Economic Support (CARES) study seeks to assess the efficacy of feasible, acceptable, and community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of the COVID-19 pandemic. Objective: The study aims to (1) compare the efficacy of microgrants with peer mentoring with that of microgrants without peer mentoring in reducing psychological distress, (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress, and (3) explore participants? intervention experiences and perceived efficacy. Methods: We will enroll 360 TNB adults into an embedded, mixed methods, 3-arm, and 12-month randomized controlled trial. Participants will be randomized 1:1:1 to arm A (enhanced usual care), which will receive a single microgrant plus monthly financial literacy education, arm B (extended microgrants), which will receive enhanced usual care plus monthly microgrants, or arm C (peer mentoring), which will receive extended microgrants combined with peer mentoring. All intervention arms last for 6 months, and participants complete semiannual, web-based surveys at 0, 6, and 12 months as well as brief process measures at 3 and 6 months. A subset of 36 participants, 12 (33%) per arm, will complete longitudinal in-depth interviews at 3 and 9 months. Results: Full recruitment began on January 8, 2024, and, as of July 26, 2024, a total of 138 participants have enrolled. Recruitment is expected to be completed no later than March 31, 2025, and the final study visit will take place in March 2026. Conclusions: This national, web-based study will demonstrate whether an intervention tailored to reduce material hardship and improve peer support among TNB adults will reduce psychological distress. Its equitable, community-academic partnership will ensure the rapid dissemination of study findings. Trial Registration: ClinicalTrials.gov NCT05971160; https://clinicaltrials.gov/study/NCT05971160 International Registered Report Identifier (IRRID): DERR1-10.2196/63656 UR - https://www.researchprotocols.org/2024/1/e63656 UR - http://dx.doi.org/10.2196/63656 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63656 ER - TY - JOUR AU - Alsallakh, Mohammad AU - Adeloye, Davies AU - Vasileiou, Eleftheria AU - Sivakumaran, Shanya AU - Akbari, Ashley AU - Lyons, A. Ronan AU - Robertson, Chris AU - Rudan, Igor AU - Davies, A. Gwyneth AU - Sheikh, Aziz PY - 2024/8/21 TI - Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis JO - JMIR Public Health Surveill SP - e43173 VL - 10 KW - influenza KW - hospitalization KW - mortality KW - COVID-19 pandemic KW - nonpharmaceutical interventions KW - Wales KW - COVID-19 KW - community health KW - hospital admission KW - endemic virus KW - public health surveillance N2 - 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. UR - https://publichealth.jmir.org/2024/1/e43173 UR - http://dx.doi.org/10.2196/43173 ID - info:doi/10.2196/43173 ER - TY - JOUR AU - Chang, Min-Chien AU - Wen, Tzai-Hung PY - 2024/8/20 TI - 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 JO - JMIR Public Health Surveill SP - e55183 VL - 10 KW - human mobility KW - risk perception KW - COVID-19 KW - Omicron KW - Taiwan KW - pandemic KW - disease transmission KW - pandemic dynamics KW - global threats KW - infectious disease KW - behavioural health KW - public health KW - surveillance N2 - 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. UR - https://publichealth.jmir.org/2024/1/e55183 UR - http://dx.doi.org/10.2196/55183 ID - info:doi/10.2196/55183 ER - TY - JOUR AU - Länsivaara, Annika AU - Lehto, Kirsi-Maarit AU - Hyder, Rafiqul AU - Janhonen, Sinikka Erja AU - Lipponen, Anssi AU - Heikinheimo, Annamari AU - Pitkänen, Tarja AU - Oikarinen, Sami AU - PY - 2024/8/19 TI - Comparison of Different Reverse Transcriptase?Polymerase Chain Reaction?Based Methods for Wastewater Surveillance of SARS-CoV-2: Exploratory Study JO - JMIR Public Health Surveill SP - e53175 VL - 10 KW - wastewater surveillance KW - surveillance systems KW - SARS-CoV-2 KW - COVID-19 KW - wastewater KW - surveillance KW - Finland KW - monitoring KW - detection KW - low-resource settings KW - RNA KW - spatial KW - temporal changes KW - reverse transcription droplet digital polymerase chain reaction KW - quantitative reverse transcription polymerase chain reaction KW - reverse transcription strand invasion based amplification N2 - Background: Many countries have applied the wastewater surveillance of the COVID-19 pandemic to their national public health monitoring measures. The most used methods for detecting SARS-CoV-2 in wastewater are quantitative reverse transcriptase?polymerase chain reaction (RT-qPCR) and reverse transcriptase?droplet digital polymerase chain reaction (RT-ddPCR). Previous comparison studies have produced conflicting results, thus more research on the subject is required. Objective: This study aims to compare RT-qPCR and RT-ddPCR for detecting SARS-CoV-2 in wastewater. It also aimed to investigate the effect of changes in the analytical pipeline, including the RNA extraction kit, RT-PCR kit, and target gene assay, on the results. Another aim was to find a detection method for low-resource settings. Methods: We compared 2 RT-qPCR kits, TaqMan RT-qPCR and QuantiTect RT-qPCR, and RT-ddPCR based on sensitivity, positivity rates, variability, and correlation of SARS-CoV-2 gene copy numbers in wastewater to the incidence of COVID-19. Furthermore, we compared 2 RNA extraction methods, column- and magnetic-bead?based. In addition, we assessed 2 target gene assays for RT-qPCR, N1 and N2, and 2 target gene assays for ddPCR N1 and E. Reverse transcription strand invasion-based amplification (RT-SIBA) was used to detect SARS-CoV-2 from wastewater qualitatively. Results: Our results indicated that the most sensitive method to detect SARS-CoV-2 in wastewater was RT-ddPCR. It had the highest positivity rate (26/30), and its limit of detection was the lowest (0.06 gene copies/µL). However, we obtained the best correlation between COVID-19 incidence and SARS-CoV-2 gene copy number in wastewater using TaqMan RT-qPCR (correlation coefficient [CC]=0.697, P<.001). We found a significant difference in sensitivity between the TaqMan RT-qPCR kit and the QuantiTect RT-qPCR kit, the first having a significantly lower limit of detection and a higher positivity rate than the latter. Furthermore, the N1 target gene assay was the most sensitive for both RT-qPCR kits, while no significant difference was found between the gene targets using RT-ddPCR. In addition, the use of different RNA extraction kits affected the result when the TaqMan RT-qPCR kit was used. RT-SIBA was able to detect SARS-CoV-2 RNA in wastewater. Conclusions: As our study, as well as most of the previous studies, has shown RT-ddPCR to be more sensitive than RT-qPCR, its use in the wastewater surveillance of SARS-CoV-2 should be considered, especially if the amount of SARS-CoV-2 circulating in the population was low. All the analysis steps must be optimized for wastewater surveillance as our study showed that all the analysis steps including the compatibility of the RNA extraction, the RT-PCR kit, and the target gene assay influence the results. In addition, our study showed that RT-SIBA could be used to detect SARS-CoV-2 in wastewater if a qualitative result is sufficient. UR - https://publichealth.jmir.org/2024/1/e53175 UR - http://dx.doi.org/10.2196/53175 UR - http://www.ncbi.nlm.nih.gov/pubmed/39158943 ID - info:doi/10.2196/53175 ER - TY - JOUR AU - El-Toukhy, Sherine AU - Hegeman, Phillip AU - Zuckerman, Gabrielle AU - Das, Roy Anirban AU - Moses, Nia AU - Troendle, James AU - Powell-Wiley, M. Tiffany PY - 2024/8/16 TI - Study of Postacute Sequelae of COVID-19 Using Digital Wearables: Protocol for a Prospective Longitudinal Observational Study JO - JMIR Res Protoc SP - e57382 VL - 13 KW - postacute sequelae of COVID-19 KW - wearable devices KW - physiological parameters KW - prospective observational study KW - mobile phone N2 - Background: Postacute sequelae of COVID-19 (PASC) remain understudied in nonhospitalized patients. Digital wearables allow for a continuous collection of physiological parameters such as respiratory rate and oxygen saturation that have been predictive of disease trajectories in hospitalized patients. Objective: This protocol outlines the design and procedures of a prospective, longitudinal, observational study of PASC that aims to identify wearables-collected physiological parameters that are associated with PASC in patients with a positive diagnosis. Methods: This is a single-arm, prospective, observational study of a cohort of 550 patients, aged 18 to 65 years, male or female, who own a smartphone or a tablet that meets predetermined Bluetooth version and operating system requirements, speak English, and provide documentation of a positive COVID-19 test issued by a health care professional within 5 days before enrollment. The primary end point is long COVID-19, defined as ?1 symptom at 3 weeks beyond the first symptom onset or positive diagnosis, whichever comes first. The secondary end point is chronic COVID-19, defined as ?1 symptom at 12 weeks beyond the first symptom onset or positive diagnosis. Participants must be willing and able to consent to participate in the study and adhere to study procedures for 6 months. Results: The first patient was enrolled in October 2021. The estimated year for publishing the study results is 2025. Conclusions: This is a fully decentralized study investigating PASC using wearable devices to collect physiological parameters and patient-reported outcomes. The study will shed light on the duration and symptom manifestation of PASC in nonhospitalized patient subgroups and is an exemplar of the use of wearables as population-level monitoring health tools for communicable diseases. Trial Registration: ClinicalTrials.gov NCT04927442; https://clinicaltrials.gov/study/NCT04927442 International Registered Report Identifier (IRRID): DERR1-10.2196/57382 UR - https://www.researchprotocols.org/2024/1/e57382 UR - http://dx.doi.org/10.2196/57382 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57382 ER - TY - JOUR AU - Pusnik, Adrijana AU - Hartzler, Bryan AU - Vjorn, Olivia AU - Rutkowski, A. Beth AU - Chaple, Michael AU - Becker, Sara AU - Freese, Thomas AU - Nichols, Maureen AU - Molfenter, Todd PY - 2024/8/12 TI - Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys JO - JMIR Ment Health SP - e52363 VL - 11 KW - telehealth KW - COVID-19 KW - substance use disorders KW - telephone counseling KW - video counseling N2 - 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. UR - https://mental.jmir.org/2024/1/e52363 UR - http://dx.doi.org/10.2196/52363 ID - info:doi/10.2196/52363 ER - TY - JOUR AU - Dong, Wenyong AU - Miao, Yudong AU - Shen, Zhanlei AU - Zhang, Wanliang AU - Bai, Junwen AU - Zhu, Dongfang AU - Ren, Ruizhe AU - Zhang, Jingbao AU - Wu, Jian AU - Tarimo, Silver Clifford AU - Ojangba, Theodora AU - Li, Yi PY - 2024/7/19 TI - Quantifying Disparities in COVID-19 Vaccination Rates by Rural and Urban Areas: Cross-Sectional Observational Study JO - JMIR Public Health Surveill SP - e50595 VL - 10 KW - COVID-19 vaccination KW - urban and rural KW - the fourth COVID-19 (second booster) vaccine KW - disparities KW - China KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2024/1/e50595 UR - http://dx.doi.org/10.2196/50595 UR - http://www.ncbi.nlm.nih.gov/pubmed/39028548 ID - info:doi/10.2196/50595 ER - TY - JOUR AU - Dotson, Timothy AU - Price, Brad AU - Witrick, Brian AU - Davis, Sherri AU - Kemper, Emily AU - Whanger, Stacey AU - Hodder, Sally AU - Hendricks, Brian PY - 2024/7/18 TI - Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis JO - JMIR Public Health Surveill SP - e52762 VL - 10 KW - COVID-19 KW - testing KW - symptomatic KW - RADx KW - rural KW - health disparities KW - regression analysis KW - surveillance KW - SARS-CoV-2 KW - United States KW - asymptomatic KW - survey KW - demographic KW - clinical KW - behavioral KW - logistic regression KW - bivariate map KW - child KW - children KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - public health KW - machine learning KW - mHealth KW - mobile health KW - digital health KW - cross-sectional study KW - physical health KW - mental health KW - Rapid Acceleration of Diagnostics N2 - 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. UR - https://publichealth.jmir.org/2024/1/e52762 UR - http://dx.doi.org/10.2196/52762 ID - info:doi/10.2196/52762 ER - TY - JOUR AU - Huo, Weixue AU - He, Mengwei AU - Zeng, Zhaoxiang AU - Bao, Xianhao AU - Lu, Ye AU - Tian, Wen AU - Feng, Jiaxuan AU - Feng, Rui PY - 2024/7/2 TI - Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study JO - J Med Internet Res SP - e52992 VL - 26 KW - patient satisfaction KW - physician-patient relationship KW - ChatGPT KW - patient concern KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2024/1/e52992 UR - http://dx.doi.org/10.2196/52992 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52992 ER - TY - JOUR AU - Liu, Chuchu AU - Holme, Petter AU - Lehmann, Sune AU - Yang, Wenchuan AU - Lu, Xin PY - 2024/6/28 TI - Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation JO - JMIR Form Res SP - e55013 VL - 8 KW - human mobility KW - data representativeness KW - population composition KW - COVID-19 KW - epidemiological modeling N2 - 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. UR - https://formative.jmir.org/2024/1/e55013 UR - http://dx.doi.org/10.2196/55013 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55013 ER - TY - JOUR AU - Wass, Minh Lily AU - O'Keeffe Hoare, Derek AU - Smits, Elena Georgia AU - Osman, Marwan AU - Zhang, Ning AU - Klepack, William AU - Parrilla, Lara AU - Busche, M. Jefferson AU - Clarkberg, E. Marin AU - Basu, Sumanta AU - Cazer, L. Casey PY - 2024/6/27 TI - Syndromic Surveillance Tracks COVID-19 Cases in University and County Settings: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e54551 VL - 10 KW - COVID-19 KW - epidemiology KW - epidemiological KW - SARS-CoV-2 KW - syndromic surveillance KW - surveillance system KW - syndromic KW - surveillance KW - coronavirus KW - pandemic KW - epidemic KW - respiratory KW - infectious KW - predict KW - predictive KW - prediction KW - predictions N2 - 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. UR - https://publichealth.jmir.org/2024/1/e54551 UR - http://dx.doi.org/10.2196/54551 ID - info:doi/10.2196/54551 ER - TY - JOUR AU - Yeung, Y. Nelson C. AU - Lau, Y. Stephanie T. AU - Mak, S. Winnie W. AU - Cheng, Cecilia AU - Chan, Y. Emily Y. AU - Siu, M. Judy Y. AU - Cheung, Y. Polly S. PY - 2024/6/27 TI - 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 JO - JMIR Cancer SP - e51072 VL - 10 KW - telehealth KW - tele-delivered supportive cancer care KW - breast cancer KW - COVID-19 KW - technology acceptance KW - UTAUT N2 - 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: ?=0.16, P=.03 to ?=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 (?=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups (?=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. UR - https://cancer.jmir.org/2024/1/e51072 UR - http://dx.doi.org/10.2196/51072 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51072 ER - TY - JOUR AU - Yang, Meng AU - He, Zonglin AU - Zhang, Yin AU - Liu, Taoran AU - Ming, Wai-kit PY - 2024/6/27 TI - Pandemic Fatigue and Preferences for COVID-19 Public Health and Social Measures in China: Nationwide Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e45840 VL - 10 KW - pandemic fatigue KW - preference KW - public health and social measures KW - discrete choice experiment KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2024/1/e45840 UR - http://dx.doi.org/10.2196/45840 UR - http://www.ncbi.nlm.nih.gov/pubmed/38935420 ID - info:doi/10.2196/45840 ER - TY - JOUR AU - Okuhara, Tsuyoshi AU - Terada, Marina AU - Okada, Hiroko AU - Kiuchi, Takahiro PY - 2024/6/27 TI - 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 JO - JMIR Res Protoc SP - e58040 VL - 13 KW - COVID-19 KW - health communication KW - infodemic KW - misinformation KW - social media KW - SARS-CoV-2 KW - coronavirus KW - pandemic KW - infectious KW - digital age KW - systematic review KW - internet KW - public health KW - government KW - governments KW - crisis communication KW - qualitative KW - methodology KW - disinformation KW - eHealth KW - digital health KW - medical informatics N2 - 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 UR - https://www.researchprotocols.org/2024/1/e58040 UR - http://dx.doi.org/10.2196/58040 UR - http://www.ncbi.nlm.nih.gov/pubmed/38935414 ID - info:doi/10.2196/58040 ER - TY - JOUR AU - Turnbull, Sophie AU - Cabral, Christie PY - 2024/6/25 TI - 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 JO - JMIR Diabetes SP - e55201 VL - 9 KW - diabetes KW - diabetic KW - DM KW - diabetes mellitus KW - type 2 diabetes KW - type 1 diabetes KW - prediabetes KW - prediabetic KW - COVID-19 pandemic KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - severe acute respiratory syndrome KW - coronavirus infections KW - novel coronavirus KW - motivation KW - health inequalities KW - self-care KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - digital health KW - digital intervention KW - digital interventions KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - remote consultation KW - telephone consultation KW - video consultation KW - remote consultations KW - telephone consultations KW - video consultations N2 - 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. UR - https://diabetes.jmir.org/2024/1/e55201 UR - http://dx.doi.org/10.2196/55201 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55201 ER - TY - JOUR AU - Schrills, Tim AU - Kojan, Lilian AU - Gruner, Marthe AU - Calero Valdez, André AU - Franke, Thomas PY - 2024/6/25 TI - Effects of User Experience in Automated Information Processing on Perceived Usefulness of Digital Contact-Tracing Apps: Cross-Sectional Survey Study JO - JMIR Hum Factors SP - e53940 VL - 11 KW - COVID-19 KW - contact tracing KW - user experience KW - trust KW - health information processing N2 - 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 (?=.54; P<.001) followed by moral obligation (?=.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. UR - https://humanfactors.jmir.org/2024/1/e53940 UR - http://dx.doi.org/10.2196/53940 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916941 ID - info:doi/10.2196/53940 ER - TY - JOUR AU - Xu, Stanley AU - Sy, S. Lina AU - Hong, Vennis AU - Holmquist, J. Kimberly AU - Qian, Lei AU - Farrington, Paddy AU - Bruxvoort, J. Katia AU - Klein, P. Nicola AU - Fireman, Bruce AU - Han, Bing AU - Lewin, J. Bruno PY - 2024/6/25 TI - Ischemic Stroke After Bivalent COVID-19 Vaccination: Self-Controlled Case Series Study JO - JMIR Public Health Surveill SP - e53807 VL - 10 KW - ischemic stroke KW - bivalent COVID-19 vaccine KW - influenza vaccine KW - self-controlled case series KW - coadministration KW - ischemic KW - stroke KW - TIA KW - transient ischemic attack KW - ischemia KW - cardiovascular KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - vaccines KW - vaccination KW - association KW - correlation KW - risk KW - risks KW - adverse KW - side effect KW - subgroup analyses KW - subgroup analysis KW - bivalent KW - influenza KW - infectious KW - respiratory KW - incidence KW - case series N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53807 UR - http://dx.doi.org/10.2196/53807 UR - http://www.ncbi.nlm.nih.gov/pubmed/38916940 ID - info:doi/10.2196/53807 ER - TY - JOUR AU - Lee, Heekyung AU - Oh, Jaehoon AU - Choi, Joong Hyuk AU - Shin, Hyungoo AU - Cho, Yongil AU - Lee, Juncheol PY - 2024/6/24 TI - The Incidence and Outcomes of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic in South Korea: Multicenter Registry Study JO - JMIR Public Health Surveill SP - e52402 VL - 10 KW - heart arrest KW - cardiopulmonary resuscitation KW - SARS-CoV-2 KW - mortality KW - outpatient KW - cardiac arrest KW - multicenter registry study KW - out-of-hospital cardiac arrest KW - heart attack KW - observational study KW - adult KW - older adults KW - analysis KW - pandemic KW - prepandemic KW - endemic KW - defibrillator KW - COVID-19 N2 - 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 UR - https://publichealth.jmir.org/2024/1/e52402 UR - http://dx.doi.org/10.2196/52402 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52402 ER - TY - JOUR AU - Lundberg, L. Alexander AU - Wu, A. Scott AU - Soetikno, G. Alan AU - Hawkins, Claudia AU - Murphy, L. Robert AU - Havey, J. Robert AU - Ozer, A. Egon AU - Moss, B. Charles AU - Welch, B. Sarah AU - Mason, Maryann AU - Liu, Yingxuan AU - Post, A. Lori PY - 2024/6/21 TI - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e53551 VL - 10 KW - Europe KW - COVID-19 KW - history of the pandemic KW - method of the moments KW - Arellano-Bond estimators KW - Albania KW - Andorra KW - Austria KW - Belarus KW - Belgium KW - Bosnia and Herzegovina KW - Bulgaria KW - Croatia KW - the Czech Republic KW - Denmark KW - Estonia KW - Finland KW - France KW - Germany KW - Greece KW - Greenland KW - Hungary KW - Iceland KW - Ireland KW - the Isle of Man KW - Italy KW - Latvia KW - Liechtenstein KW - Lithuania KW - Luxembourg KW - Moldova KW - Monaco KW - Montenegro KW - the Netherlands KW - Norway KW - Poland KW - Portugal KW - Romania KW - San Marino KW - Serbia KW - Slovakia KW - Slovenia KW - Spain KW - Sweden KW - Switzerland KW - Ukraine KW - the United Kingdom KW - the Vatican City N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53551 UR - http://dx.doi.org/10.2196/53551 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568186 ID - info:doi/10.2196/53551 ER - TY - JOUR AU - Pare, M. Shannon AU - Gunn, Elizabeth AU - Morrison, M. Katherine AU - Miller, L. Alison AU - Duncan, M. Alison AU - Buchholz, C. Andrea AU - Ma, L. David W. AU - Tremblay, F. Paul AU - Vallis, Ann Lori AU - Mercer, J. Nicola AU - Haines, Jess PY - 2024/6/20 TI - 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 JO - JMIR Res Protoc SP - e48549 VL - 13 KW - stress KW - child, preschool KW - adiposity KW - household chaos KW - cortisol KW - COVID-19 KW - behavioral mechanisms KW - caregiver-child relationship quality N2 - 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 UR - https://www.researchprotocols.org/2024/1/e48549 UR - http://dx.doi.org/10.2196/48549 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900565 ID - info:doi/10.2196/48549 ER - TY - JOUR AU - Jones, Jennifer AU - Johnston, Sewan Jamie AU - Ndiaye, Yabsa Ngouille AU - Tokar, Anna AU - Singla, Saumya AU - Skinner, Ann Nadine AU - Strehlow, Matthew AU - Utunen, Heini PY - 2024/6/19 TI - Health Care Workers? Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis JO - JMIR Med Educ SP - e51915 VL - 10 KW - massive open online course KW - MOOC KW - online learning KW - online courses KW - online course KW - health care education KW - medical education KW - education KW - training KW - professional development KW - continuing education KW - COVID-19 training KW - infectious disease outbreak response KW - emergency KW - public health KW - crisis KW - crises KW - outbreak KW - pandemic KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - humanitarian emergency response KW - health care workers KW - nurse KW - nurses KW - practitioner KW - practitioners KW - clinician KW - clinicians KW - health care worker KW - medic KW - low-income KW - lower-middle income KW - LIC KW - LMIC KW - developing country KW - developing countries KW - developing nation KW - developing nations KW - case study KW - survey KW - surveys KW - descriptive analysis KW - descriptive analyses KW - motivation KW - motivations KW - lower-middle?income country KW - low-income country N2 - 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. UR - https://mededu.jmir.org/2024/1/e51915 UR - http://dx.doi.org/10.2196/51915 ID - info:doi/10.2196/51915 ER - TY - JOUR AU - Chan, Pok Chin AU - Lee, Shan Shui AU - Kwan, Ho Tsz AU - Wong, Shan Samuel Yeung AU - Yeoh, Eng-Kiong AU - Wong, Sze Ngai PY - 2024/6/19 TI - Population Behavior Changes Underlying Phasic Shifts of SARS-CoV-2 Exposure Settings Across 3 Omicron Epidemic Waves in Hong Kong: Prospective Cohort Study JO - JMIR Public Health Surveill SP - e51498 VL - 10 KW - exposure risk KW - contact setting KW - social distancing KW - epidemic control KW - participatory surveillance KW - SARS-CoV-2 KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2024/1/e51498 UR - http://dx.doi.org/10.2196/51498 UR - http://www.ncbi.nlm.nih.gov/pubmed/38896447 ID - info:doi/10.2196/51498 ER - TY - JOUR AU - Peprah, Emmanuel AU - Amesimeku, Etornam AU - Angulo, Brian AU - Chhetri, Himani AU - Fordjuoh, Judy AU - Ruan, Christina AU - Wang, Cong AU - Patena, John AU - Vieira, Dorice AU - Ryan, Nessa AU - Iloegbu, Chukwuemeka AU - Gyamfi, Joyce AU - Odumegwu, Jonathan PY - 2024/6/17 TI - How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study JO - JMIR Form Res SP - e51292 VL - 8 KW - COVID-19 KW - pandemic KW - public health KW - preventative KW - prevention KW - social distancing KW - masks KW - personal protective equipment KW - cross-sectional KW - surveys KW - higher learning KW - higher education KW - university students KW - information source KW - web-based information KW - health information KW - dissemination KW - awareness KW - information spread KW - young adults KW - social media KW - university KW - postsecondary KW - students KW - young adult KW - college KW - concern KW - worry KW - anxiety KW - perceptions N2 - 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. UR - https://formative.jmir.org/2024/1/e51292 UR - http://dx.doi.org/10.2196/51292 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885019 ID - info:doi/10.2196/51292 ER - TY - JOUR AU - Soetikno, G. Alan AU - Lundberg, L. Alexander AU - Ozer, A. Egon AU - Wu, A. Scott AU - Welch, B. Sarah AU - Mason, Maryann AU - Liu, Yingxuan AU - Havey, J. Robert AU - Murphy, L. Robert AU - Hawkins, Claudia AU - Moss, B. Charles AU - Post, Ann Lori PY - 2024/6/12 TI - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in the Middle East and North Africa: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e53219 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - Middle East KW - North Africa KW - Bahrain KW - Iran KW - Iraq KW - Israel KW - Jordan KW - Kuwait KW - Lebanon KW - Oman KW - Qatar KW - Saudi Arabia KW - Syria KW - the United Arab Emirates KW - Yemen KW - Algeria KW - Djibouti KW - Egypt KW - Libya KW - Morocco KW - Tunisia KW - pandemic history KW - COVID-19 transmission KW - speed KW - acceleration KW - deceleration KW - jerk KW - dynamic panel KW - generalized method of moments KW - Arellano-Bond KW - 7-day lag N2 - 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. UR - https://publichealth.jmir.org/2024/1/e53219 UR - http://dx.doi.org/10.2196/53219 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568184 ID - info:doi/10.2196/53219 ER - TY - JOUR AU - Lytras, Theodore PY - 2024/6/10 TI - 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 JO - JMIRx Med SP - e43341 VL - 5 KW - COVID-19 KW - pandemic KW - health care disparities KW - intensive care unit KW - right to health KW - quality of care KW - intubation KW - mortality KW - health disparity KW - health inequality KW - surveillance data KW - inpatient KW - COVID-19 patient KW - hospitalization KW - ICU KW - disparity KW - inequality KW - surveillance KW - health care system KW - Greece KW - region KW - Delta KW - Omicron KW - vaccination KW - vaccine KW - public health KW - patient load KW - deterioration KW - time N2 - 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. UR - https://xmed.jmir.org/2024/1/e43341 UR - http://dx.doi.org/10.2196/43341 ID - info:doi/10.2196/43341 ER - TY - JOUR AU - Wang, Hanjing AU - Li, Yupeng AU - Ning, Xuan PY - 2024/6/6 TI - News Coverage of the COVID-19 Pandemic on Social Media and the Public?s Negative Emotions: Computational Study JO - J Med Internet Res SP - e48491 VL - 26 KW - web news coverage KW - emotions KW - social media KW - Facebook KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2024/1/e48491 UR - http://dx.doi.org/10.2196/48491 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843521 ID - info:doi/10.2196/48491 ER - TY - JOUR AU - González-Spinoglio, Leticia AU - Monistrol-Mula, Anna AU - Vindrola-Padros, Cecilia AU - Aguilar-Ortiz, Salvatore AU - Carreras, Bernat AU - Haro, Maria Josep AU - Felez-Nobrega, Mireia PY - 2024/5/29 TI - Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study JO - J Med Internet Res SP - e47546 VL - 26 KW - COVID-19 pandemic KW - digital technology KW - health care professionals KW - long-term care KW - mental health KW - well-being KW - digital mental health KW - digital mental health interventions KW - mobile phone N2 - Background: The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. Objective: This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. Methods: We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. Results: The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. Conclusions: More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees? well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic. UR - https://www.jmir.org/2024/1/e47546 UR - http://dx.doi.org/10.2196/47546 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809605 ID - info:doi/10.2196/47546 ER - TY - JOUR AU - Corbera, Silvia AU - Marín-Chollom, M. Amanda PY - 2024/5/27 TI - The Role of Anxiety and Prosocial Behaviors on Adherence Behaviors to Prevent COVID-19 in University Students in the United States: Cross-Sectional Study JO - JMIRx Med SP - e52970 VL - 5 KW - prosocial behavior KW - COVID-19 KW - anxiety KW - COVID-19 prevention KW - preventive health behavior KW - adherence to prevention N2 - Background: In situations of acute stress, individuals may engage in prosocial behaviors or risk-taking self-oriented behaviors. The COVID-19 pandemic created large stress-promoting conditions that impacted individuals? decisions to adhere to COVID-19 preventative behaviors. Objectives: The study aimed to examine the relationship between anxiety during the pandemic and adherence behaviors to prevent the spread of COVID-19, and the moderating influence of prosocial behaviors. We hypothesized that individuals with high anxiety during COVID-19 would adhere more to preventive COVID-19 behaviors than ones with low anxiety and that this relationship would be stronger in those individuals with higher prosocial behaviors. Methods: A web-based survey was administered through the SONA web-based participant tool of the psychology department of a university in the Northeastern United States. A final sample of 54 undergraduate students completed web-based questionnaires during the second wave of the COVID-19 pandemic, from January to May 2021, which included demographic measures and surveys on prosocial behaviors, anxiety, and COVID-19 preventive behaviors. Moderation analyses were conducted using PROCESS in SPSS. Results: Participants reported high levels of trait and state anxiety symptoms, most of them meeting or exceeding the cutoff criteria to be clinically meaningful (state anxiety: 47/54, 87%; trait anxiety: 38/44, 86%), and over 50% highly adhered to the COVID-19 preventive behaviors of wearing a face mask, using hand sanitizer, handwashing, coughing/sneezing into their elbow or a tissue, self-quarantining, maintaining social distance, avoiding social gatherings, and avoiding nonessential travel. No significant associations were observed between prosocial behavior, anxiety types, and adherence to COVID-19 preventive behaviors. However, when moderation analyses were conducted between anxiety types and adherence to COVID-19 preventive behaviors, results demonstrated a statistically significant interaction of public prosocial behavior with state anxiety (?=?.17, t53=?2.60; P=.01), predicting engagement in COVID-19 preventative behaviors. At high levels of anxiety, low levels of prosocial public behaviors were associated with higher engagement in COVID-19 preventative behaviors. In contrast, high levels of public prosocial behavior were associated with low engagement in COVID-19 preventative behaviors at higher levels of anxiety. Conclusions: These results provide information that can aid in the creation of interventions that could increase adherence to COVID-19 preventative behaviors (Reviewed by the Plan P #PeerRef Community). UR - https://xmed.jmir.org/2024/1/e52970 UR - http://dx.doi.org/10.2196/52970 ID - info:doi/10.2196/52970 ER - TY - JOUR AU - Tran, D. Amanda AU - White, E. Alice AU - Torok, R. Michelle AU - Jervis, H. Rachel AU - Albanese, A. Bernadette AU - Scallan Walter, J. Elaine PY - 2024/5/27 TI - Lessons Learned From a Sequential Mixed-Mode Survey Design to Recruit and Collect Data From Case-Control Study Participants: Formative Evaluation JO - JMIR Form Res SP - e56218 VL - 8 KW - case-control studies KW - mixed-mode design KW - epidemiologic study methods KW - web-based survey KW - telephone interview KW - public health KW - outbreak preparedness KW - COVID-19 KW - survey KW - recruitment KW - epidemiology KW - methods N2 - 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. UR - https://formative.jmir.org/2024/1/e56218 UR - http://dx.doi.org/10.2196/56218 UR - http://www.ncbi.nlm.nih.gov/pubmed/38801768 ID - info:doi/10.2196/56218 ER - TY - JOUR AU - Comer, Leigha AU - Donelle, Lorie AU - Hiebert, Bradley AU - Smith, J. Maxwell AU - Kothari, Anita AU - Stranges, Saverio AU - Gilliland, Jason AU - Long, Jed AU - Burkell, Jacquelyn AU - Shelley, J. Jacob AU - Hall, Jodi AU - Shelley, James AU - Cooke, Tommy AU - Ngole Dione, Marionette AU - Facca, Danica PY - 2024/5/24 TI - Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review JO - JMIR Public Health Surveill SP - e47154 VL - 10 KW - digital surveillance KW - COVID-19 KW - public health KW - scoping review KW - pandemic KW - digital technologies N2 - 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 UR - https://publichealth.jmir.org/2024/1/e47154 UR - http://dx.doi.org/10.2196/47154 UR - http://www.ncbi.nlm.nih.gov/pubmed/38788212 ID - info:doi/10.2196/47154 ER - TY - JOUR AU - Xu, Huan Richard AU - Sun, Ruiqi AU - Fu, Siu-Ngor PY - 2024/5/21 TI - Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023 JO - JMIR Public Health Surveill SP - e56054 VL - 10 KW - out-of-hospital cardiac arrest KW - OHCA KW - COVID-19 KW - pandemic KW - survival KW - Chinese KW - Asian N2 - 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 ?2 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. UR - https://publichealth.jmir.org/2024/1/e56054 UR - http://dx.doi.org/10.2196/56054 UR - http://www.ncbi.nlm.nih.gov/pubmed/38771620 ID - info:doi/10.2196/56054 ER - TY - JOUR AU - Zhu, Jianfeng AU - Jin, Ruoming AU - Kenne, R. Deric AU - Phan, NhatHai AU - Ku, Wei-Shinn PY - 2024/5/20 TI - User Dynamics and Thematic Exploration in r/Depression During the COVID-19 Pandemic: Insights From Overlapping r/SuicideWatch Users JO - J Med Internet Res SP - e53968 VL - 26 KW - reddit KW - natural language processing KW - NLP KW - suicidal ideation KW - SI KW - online communities KW - depression symptoms KW - COVID-19 pandemic KW - bidirectional encoder representations from transformers KW - BERT KW - r/SuicideWatch KW - r/Depression N2 - 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. UR - https://www.jmir.org/2024/1/e53968 UR - http://dx.doi.org/10.2196/53968 UR - http://www.ncbi.nlm.nih.gov/pubmed/38767953 ID - info:doi/10.2196/53968 ER - TY - JOUR AU - Post, Ann Lori AU - Wu, A. Scott AU - Soetikno, G. Alan AU - Ozer, A. Egon AU - Liu, Yingxuan AU - Welch, B. Sarah AU - Hawkins, Claudia AU - Moss, B. Charles AU - Murphy, L. Robert AU - Mason, Maryann AU - Havey, J. Robert AU - Lundberg, L. Alexander PY - 2024/5/17 TI - Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Latin America and the Caribbean: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e44398 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - Latin America KW - Caribbean KW - pandemic KW - surveillance KW - COVID-19 transmission KW - speed KW - acceleration KW - deceleration KW - jerk KW - dynamic panel KW - generalized method of moments KW - GMM KW - Arellano-Bond KW - 7-day lag KW - epidemiological KW - genomic KW - transmission N2 - 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. UR - https://publichealth.jmir.org/2024/1/e44398 UR - http://dx.doi.org/10.2196/44398 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568194 ID - info:doi/10.2196/44398 ER - TY - JOUR AU - Aledia, S. Anna AU - Dangodara, A. Amish AU - Amin, A. Aanya AU - Amin, N. Alpesh PY - 2024/5/16 TI - Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study JO - J Med Internet Res SP - e55623 VL - 26 KW - COVID-19 KW - electronic consultation KW - eConsult KW - e-consult KW - inpatient KW - consultations KW - pandemic KW - infectious KW - novel coronavirus KW - coronavirus KW - patients KW - patient KW - staff KW - health care KW - health care providers KW - tool KW - tools KW - effectiveness N2 - 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. UR - https://www.jmir.org/2024/1/e55623 UR - http://dx.doi.org/10.2196/55623 UR - http://www.ncbi.nlm.nih.gov/pubmed/38754103 ID - info:doi/10.2196/55623 ER - TY - JOUR AU - Maugeri, Andrea AU - Barchitta, Martina AU - Basile, Guido AU - Agodi, Antonella PY - 2024/5/16 TI - Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature JO - J Med Internet Res SP - e50088 VL - 26 KW - telemedicine KW - eHealth KW - digital medicine KW - COVID-19 KW - Google Trends KW - bibliometric KW - Google KW - data spanning KW - accessibility KW - cost reduction KW - cost KW - noncommunicable disease KW - mobile health KW - awareness KW - policy decision N2 - 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. UR - https://www.jmir.org/2024/1/e50088 UR - http://dx.doi.org/10.2196/50088 UR - http://www.ncbi.nlm.nih.gov/pubmed/38753427 ID - info:doi/10.2196/50088 ER - TY - JOUR AU - Liu, Xiaoqi AU - Hu, Qingyuan AU - Wang, Jie AU - Wu, Xusheng AU - Hu, Dehua PY - 2024/5/15 TI - Difference in Rumor Dissemination and Debunking Before and After the Relaxation of COVID-19 Prevention and Control Measures in China: Infodemiology Study JO - J Med Internet Res SP - e48564 VL - 26 KW - new stage KW - public health emergency KW - information epidemic KW - propagation characteristic KW - debunking mechanism KW - China N2 - 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 ?2 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. UR - https://www.jmir.org/2024/1/e48564 UR - http://dx.doi.org/10.2196/48564 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748460 ID - info:doi/10.2196/48564 ER - TY - JOUR AU - Müllenmeister, Christina AU - Stoelting, Andrea AU - Schröder, Dominik AU - Schmachtenberg, Tim AU - Ritter, Simon AU - El-Sayed, Iman AU - Steffens, Sandra AU - Klawonn, Frank AU - Klawitter, Sandra AU - Homann, Stefanie AU - Mikuteit, Marie AU - Berg, Christoph AU - Behrens, Georg AU - Hummers, Eva AU - Cook, Aisha AU - Müller, Frank AU - Dopfer-Jablonka, Alexandra AU - Happle, Christine PY - 2024/5/13 TI - Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post?COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study) JO - JMIR Res Protoc SP - e50230 VL - 13 KW - SARS-CoV-2 KW - COVID-19 KW - post COVID-19 condition KW - pandemic KW - occupational therapy KW - cognitive deficits KW - online treatment KW - long Covid KW - RCT KW - randomized controlled trial KW - controlled trials KW - internet based KW - digital health KW - digital intervention KW - video KW - prerecorded KW - feasibility KW - acceptability KW - effectiveness KW - online therapy N2 - Background: Post?COVID-19 syndrome (PCS; also known as ?long COVID?) is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID. Objective: The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation. Methods: This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints. Results: The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024. Conclusions: Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS. Trial Registration: German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990 International Registered Report Identifier (IRRID): PRR1-10.2196/50230 UR - https://www.researchprotocols.org/2024/1/e50230 UR - http://dx.doi.org/10.2196/50230 UR - http://www.ncbi.nlm.nih.gov/pubmed/38739435 ID - info:doi/10.2196/50230 ER - TY - JOUR AU - Law, Graham AU - Cooper, Rhiannon AU - Pirrie, Melissa AU - Ferron, Richard AU - McLeod, Brent AU - Spaight, Robert AU - Siriwardena, Niroshan A. AU - Agarwal, Gina AU - PY - 2024/5/10 TI - Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study JO - JMIR Public Health Surveill SP - e46029 VL - 10 KW - COVID-19 KW - mental health KW - overdose KW - emergency medical services KW - administrative data KW - Canada KW - the United Kingdom KW - ambulance KW - sex KW - age KW - lockdown KW - pandemic planning KW - emergency service N2 - 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. UR - https://publichealth.jmir.org/2024/1/e46029 UR - http://dx.doi.org/10.2196/46029 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728683 ID - info:doi/10.2196/46029 ER - TY - JOUR AU - Menger, S. Nick AU - Tognetti, Arnaud AU - Farruggia, C. Michael AU - Mucignat, Carla AU - Bhutani, Surabhi AU - Cooper, W. Keiland AU - Rohlfs Domínguez, Paloma AU - Heinbockel, Thomas AU - Shields, C. Vonnie D. AU - D'Errico, Anna AU - Pereda-Loth, Veronica AU - Pierron, Denis AU - Koyama, Sachiko AU - Croijmans, Ilja PY - 2024/5/10 TI - Giving a Voice to Patients With Smell Disorders Associated With COVID-19: Cross-Sectional Longitudinal Analysis Using Natural Language Processing of Self-Reports JO - JMIR Public Health Surveill SP - e47064 VL - 10 KW - parosmia KW - anosmia KW - phantosmia KW - hyposmia KW - hyperosmia KW - long-hauler KW - sentiment classification KW - web-based study KW - COVID-19 KW - smell disorders N2 - 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. UR - https://publichealth.jmir.org/2024/1/e47064 UR - http://dx.doi.org/10.2196/47064 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728069 ID - info:doi/10.2196/47064 ER - TY - JOUR AU - Gilca, Rodica AU - Amini, Rachid AU - Carazo, Sara AU - Doggui, Radhouene AU - Frenette, Charles AU - Boivin, Guy AU - Charest, Hugues AU - Dumaresq, Jeannot PY - 2024/5/6 TI - The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study JO - JMIR Public Health Surveill SP - e40792 VL - 10 KW - respiratory viruses KW - SARS-CoV-2 KW - COVID-19 KW - hospitalizations KW - acute respiratory infections KW - children KW - adults KW - coinfections KW - prepandemic KW - pandemic N2 - 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. UR - https://publichealth.jmir.org/2024/1/e40792 UR - http://dx.doi.org/10.2196/40792 UR - http://www.ncbi.nlm.nih.gov/pubmed/38709551 ID - info:doi/10.2196/40792 ER - TY - JOUR AU - Resendez, Skyler AU - Brown, H. Steven AU - Ruiz Ayala, Sebastian Hugo AU - Rangan, Prahalad AU - Nebeker, Jonathan AU - Montella, Diane AU - Elkin, L. Peter PY - 2024/4/30 TI - Defining the Subtypes of Long COVID and Risk Factors for Prolonged Disease: Population-Based Case-Crossover Study JO - JMIR Public Health Surveill SP - e49841 VL - 10 KW - long COVID KW - PASC KW - postacute sequelae of COVID-19 KW - public health KW - policy initiatives KW - pandemic KW - diagnosis KW - COVID-19 treatment KW - long COVID cause KW - health care support KW - public safety KW - COVID-19 KW - Veterans Affairs KW - United States KW - COVID-19 testing KW - clinician KW - mobile phone N2 - 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. UR - https://publichealth.jmir.org/2024/1/e49841 UR - http://dx.doi.org/10.2196/49841 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687984 ID - info:doi/10.2196/49841 ER - TY - JOUR AU - Anikamadu, Onyekachukwu AU - Ezechi, Oliver AU - Engelhart, Alexis AU - Nwaozuru, Ucheoma AU - Obiezu-Umeh, Chisom AU - Ogunjemite, Ponmile AU - Bale, Ismail Babatunde AU - Nwachukwu, Daniel AU - Gbaja-biamila, Titilola AU - Oladele, David AU - Musa, Z. Adesola AU - Mason, Stacey AU - Ojo, Temitope AU - Tucker, Joseph AU - Iwelunmor, Juliet PY - 2024/4/30 TI - Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria JO - JMIR Form Res SP - e46945 VL - 8 KW - crowdsourcing KW - World AIDS Day KW - HIV KW - self-testing KW - young people KW - COVID-19 pandemic restrictions KW - Nigeria KW - HIV self-testing KW - health promotion KW - crowdsourcing open call KW - young adult N2 - 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 UR - https://formative.jmir.org/2024/1/e46945 UR - http://dx.doi.org/10.2196/46945 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687582 ID - info:doi/10.2196/46945 ER - TY - JOUR AU - Harnik, Alexander Michael AU - Scheidegger, Alina AU - Blättler, Larissa AU - Nemecek, Zdenek AU - Sauter, C. Thomas AU - Limacher, Andreas AU - Reisig, Florian AU - grosse Holtforth, Martin AU - Streitberger, Konrad PY - 2024/4/29 TI - Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain JO - JMIR Form Res SP - e53154 VL - 8 KW - acceptance KW - satisfaction KW - patient preferences KW - COVID-19 pandemic KW - health care providers KW - phone consultations KW - pain therapy KW - eHealth services KW - patient care KW - health care delivery KW - telemedicine KW - chronic pain KW - preference N2 - 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%; ?22 [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%; ?22 [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. UR - https://formative.jmir.org/2024/1/e53154 UR - http://dx.doi.org/10.2196/53154 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684086 ID - info:doi/10.2196/53154 ER - TY - JOUR AU - Chadwick, L. Verity AU - Saich, Freya AU - Freeman, Joseph AU - Martiniuk, Alexandra PY - 2024/4/29 TI - 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 JO - JMIR Form Res SP - e38761 VL - 8 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - mRNA KW - Pfizer-BioNTech KW - pediatric KW - children KW - media KW - news KW - web-based KW - infodemic KW - disinformation N2 - 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. UR - https://formative.jmir.org/2024/1/e38761 UR - http://dx.doi.org/10.2196/38761 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383344 ID - info:doi/10.2196/38761 ER - TY - JOUR AU - Gotra, Milena AU - Lindberg, Katharine AU - Jasinski, Nicholas AU - Scarisbrick, David AU - Reilly, Shannon AU - Perle, Jonathan AU - Miller, Liv AU - Mahoney III, James PY - 2024/4/29 TI - Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study JO - JMIR Form Res SP - e50303 VL - 8 KW - COVID-19 pandemic KW - mental health KW - social worker KW - psychologist KW - neuropsychologist KW - academic medical center KW - community mental health KW - private practice KW - Veteran?s Affairs hospital KW - longitudinal questionnaire study KW - COVID-19 KW - implementation KW - telemental health KW - hybrid model KW - availability N2 - 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. UR - https://formative.jmir.org/2024/1/e50303 UR - http://dx.doi.org/10.2196/50303 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683653 ID - info:doi/10.2196/50303 ER - TY - JOUR AU - Wang, Di AU - Li, Peifan AU - Huang, Xiaoling AU - Liu, Yixuan AU - Mao, Shihang AU - Yin, Haoning AU - Wang, Na AU - Luo, Yan AU - Sun, Shan PY - 2024/4/24 TI - Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey JO - JMIR Form Res SP - e54326 VL - 8 KW - COVID-19 pandemic KW - tinnitus KW - ear-related symptoms KW - online survey KW - prevalence KW - ear-related KW - China KW - cross-sectional KW - complex KW - heterogeneous KW - symptom KW - symptoms KW - Chinese KW - population KW - investigate KW - health care KW - exploratory KW - teen KW - teens KW - teenager KW - teenagers KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - COVID-19 KW - regression analysis N2 - 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. UR - https://formative.jmir.org/2024/1/e54326 UR - http://dx.doi.org/10.2196/54326 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54326 ER - TY - JOUR AU - Garrett, Camryn AU - Aghaei, Atefeh AU - Aggarwal, Abhishek AU - Qiao, Shan PY - 2024/4/23 TI - The Role of Social Media in the Experiences of COVID-19 Among Long-Hauler Women: Qualitative Study JO - JMIR Hum Factors SP - e50443 VL - 11 KW - COVID-19 KW - long COVID KW - long-haulers KW - women KW - gender KW - social media KW - digital media KW - qualitative study N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e50443 UR - http://dx.doi.org/10.2196/50443 UR - http://www.ncbi.nlm.nih.gov/pubmed/38652515 ID - info:doi/10.2196/50443 ER - TY - JOUR AU - Zhou, Jinquan AU - Ho, Hong-Wai AU - Chan, ChiBiu PY - 2024/4/22 TI - Effect of the COVID-19 Pandemic on Gambling Behavior in Mainland Chinese Gamblers in Macau: Cross-Sectional Survey Study JO - JMIR Form Res SP - e45700 VL - 8 KW - Chinese gamblers KW - gambling behavior KW - online gambling KW - COVID-19 KW - Macau N2 - 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. UR - https://formative.jmir.org/2024/1/e45700 UR - http://dx.doi.org/10.2196/45700 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648630 ID - info:doi/10.2196/45700 ER - TY - JOUR AU - Kurita, Junko AU - Iwasaki, Yoshitaro PY - 2024/4/22 TI - 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 JO - Online J Public Health Inform SP - e44931 VL - 16 KW - airport users KW - COVID-19 KW - effective reproduction number KW - Go To Travel campaign KW - hotel visitors KW - mobility KW - long-distance travel KW - infection control KW - lockdown KW - travelling KW - travel KW - pandemic N2 - 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. UR - https://ojphi.jmir.org/2024/1/e44931 UR - http://dx.doi.org/10.2196/44931 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648635 ID - info:doi/10.2196/44931 ER - TY - JOUR AU - Liao, Qiuyan AU - Yuan, Jiehu AU - Wong, Ling Irene Oi AU - Ni, Yuxuan Michael AU - Cowling, John Benjamin AU - Lam, Tak Wendy Wing PY - 2024/4/22 TI - 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 JO - JMIR Public Health Surveill SP - e50958 VL - 10 KW - COVID-19 KW - vaccination acceptance KW - vaccine hesitancy KW - motivators KW - co-occurrence network analysis N2 - 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. UR - https://publichealth.jmir.org/2024/1/e50958 UR - http://dx.doi.org/10.2196/50958 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648099 ID - info:doi/10.2196/50958 ER - TY - JOUR AU - Major, G. Chelsea AU - Rodríguez, M. Dania AU - Sánchez-González, Liliana AU - Rodríguez-Estrada, Vanessa AU - Morales-Ortíz, Tatiana AU - Torres, Carolina AU - Pérez-Rodríguez, M. Nicole AU - Medina-Lópes, A. Nicole AU - Alexander, Neal AU - Mabey, David AU - Ryff, Kyle AU - Tosado-Acevedo, Rafael AU - Muñoz-Jordán, Jorge AU - Adams, E. Laura AU - Rivera-Amill, Vanessa AU - Rolfes, Melissa AU - Paz-Bailey, Gabriela PY - 2024/4/19 TI - Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results From a Community Cohort Study JO - JMIR Res Protoc SP - e53837 VL - 13 KW - cohort studies KW - COVID-19 KW - epidemiologic studies KW - Hispanic or Latino KW - incidence KW - prospective studies KW - research methodology KW - SARS-CoV-2 KW - seroprevalence N2 - 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 UR - https://www.researchprotocols.org/2024/1/e53837 UR - http://dx.doi.org/10.2196/53837 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640475 ID - info:doi/10.2196/53837 ER - TY - JOUR AU - Chang, Lynne Christel AU - Sinha, Chaitali AU - Roy, Madhavi AU - Wong, Meng John Chee PY - 2024/4/19 TI - AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation JO - JMIR Form Res SP - e51858 VL - 8 KW - AI KW - app KW - application KW - artificial intelligence KW - COVID-19 KW - digital KW - health care workers KW - mental health KW - pandemic KW - Wysa N2 - 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. UR - https://formative.jmir.org/2024/1/e51858 UR - http://dx.doi.org/10.2196/51858 UR - http://www.ncbi.nlm.nih.gov/pubmed/38640476 ID - info:doi/10.2196/51858 ER - TY - JOUR AU - García, E. Yury AU - Schmidt, J. Alec AU - Solis, Leslie AU - Daza-Torres, L. María AU - Montesinos-López, Cricelio J. AU - Pollock, H. Brad AU - Nuño, Miriam PY - 2024/4/17 TI - Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis JO - JMIR Public Health Surveill SP - e48784 VL - 10 KW - Healthy Davis Together KW - COVID-19 KW - COVID-19 surveillance program KW - community surveillance KW - HDT: HYT KW - Healthy Yolo Together KW - SARS-CoV-2 KW - severe acute respiratory syndrome coronavirus 2 KW - coronavirus KW - demographic KW - demographics KW - testing KW - adherence KW - compliance KW - USA KW - United States KW - response program KW - response programs KW - engagement KW - participation KW - infectious KW - trend KW - trends KW - community based KW - surveillance KW - public health KW - infection control KW - PCR KW - polymerase chain reaction KW - RT-qPCR KW - reverse transcription quantitative polymerase chain reaction KW - viral KW - virus KW - viruses N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48784 UR - http://dx.doi.org/10.2196/48784 UR - http://www.ncbi.nlm.nih.gov/pubmed/38631033 ID - info:doi/10.2196/48784 ER - TY - JOUR AU - Qian, Weicheng AU - Cooke, Aranock AU - Stanley, Gordon Kevin AU - Osgood, David Nathaniel PY - 2024/4/17 TI - Comparing Contact Tracing Through Bluetooth and GPS Surveillance Data: Simulation-Driven Approach JO - J Med Internet Res SP - e38170 VL - 26 KW - smartphone-based sensing KW - proximity contact data KW - transmission models KW - agent-based simulation KW - health informatics KW - mobile phone N2 - 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. UR - https://www.jmir.org/2024/1/e38170 UR - http://dx.doi.org/10.2196/38170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38422493 ID - info:doi/10.2196/38170 ER - TY - JOUR AU - Cheng, Wei AU - Xu, Yun AU - Jiang, Haibo AU - Li, Jun AU - Hou, Zhigang AU - Meng, Haibin AU - Wang, Wei AU - Chai, Chengliang AU - Jiang, Jianmin PY - 2024/4/17 TI - SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey JO - JMIR Public Health Surveill SP - e51449 VL - 10 KW - associated factors KW - COVID-19 KW - hospitalization KW - infection KW - people living with HIV KW - SARS-CoV-2 Omicron variant N2 - Background: Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. Objective: This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. Methods: A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. Results: Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13% (95% CI 65.81%-68.13%), whereas the hospitalization rate was 0.71% (95% CI 0.46%-0.97%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95% CI 0.07-0.72; P=.01). Conclusions: After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future. UR - https://publichealth.jmir.org/2024/1/e51449 UR - http://dx.doi.org/10.2196/51449 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630534 ID - info:doi/10.2196/51449 ER - TY - JOUR AU - Guan, Huixin AU - Wang, Wei PY - 2024/4/17 TI - Factors Impacting Chinese Older Adults? Intention to Prevent COVID-19 in the Post?COVID-19 Pandemic Era: Survey Study JO - JMIR Form Res SP - e53608 VL - 8 KW - COVID-19 KW - SARS-CoV-2 KW - health protection KW - social capital KW - media exposure KW - negative emotions KW - structural influence model of communication KW - SIM KW - protect KW - protection KW - protective KW - intent KW - intention KW - prevention KW - preventative KW - restriction KW - restrictions KW - public health measures KW - safety KW - news KW - newspaper KW - media KW - radio KW - health communication KW - influence KW - influencing KW - infectious KW - infection control KW - pandemic KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - older person KW - older people KW - aging N2 - 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. UR - https://formative.jmir.org/2024/1/e53608 UR - http://dx.doi.org/10.2196/53608 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630517 ID - info:doi/10.2196/53608 ER - TY - JOUR AU - Verot, Elise AU - Chaux, Robin AU - Gagnaire, Julie AU - Bonjean, Paul AU - Gagneux-Brunon, Amandine AU - Berthelot, Philippe AU - Pelissier, Carole AU - Boulamail, Billal AU - Chauvin, Franck AU - Pozzetto, Bruno AU - Botelho-Nevers, Elisabeth PY - 2024/4/11 TI - Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study JO - JMIR Public Health Surveill SP - e47170 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - health literacy KW - knowledge, attitude, and perception/practices (KAP) KW - public health KW - population KW - mass testing KW - screening KW - pandemic KW - sociological trends KW - COVID-19 screening N2 - 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 ? coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted ? coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ?60 years (adjusted ? 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 ? 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 ? coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted ? coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ?60 years (adjusted ? 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. UR - https://publichealth.jmir.org/2024/1/e47170 UR - http://dx.doi.org/10.2196/47170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602767 ID - info:doi/10.2196/47170 ER - TY - JOUR AU - Themistocleous, Sophia AU - Argyropoulos, D. Christos AU - Vogazianos, Paris AU - Shiamakkides, George AU - Noula, Evgenia AU - Nearchou, Andria AU - Yiallouris, Andreas AU - Filippou, Charalampos AU - Stewart, A. Fiona AU - Koniordou, Markela AU - Kopsidas, Ioannis AU - Askling, H. Helena AU - Vene, Sirkka AU - Gagneux-Brunon, Amandine AU - Prellezo, Baranda Jana AU - Álvarez-Barco, Elena AU - Salmanton-García, Jon AU - Leckler, Janina AU - Macken, J. Alan AU - Davis, Joanna Ruth AU - Azzini, Maria Anna AU - Armeftis, Charis AU - Hellemans, Margot AU - Di Marzo, Romina AU - Luis, Catarina AU - Olesen, F. Ole AU - Valdenmaiier, Olena AU - Jakobsen, Finne Stine AU - Nauclér, Pontus AU - Launay, Odile AU - Mallon, Patrick AU - Ochando, Jordi AU - van Damme, Pierre AU - Tacconelli, Evelina AU - Zaoutis, Theoklis AU - Cornely, A. Oliver AU - Pana, Dorothea Zoi PY - 2024/4/4 TI - Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study JO - JMIR Public Health Surveill SP - e47241 VL - 10 KW - patient advocacy groups KW - clinical trials KW - volunteer registry KW - vaccines KW - public health KW - healthcare KW - COVID-19 KW - vaccine trial KW - VACCELERATE KW - health promotion KW - health advocate KW - clinical trial N2 - 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. UR - https://publichealth.jmir.org/2024/1/e47241 UR - http://dx.doi.org/10.2196/47241 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573762 ID - info:doi/10.2196/47241 ER - TY - JOUR AU - McMurry, J. Andrew AU - Zipursky, R. Amy AU - Geva, Alon AU - Olson, L. Karen AU - Jones, R. James AU - Ignatov, Vladimir AU - Miller, A. Timothy AU - Mandl, D. Kenneth PY - 2024/4/4 TI - Moving Biosurveillance Beyond Coded Data Using AI for Symptom Detection From Physician Notes: Retrospective Cohort Study JO - J Med Internet Res SP - e53367 VL - 26 KW - natural language processing KW - COVID-19 KW - artificial intelligence KW - AI KW - public health, biosurveillance KW - surveillance KW - respiratory KW - infectious KW - pulmonary KW - SARS-CoV-2 KW - symptom KW - symptoms KW - detect KW - detection KW - pipeline KW - pipelines KW - clinical note KW - clinical notes KW - documentation KW - emergency KW - urgent KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - child KW - children KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - diagnose KW - diagnosis KW - diagnostic KW - diagnostics N2 - 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. UR - https://www.jmir.org/2024/1/e53367 UR - http://dx.doi.org/10.2196/53367 UR - http://www.ncbi.nlm.nih.gov/pubmed/38573752 ID - info:doi/10.2196/53367 ER - TY - JOUR AU - Kamba, Masaru AU - She, Jou Wan AU - Ferawati, Kiki AU - Wakamiya, Shoko AU - Aramaki, Eiji PY - 2024/4/1 TI - Exploring the Impact of the COVID-19 Pandemic on Twitter in Japan: Qualitative Analysis of Disrupted Plans and Consequences JO - JMIR Infodemiology SP - e49699 VL - 4 KW - COVID-19 KW - natural language processing KW - NLP KW - Twitter KW - disrupted plans KW - concerns N2 - Background: Despite being a pandemic, the impact of the spread of COVID-19 extends beyond public health, influencing areas such as the economy, education, work style, and social relationships. Research studies that document public opinions and estimate the long-term potential impact after the pandemic can be of value to the field. Objective: This study aims to uncover and track concerns in Japan throughout the COVID-19 pandemic by analyzing Japanese individuals? self-disclosure of disruptions to their life plans on social media. This approach offers alternative evidence for identifying concerns that may require further attention for individuals living in Japan. Methods: We extracted 300,778 tweets using the query phrase Corona-no-sei (?due to COVID-19,? ?because of COVID-19,? or ?considering COVID-19?), enabling us to identify the activities and life plans disrupted by the pandemic. The correlation between the number of tweets and COVID-19 cases was analyzed, along with an examination of frequently co-occurring words. Results: The top 20 nouns, verbs, and noun plus verb pairs co-occurring with Corona no-sei were extracted. The top 5 keywords were graduation ceremony, cancel, school, work, and event. The top 5 verbs were disappear, go, rest, can go, and end. Our findings indicate that education emerged as the top concern when the Japanese government announced the first state of emergency. We also observed a sudden surge in anxiety about material shortages such as toilet paper. As the pandemic persisted and more states of emergency were declared, we noticed a shift toward long-term concerns, including careers, social relationships, and education. Conclusions: Our study incorporated machine learning techniques for disease monitoring through the use of tweet data, allowing the identification of underlying concerns (eg, disrupted education and work conditions) throughout the 3 stages of Japanese government emergency announcements. The comparison with COVID-19 case numbers provides valuable insights into the short- and long-term societal impacts, emphasizing the importance of considering citizens? perspectives in policy-making and supporting those affected by the pandemic, particularly in the context of Japanese government decision-making. UR - https://infodemiology.jmir.org/2024/1/e49699 UR - http://dx.doi.org/10.2196/49699 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557446 ID - info:doi/10.2196/49699 ER - TY - JOUR AU - Sung, Sumi AU - Kim, Youlim AU - Kim, Hwan Su AU - Jung, Hyesil PY - 2024/3/29 TI - Identification of Predictors for Clinical Deterioration in Patients With COVID-19 via Electronic Nursing Records: Retrospective Observational Study JO - J Med Internet Res SP - e53343 VL - 26 KW - COVID-19 KW - infectious KW - respiratory KW - SARS-CoV-2 KW - nursing records KW - SNOMED CT KW - random forest KW - logistic regression KW - EHR KW - EHRs KW - machine learning KW - documentation KW - deterioration KW - health records KW - health record KW - patient record KW - patient records KW - nursing KW - standardization KW - standard KW - standards KW - standardized KW - standardize KW - nomenclature KW - term KW - terms KW - terminologies KW - terminology N2 - 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. UR - https://www.jmir.org/2024/1/e53343 UR - http://dx.doi.org/10.2196/53343 UR - http://www.ncbi.nlm.nih.gov/pubmed/38414056 ID - info:doi/10.2196/53343 ER - TY - JOUR AU - Ahmed, Wasim AU - Aiyenitaju, Opeoluwa AU - Chadwick, Simon AU - Hardey, Mariann AU - Fenton, Alex PY - 2024/3/29 TI - The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data JO - J Med Internet Res SP - e49921 VL - 26 KW - social media KW - social network analysis KW - COVID-19 KW - influencers KW - public health KW - social network KW - physical activity KW - promotion KW - fitness KW - exercise KW - workout KW - Twitter KW - content creation KW - communication N2 - 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. UR - https://www.jmir.org/2024/1/e49921 UR - http://dx.doi.org/10.2196/49921 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551627 ID - info:doi/10.2196/49921 ER - TY - JOUR AU - Ng, Reuben AU - Indran, Nicole PY - 2024/3/29 TI - #ProtectOurElders: Analysis of Tweets About Older Asian Americans and Anti-Asian Sentiments During the COVID-19 Pandemic JO - J Med Internet Res SP - e45864 VL - 26 KW - AAPI KW - anti-Asian hate KW - anti-Asian KW - Asian Americans and Pacific Islanders KW - Asian-American KW - content analysis KW - coronavirus KW - COVID-19 KW - discourse KW - discriminate KW - discrimination KW - discriminatory KW - Pacific Islander KW - racial KW - racism KW - racist KW - SARS-CoV-2 KW - social media KW - tweet KW - Twitter N2 - 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. UR - https://www.jmir.org/2024/1/e45864 UR - http://dx.doi.org/10.2196/45864 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551624 ID - info:doi/10.2196/45864 ER - TY - JOUR AU - Chlabicz, Ma?gorzata AU - Nabo?ny, Aleksandra AU - Koszelew, Jolanta AU - ?aguna, Wojciech AU - Szpakowicz, Anna AU - Sowa, Pawe? AU - Budny, Wojciech AU - Guziejko, Katarzyna AU - Róg-Makal, Magdalena AU - Pancewicz, S?awomir AU - Kondrusik, Maciej AU - Czupryna, Piotr AU - Cudowska, Beata AU - Lebensztejn, Dariusz AU - Moniuszko-Malinowska, Anna AU - Wierzbicki, Adam AU - Kami?ski, A. Karol PY - 2024/3/29 TI - Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study JO - J Med Internet Res SP - e48130 VL - 26 KW - infodemic KW - fake news KW - information credibility KW - online health information KW - evidence based medicine KW - EBM KW - false KW - credibility KW - credible KW - health information KW - online information KW - information quality KW - infoveillance KW - infodemiology KW - misinformation KW - disinformation N2 - 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. UR - https://www.jmir.org/2024/1/e48130 UR - http://dx.doi.org/10.2196/48130 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551638 ID - info:doi/10.2196/48130 ER - TY - JOUR AU - Rigby, C. Ryan AU - Ferdinand, O. Alva AU - Kum, Hye-Chung AU - Schmit, Cason PY - 2024/3/28 TI - Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance JO - JMIR Public Health Surveill SP - e52587 VL - 10 KW - syndromic surveillance KW - federalism KW - COVID-19 KW - public health KW - SARS-CoV-2 KW - COVID-19 pandemic KW - United States KW - decentralized KW - data sharing KW - digital health KW - ethical guidelines KW - risk score KW - technology KW - innovation KW - information system KW - collaborative framework KW - infodemiology KW - digital technology KW - health information KW - health data KW - health policy KW - surveillance UR - https://publichealth.jmir.org/2024/1/e52587 UR - http://dx.doi.org/10.2196/52587 UR - http://www.ncbi.nlm.nih.gov/pubmed/38546731 ID - info:doi/10.2196/52587 ER - TY - JOUR AU - Näher, Anatol-Fiete AU - Schulte-Althoff, Matthias AU - Kopka, Marvin AU - Balzer, Felix AU - Pozo-Martin, Francisco PY - 2024/3/8 TI - Effects of Face Mask Mandates on COVID-19 Transmission in 51 Countries: Retrospective Event Study JO - JMIR Public Health Surveill SP - e49307 VL - 10 KW - nonpharmacological interventions KW - face masks KW - infectious diseases KW - acute respiratory infections KW - COVID-19 KW - real-world evidence N2 - 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. UR - https://publichealth.jmir.org/2024/1/e49307 UR - http://dx.doi.org/10.2196/49307 UR - http://www.ncbi.nlm.nih.gov/pubmed/38457225 ID - info:doi/10.2196/49307 ER - TY - JOUR AU - Kumwichar, Ponlagrit AU - Poonsiri, Chittawan AU - Botwright, Siobhan AU - Sirichumroonwit, Natchalaikorn AU - Loharjun, Bootsakorn AU - Thawillarp, Supharerk AU - Cheewaruangroj, Nontawit AU - Chokchaisiripakdee, Amorn AU - Teerawattananon, Yot AU - Chongsuvivatwong, Virasakdi PY - 2024/3/5 TI - Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data JO - JMIR Public Health Surveill SP - e48255 VL - 10 KW - COVID-19 KW - heterologous vaccine KW - vaccine KW - vaccine effectiveness KW - durability KW - time KW - waning KW - real-world KW - public health KW - vaccination strategy KW - health outcome KW - vaccines KW - vaccination KW - unvaccinated KW - big data KW - registry KW - registries KW - health outcomes KW - effectiveness KW - SARS-CoV-2 KW - cohort KW - database KW - databases KW - vaccinated KW - Cochran-Mantel-Haenszel KW - Mantel-Haenszel KW - regression KW - risk KW - risks KW - association KW - associations KW - odds ratio KW - odds ratios N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48255 UR - http://dx.doi.org/10.2196/48255 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441923 ID - info:doi/10.2196/48255 ER - TY - JOUR AU - Liu, Yuanhua AU - Yin, Yun AU - Ward, P. Michael AU - Li, Ke AU - Chen, Yue AU - Duan, Mengwei AU - Wong, Y. Paulina P. AU - Hong, Jie AU - Huang, Jiaqi AU - Shi, Jin AU - Zhou, Xuan AU - Chen, Xi AU - Xu, Jiayao AU - Yuan, Rui AU - Kong, Lingcai AU - Zhang, Zhijie PY - 2024/2/27 TI - Optimization of Screening Strategies for COVID-19: Scoping Review JO - JMIR Public Health Surveill SP - e44349 VL - 10 KW - COVID-19 KW - screening strategy KW - optimization KW - polymerase chain reaction test KW - antigen test N2 - 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. UR - https://publichealth.jmir.org/2024/1/e44349 UR - http://dx.doi.org/10.2196/44349 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412011 ID - info:doi/10.2196/44349 ER - TY - JOUR AU - Jeong, Yejin AU - Crowell, Trevor AU - Devon-Sand, Anna AU - Sakata, Theadora AU - Sattler, Amelia AU - Shah, Shreya AU - Tsai, Timothy AU - Lin, Steven PY - 2024/2/23 TI - Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19 JO - J Med Internet Res SP - e47667 VL - 26 KW - barrier KW - COVID-19 KW - digital health KW - implementation KW - internet-based care KW - pandemic KW - primary care KW - resilience KW - resilient system KW - telehealth KW - telemedicine UR - https://www.jmir.org/2024/1/e47667 UR - http://dx.doi.org/10.2196/47667 UR - http://www.ncbi.nlm.nih.gov/pubmed/38393776 ID - info:doi/10.2196/47667 ER - TY - JOUR AU - Macaluso, Maurizio AU - Rothenberg, E. Marc AU - Ferkol, Thomas AU - Kuhnell, Pierce AU - Kaminski, J. Henry AU - Kimberlin, W. David AU - Benatar, Michael AU - Chehade, Mirna AU - PY - 2024/2/14 TI - Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey JO - JMIR Public Health Surveill SP - e48430 VL - 10 KW - rare diseases KW - rare KW - chronic KW - COVID-19 infection KW - cross-sectional survey KW - access to care KW - changes in symptoms and use of medications KW - psychological impact on self and family KW - access KW - accessibility KW - cross-sectional KW - national KW - nationwide KW - survey KW - surveys KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - comorbid KW - comorbidity KW - vulnerable N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48430 UR - http://dx.doi.org/10.2196/48430 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354030 ID - info:doi/10.2196/48430 ER - TY - JOUR AU - Kim, Jina AU - Choi, Sung Yong AU - Lee, Joo Young AU - Yeo, Geun Seung AU - Kim, Won Kyung AU - Kim, Seo Min AU - Rahmati, Masoud AU - Yon, Keon Dong AU - Lee, Jinseok PY - 2024/2/6 TI - Limitations of the Cough Sound-Based COVID-19 Diagnosis Artificial Intelligence Model and its Future Direction: Longitudinal Observation Study JO - J Med Internet Res SP - e51640 VL - 26 KW - COVID-19 variants KW - cough sound KW - artificial intelligence KW - diagnosis KW - human lifestyle KW - SARS-CoV-2 KW - AI model KW - cough KW - sound-based KW - sounds app KW - development KW - COVID-19 KW - AI N2 - Background: The outbreak of SARS-CoV-2 in 2019 has necessitated the rapid and accurate detection of COVID-19 to manage patients effectively and implement public health measures. Artificial intelligence (AI) models analyzing cough sounds have emerged as promising tools for large-scale screening and early identification of potential cases. Objective: This study aimed to investigate the efficacy of using cough sounds as a diagnostic tool for COVID-19, considering the unique acoustic features that differentiate positive and negative cases. We investigated whether an AI model trained on cough sound recordings from specific periods, especially the early stages of the COVID-19 pandemic, were applicable to the ongoing situation with persistent variants. Methods: We used cough sound recordings from 3 data sets (Cambridge, Coswara, and Virufy) representing different stages of the pandemic and variants. Our AI model was trained using the Cambridge data set with subsequent evaluation against all data sets. The performance was analyzed based on the area under the receiver operating curve (AUC) across different data measurement periods and COVID-19 variants. Results: The AI model demonstrated a high AUC when tested with the Cambridge data set, indicative of its initial effectiveness. However, the performance varied significantly with other data sets, particularly in detecting later variants such as Delta and Omicron, with a marked decline in AUC observed for the latter. These results highlight the challenges in maintaining the efficacy of AI models against the backdrop of an evolving virus. Conclusions: While AI models analyzing cough sounds offer a promising noninvasive and rapid screening method for COVID-19, their effectiveness is challenged by the emergence of new virus variants. Ongoing research and adaptations in AI methodologies are crucial to address these limitations. The adaptability of AI models to evolve with the virus underscores their potential as a foundational technology for not only the current pandemic but also future outbreaks, contributing to a more agile and resilient global health infrastructure. UR - https://www.jmir.org/2024/1/e51640 UR - http://dx.doi.org/10.2196/51640 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319694 ID - info:doi/10.2196/51640 ER - TY - JOUR AU - Riley, Claire AU - Venkatesh, Shruthi AU - Dhand, Amar AU - Doshi, Nandini AU - Kavak, Katelyn AU - Levit, Elle AU - Perrone, Christopher AU - Weinstock-Guttman, Bianca AU - Longbrake, Erin AU - De Jager, Philip AU - Xia, Zongqi PY - 2024/2/6 TI - 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 JO - JMIR Public Health Surveill SP - e45429 VL - 10 KW - neurology KW - neurodegenerative disease KW - multiple sclerosis KW - personal networks KW - COVID-19 N2 - 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: ?=2.181, 95% CI 1.082-3.279; P<.001) and poor physical function in controls (PROMIS Physical Function: ?=?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. UR - https://publichealth.jmir.org/2024/1/e45429 UR - http://dx.doi.org/10.2196/45429 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319703 ID - info:doi/10.2196/45429 ER - TY - JOUR AU - Yu, Chuen Chou AU - Tou, Xiang Nien AU - Low, Alvin James PY - 2024/2/6 TI - Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study JO - JMIR Form Res SP - e46824 VL - 8 KW - COVID-19 KW - digital divide KW - well-being KW - older adults KW - information and communication technology KW - internet of things KW - online KW - mental health KW - lockdown KW - depression KW - stress KW - anxiety KW - digital technology KW - pandemic N2 - Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. UR - https://formative.jmir.org/2024/1/e46824 UR - http://dx.doi.org/10.2196/46824 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319700 ID - info:doi/10.2196/46824 ER - TY - JOUR AU - Guo, Feipeng AU - Liu, Zixiang AU - Lu, Qibei AU - Ji, Shaobo AU - Zhang, Chen PY - 2024/1/31 TI - Public Opinion About COVID-19 on a Microblog Platform in China: Topic Modeling and Multidimensional Sentiment Analysis of Social Media JO - J Med Internet Res SP - e47508 VL - 26 KW - COVID-19 KW - social media public opinion KW - microblog KW - sentiment analysis KW - topic modeling N2 - Background: The COVID-19 pandemic raised wide concern from all walks of life globally. Social media platforms became an important channel for information dissemination and an effective medium for public sentiment transmission during the COVID-19 pandemic. Objective: Mining and analyzing social media text information can not only reflect the changes in public sentiment characteristics during the COVID-19 pandemic but also help the government understand the trends in public opinion and reasonably control public opinion. Methods: First, this study collected microblog comments related to the COVID-19 pandemic as a data set. Second, sentiment analysis was carried out based on the topic modeling method combining latent Dirichlet allocation (LDA) and Bidirectional Encoder Representations from Transformers (BERT). Finally, a machine learning logistic regression (ML-LR) model combined with a sparse matrix was proposed to explore the evolutionary trend in public opinion on social media and verify the high accuracy of the model. Results: The experimental results show that, in different stages, the characteristics of public emotion are different, and the overall trend is from negative to positive. Conclusions: The proposed method can effectively reflect the characteristics of the different times and space of public opinion. The results provide theoretical support and practical reference in response to public health and safety events. UR - https://www.jmir.org/2024/1/e47508 UR - http://dx.doi.org/10.2196/47508 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294856 ID - info:doi/10.2196/47508 ER - TY - JOUR AU - Qian, Lei AU - Sy, S. Lina AU - Hong, Vennis AU - Glenn, C. Sungching AU - Ryan, S. Denison AU - Nelson, C. Jennifer AU - Hambidge, J. Simon AU - Crane, Bradley AU - Zerbo, Ousseny AU - DeSilva, B. Malini AU - Glanz, M. Jason AU - Donahue, G. James AU - Liles, Elizabeth AU - Duffy, Jonathan AU - Xu, Stanley PY - 2024/1/23 TI - Impact of the COVID-19 Pandemic on Health Care Utilization in the Vaccine Safety Datalink: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e48159 VL - 10 KW - COVID-19 pandemic KW - health care utilization KW - telehealth KW - inpatient KW - emergency department KW - outpatient KW - vaccine safety KW - electronic health record KW - resource allocation KW - difference-in-difference KW - interrupted time series analysis N2 - 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. UR - https://publichealth.jmir.org/2024/1/e48159 UR - http://dx.doi.org/10.2196/48159 UR - http://www.ncbi.nlm.nih.gov/pubmed/38091476 ID - info:doi/10.2196/48159 ER - TY - JOUR AU - Khairat, Saif AU - John, Roshan AU - Pillai, Malvika AU - McDaniel, Philip AU - Edson, Barbara PY - 2024/1/19 TI - Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study JO - Online J Public Health Inform SP - e50962 VL - 16 KW - telehealth KW - telemedicine KW - tele-urgent care KW - virtual urgent care KW - nonemergency care KW - televisit KW - phone visit KW - video visit KW - urgent care KW - health services research KW - COVID-19 KW - health disparities KW - insurance status KW - cross-sectional study N2 - Background: Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients? choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. Objective: This study aimed to investigate patients? characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. Methods: We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Results: Of 1803 telemedicine visits, 1278 (70.9%) patients were women, 730 (40.5%) were aged 18 to 34 years, and 1423 (78.9%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Conclusions: Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation. UR - https://ojphi.jmir.org/2024/1/e50962 UR - http://dx.doi.org/10.2196/50962 UR - http://www.ncbi.nlm.nih.gov/pubmed/38241073 ID - info:doi/10.2196/50962 ER - TY - JOUR AU - Apio, Catherine AU - Han, Kyulhee AU - Lee, Doeun AU - Lee, Bogyeom AU - Park, Taesung PY - 2024/1/8 TI - Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach JO - JMIR Public Health Surveill SP - e47099 VL - 10 KW - COVID-19 KW - restriction policy KW - Stringency Index KW - Korea Stringency Index KW - social distancing KW - physical distancing KW - pandemic KW - government KW - restriction KW - effectiveness KW - policy N2 - 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. UR - https://publichealth.jmir.org/2024/1/e47099 UR - http://dx.doi.org/10.2196/47099 UR - http://www.ncbi.nlm.nih.gov/pubmed/38190233 ID - info:doi/10.2196/47099 ER - TY - JOUR AU - Chung, Kei Ming AU - Hart, Brian AU - Santillana, Mauricio AU - Patel, J. Chirag PY - 2024/1/4 TI - Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study JO - J Med Internet Res SP - e44249 VL - 26 KW - household transmission KW - infectivity KW - pediatric KW - COVID-19 KW - children KW - claims data KW - administrative data KW - transmission KW - risk factor KW - logistic regression KW - regression KW - multivariable logistics regression KW - multiple logistic regression statistics KW - cohort KW - retrospective cohort KW - laboratory KW - LOINC KW - infant KW - toddler KW - newborn N2 - 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. UR - https://www.jmir.org/2024/1/e44249 UR - http://dx.doi.org/10.2196/44249 UR - http://www.ncbi.nlm.nih.gov/pubmed/37967280 ID - info:doi/10.2196/44249 ER - TY - JOUR AU - Moghimi, Elnaz AU - Stephenson, Callum AU - Agarwal, Anika AU - Nikjoo, Niloofar AU - Malakouti, Niloufar AU - Layzell, Gina AU - O'Riordan, Anne AU - Jagayat, Jasleen AU - Shirazi, Amirhossein AU - Gutierrez, Gilmar AU - Khan, Ferwa AU - Patel, Charmy AU - Yang, Megan AU - Omrani, Mohsen AU - Alavi, Nazanin PY - 2023/12/25 TI - Efficacy of an Electronic Cognitive Behavioral Therapy Program Delivered via the Online Psychotherapy Tool for Depression and Anxiety Related to the COVID-19 Pandemic: Pre-Post Pilot Study JO - JMIR Ment Health SP - e51102 VL - 10 KW - mental health KW - depression KW - anxiety KW - cognitive behavioral therapy KW - online KW - COVID-19 KW - efficacy KW - electronic cognitive behavioral therapy KW - online psychotherapy tool KW - pandemic KW - evidence-based treatment N2 - Background: Lockdowns and social distancing resulting from the COVID-19 pandemic have worsened the population?s mental health and made it more difficult for individuals to receive care. Electronic cognitive behavioral therapy (e-CBT) is a cost-effective and evidence-based treatment for anxiety and depression and can be accessed remotely. Objective: The objective of the study was to investigate the efficacy of online psychotherapy tailored to depression and anxiety symptoms during the pandemic. Methods: The pilot study used a pre-post design to evaluate the efficacy of a 9-week e-CBT program designed for individuals with depression and anxiety affected by the pandemic. Participants were adults (N=59) diagnosed with major depressive disorder and generalized anxiety disorder, whose mental health symptoms initiated or worsened during the COVID-19 pandemic. The online psychotherapy program focused on teaching coping, mindfulness, and problem-solving skills. Symptoms of anxiety and depression, resilience, and quality of life were assessed. Results: Participants demonstrated significant improvements in symptoms of anxiety (P=.02) and depression (P=.03) after the intervention. Similar trends were observed in the intention-to-treat analysis. No significant differences were observed in resilience and quality-of-life measures. The sample comprised mostly females, making it challenging to discern the benefits of the intervention in males. Although a pre-post design is less rigorous than a controlled trial, this design was selected to observe changes in scores during a critical period. Conclusions: e-CBT for COVID-19 is an effective and accessible treatment option. Improvements in clinical symptoms of anxiety and depression can be observed in individuals whose mental health is affected by the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/study/NCT04476667 International Registered Report Identifier (IRRID): RR2-10.2196/24913 UR - https://mental.jmir.org/2023/1/e51102 UR - http://dx.doi.org/10.2196/51102 UR - http://www.ncbi.nlm.nih.gov/pubmed/37993984 ID - info:doi/10.2196/51102 ER - TY - JOUR AU - Tang, Chia-Chun AU - Chen, Hsi AU - Tsai, Shao-Yu AU - Wu, Wei-Wen PY - 2023/12/19 TI - Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model JO - JMIR Hum Factors SP - e49687 VL - 10 KW - infectious disease KW - protective behavior KW - COVID KW - health belief model KW - causal comparative KW - causal KW - protective KW - prevention KW - opinion KW - opinions KW - attitude KW - attitudes KW - COVID-19 KW - pandemic KW - infection control KW - public safety KW - public health KW - survey KW - surveys N2 - Background: While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors. Objective: This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic. Methods: This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals? protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants? various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used. Results: A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants? sex, residency, perceived barriers, self-efficacy, and cues of action. Conclusions: This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement. UR - https://humanfactors.jmir.org/2023/1/e49687 UR - http://dx.doi.org/10.2196/49687 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49687 ER - TY - JOUR AU - Chung, Ping-Chen AU - Chen, J. Kevin AU - Chang, Hui-Mei AU - Chan, Ta-Chien PY - 2023/12/15 TI - Evaluating the Effectiveness of School Closure in COVID-19?Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study JO - Interact J Med Res SP - e44606 VL - 12 KW - school closure KW - COVID-19 KW - syndromic surveillance KW - outpatient KW - mobility N2 - Background: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. Objective: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19?related syndromes in an outpatient syndromic surveillance system. Methods: We calculated the incidence of COVID-19?related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19?related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. Results: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19?related syndromes in 2021 for 2 weeks after the intervention (coefficient ?1.24, 95% CI ?2.40 to ?0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ?65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >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. UR - https://www.i-jmr.org/2023/1/e44606 UR - http://dx.doi.org/10.2196/44606 UR - http://www.ncbi.nlm.nih.gov/pubmed/38100192 ID - info:doi/10.2196/44606 ER - TY - JOUR AU - Wang, Guoyong AU - Gao, Kai AU - Liu, Qianyang AU - Wu, Yuxin AU - Zhang, Kaijun AU - Zhou, Wei AU - Guo, Chunbao PY - 2023/12/14 TI - Potential and Limitations of ChatGPT 3.5 and 4.0 as a Source of COVID-19 Information: Comprehensive Comparative Analysis of Generative and Authoritative Information JO - J Med Internet Res SP - e49771 VL - 25 KW - ChatGPT 3.5 KW - ChatGPT 4.0 KW - artificial intelligence KW - AI KW - COVID-19 KW - pandemic KW - public health KW - information retrieval N2 - Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has necessitated reliable and authoritative information for public guidance. The World Health Organization (WHO) has been a primary source of such information, disseminating it through a question and answer format on its official website. Concurrently, ChatGPT 3.5 and 4.0, a deep learning-based natural language generation system, has shown potential in generating diverse text types based on user input. Objective: This study evaluates the accuracy of COVID-19 information generated by ChatGPT 3.5 and 4.0, assessing its potential as a supplementary public information source during the pandemic. Methods: We extracted 487 COVID-19?related questions from the WHO?s official website and used ChatGPT 3.5 and 4.0 to generate corresponding answers. These generated answers were then compared against the official WHO responses for evaluation. Two clinical experts scored the generated answers on a scale of 0-5 across 4 dimensions?accuracy, comprehensiveness, relevance, and clarity?with higher scores indicating better performance in each dimension. The WHO responses served as the reference for this assessment. Additionally, we used the BERT (Bidirectional Encoder Representations from Transformers) model to generate similarity scores (0-1) between the generated and official answers, providing a dual validation mechanism. Results: The mean (SD) scores for ChatGPT 3.5?generated answers were 3.47 (0.725) for accuracy, 3.89 (0.719) for comprehensiveness, 4.09 (0.787) for relevance, and 3.49 (0.809) for clarity. For ChatGPT 4.0, the mean (SD) scores were 4.15 (0.780), 4.47 (0.641), 4.56 (0.600), and 4.09 (0.698), respectively. All differences were statistically significant (P<.001), with ChatGPT 4.0 outperforming ChatGPT 3.5. The BERT model verification showed mean (SD) similarity scores of 0.83 (0.07) for ChatGPT 3.5 and 0.85 (0.07) for ChatGPT 4.0 compared with the official WHO answers. Conclusions: ChatGPT 3.5 and 4.0 can generate accurate and relevant COVID-19 information to a certain extent. However, compared with official WHO responses, gaps and deficiencies exist. Thus, users of ChatGPT 3.5 and 4.0 should also reference other reliable information sources to mitigate potential misinformation risks. Notably, ChatGPT 4.0 outperformed ChatGPT 3.5 across all evaluated dimensions, a finding corroborated by BERT model validation. UR - https://www.jmir.org/2023/1/e49771 UR - http://dx.doi.org/10.2196/49771 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096014 ID - info:doi/10.2196/49771 ER - TY - JOUR AU - Singh, Akanksha AU - Schooley, Benjamin AU - Patel, Nitin PY - 2023/12/14 TI - Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e43105 VL - 11 KW - patient engagement KW - chatbot KW - population health KW - health recommender systems KW - conversational recommender systems KW - design factors KW - COVID-19 N2 - Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19?related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. UR - https://mhealth.jmir.org/2023/1/e43105 UR - http://dx.doi.org/10.2196/43105 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096007 ID - info:doi/10.2196/43105 ER - TY - JOUR AU - Zhang, Shaohua AU - Li, Jianbin AU - Xu, Ruonan AU - Chen, Qianjun AU - Sun, Gang AU - Lin, Ying AU - Cao, Yali AU - Chen, Yiding AU - Geng, Cuizhi AU - Teng, Yuee AU - Nie, Jianyun AU - Li, Xinzheng AU - Xu, Guiying AU - Liu, Xinlan AU - Jin, Feng AU - Fan, Zhimin AU - Luo, Ting AU - Liu, Hong AU - Wang, Fu-sheng AU - Jiang, Zefei PY - 2023/12/7 TI - Safety of COVID-19 Vaccination in Patients With Breast Cancer: Cross-Sectional Study in China JO - JMIR Public Health Surveill SP - e46009 VL - 9 KW - breast cancer KW - COVID-19 vaccines KW - patients reported adverse events KW - healthy population KW - vaccine safety N2 - 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 UR - https://publichealth.jmir.org/2023/1/e46009 UR - http://dx.doi.org/10.2196/46009 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060302 ID - info:doi/10.2196/46009 ER - TY - JOUR AU - Berthelot, Simon AU - Longtin, Yves AU - Margni, Manuele AU - Guertin, Robert Jason AU - LeBlanc, Annie AU - Marx, Tania AU - Mangou, Khadidiatou AU - Bluteau, Ariane AU - Mantovani, Diego AU - Mikhaylin, Sergey AU - Bergeron, Frédéric AU - Dancause, Valérie AU - Desjardins, Anne AU - Lahrichi, Nadia AU - Martin, Danielle AU - Sossa, Jérôme Charles AU - Lachapelle, Philippe AU - Genest, Isabelle AU - Schaal, Stéphane AU - Gignac, Anne AU - Tremblay, Stéphane AU - Hufty, Éric AU - Bélanger, Lynda AU - Beatty, Erica PY - 2023/12/7 TI - Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study JO - JMIR Res Protoc SP - e50682 VL - 12 KW - COVID-19 KW - SARS-CoV-2 KW - personal protective equipment KW - emergency department KW - health care workers KW - systematic review KW - cost-consequence analysis KW - time-driven activity-based costing KW - life cycle assessment KW - ecological footprint N2 - 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 UR - https://www.researchprotocols.org/2023/1/e50682 UR - http://dx.doi.org/10.2196/50682 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060296 ID - info:doi/10.2196/50682 ER - TY - JOUR AU - Sanchez, Travis AU - Hall, Eric AU - Siegler, J. Aaron AU - Prakash-Asrani, Radhika AU - Bradley, Heather AU - Fahimi, Mansour AU - Lopman, Benjamin AU - Luisi, Nicole AU - Nelson, N. Kristin AU - Sailey, Charles AU - Shioda, Kayoko AU - Valentine-Graves, Mariah AU - Sullivan, S. Patrick PY - 2023/12/6 TI - Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey JO - JMIR Public Health Surveill SP - e37102 VL - 9 KW - COVID-19 KW - mask KW - social distancing KW - handwashing KW - hand sanitizer KW - public health KW - pandemic KW - mitigation behavior KW - risk factor KW - disease prevention KW - health policy KW - latent class analysis KW - hygiene N2 - 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. UR - https://publichealth.jmir.org/2023/1/e37102 UR - http://dx.doi.org/10.2196/37102 UR - http://www.ncbi.nlm.nih.gov/pubmed/38055314 ID - info:doi/10.2196/37102 ER - TY - JOUR AU - Zeng, Chengbo AU - Zhang, Jiajia AU - Li, Zhenlong AU - Sun, Xiaowen AU - Ning, Huan AU - Yang, Xueying AU - Weissman, Sharon AU - Olatosi, Bankole AU - Li, Xiaoming PY - 2023/12/5 TI - Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study JO - JMIR Public Health Surveill SP - e44257 VL - 9 KW - Deep South KW - COVID-19 KW - vaccine KW - booster KW - residential segregation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44257 UR - http://dx.doi.org/10.2196/44257 UR - http://www.ncbi.nlm.nih.gov/pubmed/38051568 ID - info:doi/10.2196/44257 ER - TY - JOUR AU - Masel, Joanna AU - Petrie, Mackie James Ian AU - Bay, Jason AU - Ebbers, Wolfgang AU - Sharan, Aalekh AU - Leibrand, Michael Scott AU - Gebhard, Andreas AU - Zimmerman, Samuel PY - 2023/12/4 TI - Combatting SARS-CoV-2 With Digital Contact Tracing and Notification: Navigating Six Points of Failure JO - JMIR Public Health Surveill SP - e49560 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - pandemic preparedness KW - decentralized protocols KW - smartphone KW - mobile phone KW - contact tracing UR - https://publichealth.jmir.org/2023/1/e49560 UR - http://dx.doi.org/10.2196/49560 UR - http://www.ncbi.nlm.nih.gov/pubmed/38048155 ID - info:doi/10.2196/49560 ER - TY - JOUR AU - Solberg, M. Laurence AU - Duckworth, J. Laurie AU - Dunn, M. Elizabeth AU - Dickinson, Theresa AU - Magoc, Tanja AU - Snigurska, A. Urszula AU - Ser, E. Sarah AU - Celso, Brian AU - Bailey, Meghan AU - Bowen, Courtney AU - Radhakrishnan, Nila AU - Patel, R. Chirag AU - Lucero, Robert AU - Bjarnadottir, I. Ragnhildur PY - 2023/11/30 TI - Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study JO - JMIR Aging SP - e43185 VL - 6 KW - COVID-19 KW - delirium KW - neurocognitive disorder KW - data repository KW - adults KW - pilot study KW - symptom KW - electronic health record KW - viral infection KW - clinical KW - patient KW - research KW - diagnosis KW - disorder KW - memory KW - covid KW - memory loss KW - old KW - old age N2 - Background: Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10% to 50% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. Objective: The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. Methods: We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. Results: Less than one-third (1437/4828, 29.8%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9% (817/1437) were aged ?65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. Conclusions: The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making. UR - https://aging.jmir.org/2023/1/e43185 UR - http://dx.doi.org/10.2196/43185 UR - http://www.ncbi.nlm.nih.gov/pubmed/37910448 ID - info:doi/10.2196/43185 ER - TY - JOUR AU - Baron, Ruth AU - Hamdiui, Nora AU - Helms, B. Yannick AU - Crutzen, Rik AU - Götz, M. Hannelore AU - Stein, L. Mart PY - 2023/11/29 TI - Evaluating the Added Value of Digital Contact Tracing Support Tools for Citizens: Framework Development JO - JMIR Res Protoc SP - e44728 VL - 12 KW - contact tracing KW - digital tools KW - citizen involvement KW - COVID-19 KW - infectious disease outbreak KW - framework KW - mobile phone N2 - 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. UR - https://www.researchprotocols.org/2023/1/e44728 UR - http://dx.doi.org/10.2196/44728 UR - http://www.ncbi.nlm.nih.gov/pubmed/38019583 ID - info:doi/10.2196/44728 ER - TY - JOUR AU - Candelo, Estephania AU - Arias-Valderrama, Oriana AU - Triviño-Arias, Jacobo AU - Quiroz, Felipe AU - Isaza-Pierotti, Francisco Daniel AU - Victoria, William AU - Tintinago, F. Luis PY - 2023/11/29 TI - Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e41811 VL - 12 KW - airway KW - sequelae KW - COVID-19 KW - mechanical ventilation KW - SARS-CoV-2 KW - scoping review KW - pulmonary KW - mortality KW - voice production KW - health care cost KW - health intervention N2 - 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 UR - https://www.researchprotocols.org/2023/1/e41811 UR - http://dx.doi.org/10.2196/41811 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191952 ID - info:doi/10.2196/41811 ER - TY - JOUR AU - Lee, Edward AU - Agustines, Davin AU - Woo, P. Benjamin K. PY - 2023/11/20 TI - Selection Bias in Digital Conversations on Depression Before and During COVID-19 JO - JMIR Form Res SP - e42545 VL - 7 KW - depression KW - COVID-19 KW - treatment KW - race KW - ethnicity KW - digital conversations KW - health belief model KW - artificial intelligence KW - AI KW - natural language processing KW - NLP UR - https://formative.jmir.org/2023/1/e42545 UR - http://dx.doi.org/10.2196/42545 UR - http://www.ncbi.nlm.nih.gov/pubmed/37983077 ID - info:doi/10.2196/42545 ER - TY - JOUR AU - Hu, Qiuyue AU - Hu, Wei AU - Pan, Lingling AU - Han, Wenjuan AU - Zheng, Yue PY - 2023/11/9 TI - Association Between Concerns About COVID-19 Infection and Blood Donation Intention: Cross-Sectional Survey Study Through a Mobile Communication Platform JO - J Med Internet Res SP - e46588 VL - 25 KW - COVID-19 KW - blood donation KW - worry KW - concern KW - intention KW - blood KW - blood transfusion KW - cognition KW - blood donor KW - communication KW - questionnaire KW - behavior control N2 - 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. UR - https://www.jmir.org/2023/1/e46588 UR - http://dx.doi.org/10.2196/46588 UR - http://www.ncbi.nlm.nih.gov/pubmed/37943597 ID - info:doi/10.2196/46588 ER - TY - JOUR AU - Watase, Teruhisa AU - Omiya, Yasuhiro AU - Tokuno, Shinichi PY - 2023/11/6 TI - Severity Classification Using Dynamic Time Warping?Based Voice Biomarkers for Patients With COVID-19: Feasibility Cross-Sectional Study JO - JMIR Biomed Eng SP - e50924 VL - 8 KW - voice biomarker KW - dynamic time warping KW - COVID-19 KW - smartphone KW - severity classification KW - biomarker KW - feasibility study KW - illness KW - monitoring KW - respiratory disease KW - accuracy KW - logistic model KW - tool KW - model N2 - Background: In Japan, individuals with mild COVID-19 illness previously required to be monitored in designated areas and were hospitalized only if their condition worsened to moderate illness or worse. Daily monitoring using a pulse oximeter was a crucial indicator for hospitalization. However, a drastic increase in the number of patients resulted in a shortage of pulse oximeters for monitoring. Therefore, an alternative and cost-effective method for monitoring patients with mild illness was required. Previous studies have shown that voice biomarkers for Parkinson disease or Alzheimer disease are useful for classifying or monitoring symptoms; thus, we tried to adapt voice biomarkers for classifying the severity of COVID-19 using a dynamic time warping (DTW) algorithm where voice wavelets can be treated as 2D features; the differences between wavelet features are calculated as scores. Objective: This feasibility study aimed to test whether DTW-based indices can generate voice biomarkers for a binary classification model using COVID-19 patients? voices to distinguish moderate illness from mild illness at a significant level. Methods: We conducted a cross-sectional study using voice samples of COVID-19 patients. Three kinds of long vowels were processed into 10-cycle waveforms with standardized power and time axes. The DTW-based indices were generated by all pairs of waveforms and tested with the Mann-Whitney U test (?<.01) and verified with a linear discrimination analysis and confusion matrix to determine which indices were better for binary classification of disease severity. A binary classification model was generated based on a generalized linear model (GLM) using the most promising indices as predictors. The receiver operating characteristic curve/area under the curve (ROC/AUC) validated the model performance, and the confusion matrix calculated the model accuracy. Results: Participants in this study (n=295) were infected with COVID-19 between June 2021 and March 2022, were aged 20 years or older, and recuperated in Kanagawa prefecture. Voice samples (n=110) were selected from the participants? attribution matrix based on age group, sex, time of infection, and whether they had mild illness (n=61) or moderate illness (n=49). The DTW-based variance indices were found to be significant (P<.001, except for 1 of 6 indices), with a balanced accuracy in the range between 79% and 88.6% for the /a/, /e/, and /u/ vowel sounds. The GLM achieved a high balance accuracy of 86.3% (for /a/), 80.2% (for /e/), and 88% (for /u/) and ROC/AUC of 94.8% (95% CI 90.6%-94.8%) for /a/, 86.5% (95% CI 79.8%-86.5%) for /e/, and 95.6% (95% CI 92.1%-95.6%) for /u/. Conclusions: The proposed model can be a voice biomarker for an alternative and cost-effective method of monitoring the progress of COVID-19 patients in care. UR - https://biomedeng.jmir.org/2023/1/e50924 UR - http://dx.doi.org/10.2196/50924 UR - http://www.ncbi.nlm.nih.gov/pubmed/37982072 ID - info:doi/10.2196/50924 ER - TY - JOUR AU - Christodoulakis, Nicolette AU - Abdelkader, Wael AU - Lokker, Cynthia AU - Cotterchio, Michelle AU - Griffith, E. Lauren AU - Vanderloo, M. Leigh AU - Anderson, N. Laura PY - 2023/11/2 TI - Public Health Surveillance of Behavioral Cancer Risk Factors During the COVID-19 Pandemic: Sentiment and Emotion Analysis of Twitter Data JO - JMIR Form Res SP - e46874 VL - 7 KW - cancer risk factors KW - Twitter KW - sentiment analysis KW - emotion analysis KW - social media KW - physical inactivity KW - poor nutrition KW - alcohol KW - smoking N2 - 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. UR - https://formative.jmir.org/2023/1/e46874 UR - http://dx.doi.org/10.2196/46874 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917123 ID - info:doi/10.2196/46874 ER - TY - JOUR AU - Krämer, Dennis AU - Brachem, Elisabeth AU - Schneider-Reuter, Lydia AU - D'Angelo, Isabella AU - Vollmann, Jochen AU - Haltaufderheide, Joschka PY - 2023/10/20 TI - Smartphone Apps for Containing the COVID-19 Pandemic in Germany: Qualitative Interview Study With Experts Based on Grounded Theory JO - J Med Internet Res SP - e45549 VL - 25 KW - Corona-Warn-App KW - COVID-19 pandemic KW - eHealth KW - Germany KW - health technology KW - mobile phone KW - qualitative research KW - sovereignty KW - transparency N2 - 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. UR - https://www.jmir.org/2023/1/e45549 UR - http://dx.doi.org/10.2196/45549 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862068 ID - info:doi/10.2196/45549 ER - TY - JOUR AU - Lou, Pei AU - Fang, An AU - Zhao, Wanqing AU - Yao, Kuanda AU - Yang, Yusheng AU - Hu, Jiahui PY - 2023/10/20 TI - Potential Target Discovery and Drug Repurposing for Coronaviruses: Study Involving a Knowledge Graph?Based Approach JO - J Med Internet Res SP - e45225 VL - 25 KW - coronavirus KW - heterogeneous data integration KW - knowledge graph embedding KW - drug repurposing KW - interpretable prediction KW - COVID-19 N2 - Background: The global pandemics of severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 have caused unprecedented crises for public health. Coronaviruses are constantly evolving, and it is unknown which new coronavirus will emerge and when the next coronavirus will sweep across the world. Knowledge graphs are expected to help discover the pathogenicity and transmission mechanism of viruses. Objective: The aim of this study was to discover potential targets and candidate drugs to repurpose for coronaviruses through a knowledge graph?based approach. Methods: We propose a computational and evidence-based knowledge discovery approach to identify potential targets and candidate drugs for coronaviruses from biomedical literature and well-known knowledge bases. To organize the semantic triples extracted automatically from biomedical literature, a semantic conversion model was designed. The literature knowledge was associated and integrated with existing drug and gene knowledge through semantic mapping, and the coronavirus knowledge graph (CovKG) was constructed. We adopted both the knowledge graph embedding model and the semantic reasoning mechanism to discover unrecorded mechanisms of drug action as well as potential targets and drug candidates. Furthermore, we have provided evidence-based support with a scoring and backtracking mechanism. Results: The constructed CovKG contains 17,369,620 triples, of which 641,195 were extracted from biomedical literature, covering 13,065 concept unique identifiers, 209 semantic types, and 97 semantic relations of the Unified Medical Language System. Through multi-source knowledge integration, 475 drugs and 262 targets were mapped to existing knowledge, and 41 new drug mechanisms of action were found by semantic reasoning, which were not recorded in the existing knowledge base. Among the knowledge graph embedding models, TransR outperformed others (mean reciprocal rank=0.2510, Hits@10=0.3505). A total of 33 potential targets and 18 drug candidates were identified for coronaviruses. Among them, 7 novel drugs (ie, quinine, nelfinavir, ivermectin, asunaprevir, tylophorine, Artemisia annua extract, and resveratrol) and 3 highly ranked targets (ie, angiotensin converting enzyme 2, transmembrane serine protease 2, and M protein) were further discussed. Conclusions: We showed the effectiveness of a knowledge graph?based approach in potential target discovery and drug repurposing for coronaviruses. Our approach can be extended to other viruses or diseases for biomedical knowledge discovery and relevant applications. UR - https://www.jmir.org/2023/1/e45225 UR - http://dx.doi.org/10.2196/45225 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862061 ID - info:doi/10.2196/45225 ER - TY - JOUR AU - Wong, W. Kirstie H. T. AU - Lau, Y. Wallis C. AU - Man, C. Kenneth K. AU - Bilbow, Andrea AU - Ip, Patrick AU - Wei, Li PY - 2023/10/17 TI - Effectiveness of Facebook Groups and Pages on Participant Recruitment Into a Randomized Controlled Trial During the COVID-19 Pandemic: Descriptive Study JO - J Med Internet Res SP - e46190 VL - 25 KW - 1-2-3 Magic, ADHD KW - attention deficit/hyperactivity disorder KW - behavioral parenting training KW - BPT KW - clinical trial KW - COVID-19 KW - Facebook group KW - Facebook page KW - Facebook KW - pediatric KW - randomized controlled trial KW - recruitment KW - social media KW - youth KW - Zoom N2 - Background: In response to the unprecedented challenges posed by the COVID-19 pandemic, conventional recruitment approaches were halted, causing the suspension of numerous clinical trials. Previously, Facebook (Meta Platforms, Inc) has emerged as a promising tool for augmenting participant recruitment. While previous research has explored the use of Facebook for surveys and qualitative studies, its potential for recruiting participants into randomized controlled trials (RCTs) remains underexplored. Objective: This study aimed to comprehensively examine the effectiveness of using Facebook groups and pages to facilitate participant recruitment during the COVID-19 pandemic for an RCT on the effectiveness of a remote parenting program, 1-2-3 Magic, in families who have children with attention-deficit/hyperactivity disorder (ADHD) in the United Kingdom. Methods: We disseminated 5 Facebook posts with an attached digital flyer across 4 prominent ADHD UK support groups and pages run by the National Attention Deficit Disorder Information and Support Services, reaching an audience of around 16,000 individuals over 2 months (January 7 to March 4, 2022). Eligibility criteria mandated participants to be parents or caregivers of a child with diagnosed ADHD aged 12 years or younger, be residing in the United Kingdom, have access to stable internet, and have a device with the Zoom (Zoom Video Communications) app. Participants were required to have never attended 1-2-3 Magic training previously. Prospective participants expressed their interest through Microsoft Forms (Microsoft Corporation). The trial aimed to recruit 84 parents. It is important to note that the term ?parent? or ?caregiver? in the RCT and in this study within a trial refers to anybody who has legal responsibility for the child. Results: Overall, 478 individuals registered their interest through Microsoft Forms within the stipulated 2-month window. After the eligibility check, 135 participants were contacted for a baseline meeting through Zoom. The first 84 participants who attended a baseline meeting and returned a completed consent form were enrolled. Subsequently, another 16 participants were added, resulting in a final sample of 100 participants. This recruitment strategy incurred negligible expenses and demanded minimal human resources. The approach yielded favorable outcomes by efficiently attracting eligible participants in a condensed time frame, transcending geographical barriers throughout the United Kingdom, which would have been tedious to achieve through traditional recruitment methods. Conclusions: Our experience demonstrated that digital flyers posted in the targeted Facebook groups were a cost-effective and quick method for recruiting for an RCT, which opened during the COVID-19 pandemic when lockdown restrictions were in place in the United Kingdom. Trialists should consider this low-cost recruitment intervention for trials going forward, and in the case of a global pandemic, this novel recruitment method enabled the trial to continue where many have failed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15281572; https://www.isrctn.com/ISRCTN15281572 UR - https://www.jmir.org/2023/1/e46190 UR - http://dx.doi.org/10.2196/46190 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847536 ID - info:doi/10.2196/46190 ER - TY - JOUR AU - Bögemann, A. Sophie AU - Puhlmann, C. Lara M. AU - Wackerhagen, Carolin AU - Zerban, Matthias AU - Riepenhausen, Antje AU - Köber, Göran AU - Yuen, L. Kenneth S. AU - Pooseh, Shakoor AU - Marciniak, A. Marta AU - Reppmann, Zala AU - U?ci?ko, Aleksandra AU - Weermeijer, Jeroen AU - Lenferink, B. Dionne AU - Mituniewicz, Julian AU - Robak, Natalia AU - Donner, C. Nina AU - Mestdagh, Merijn AU - Verdonck, Stijn AU - van Dick, Rolf AU - Kleim, Birgit AU - Lieb, Klaus AU - van Leeuwen, C. Judith M. AU - Kobyli?ska, Dorota AU - Myin-Germeys, Inez AU - Walter, Henrik AU - Tüscher, Oliver AU - Hermans, J. Erno AU - Veer, M. Ilya AU - Kalisch, Raffael PY - 2023/10/17 TI - Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study JO - JMIR Ment Health SP - e46518 VL - 10 KW - resilience KW - stressor reactivity KW - positive appraisal KW - pandemic KW - mental health KW - COVID-19 N2 - 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. UR - https://mental.jmir.org/2023/1/e46518 UR - http://dx.doi.org/10.2196/46518 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847551 ID - info:doi/10.2196/46518 ER - TY - JOUR AU - Liu, Ming AU - Zhao, Tianshuo AU - Mu, Qiuyue AU - Zhang, Ruizhi AU - Liu, Chunting AU - Xu, Fei AU - Liang, Luxiang AU - Zhao, Linglu AU - Zhao, Suye AU - Cai, Xianming AU - Wang, Mingting AU - Huang, Ninghua AU - Feng, Tian AU - Lei, Shiguang AU - Yang, Guanghong AU - Cui, Fuqiang PY - 2023/10/11 TI - Immune-Boosting Effect of the COVID-19 Vaccine: Real-World Bidirectional Cohort Study JO - JMIR Public Health Surveill SP - e47272 VL - 9 KW - bidirectional cohort study KW - booster administration KW - COVID-19 vaccine KW - real-world study KW - SARS-CoV-2 KW - vaccine efficacy KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e47272 UR - http://dx.doi.org/10.2196/47272 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819703 ID - info:doi/10.2196/47272 ER - TY - JOUR AU - Tran, Xuan Bach AU - Dam, Trong Vu Anh AU - Auquier, Pascal AU - Boyer, Laurent AU - Fond, Guillaume AU - Nguyen, Manh Hung AU - Nguyen, Tuan Hung AU - Le, Thi Huong AU - Tran, Thi Ha Nhi AU - Vu, Thu Giang AU - Nguyen, Duc Manh AU - Nguyen, Thi Duong Anh AU - Ly, Viet Bang AU - Latkin, A. Carl AU - Zhang, WB Melvyn AU - Ho, CM Roger AU - Ho, SH Cyrus PY - 2023/10/11 TI - Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic JO - JMIR Public Health Surveill SP - e47239 VL - 9 KW - contextual KW - social support KW - quality of life KW - mental health disorders KW - Vietnam KW - mental health KW - mental illness KW - cross-sectional KW - association N2 - 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. UR - https://publichealth.jmir.org/2023/1/e47239 UR - http://dx.doi.org/10.2196/47239 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819706 ID - info:doi/10.2196/47239 ER - TY - JOUR AU - Bagasra, Anisah AU - Allen, T. Christopher AU - Doan, Sara PY - 2023/10/10 TI - Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States JO - JMIR Hum Factors SP - e39919 VL - 10 KW - health promotion KW - health communication KW - health risk behavior KW - behavioral intention KW - public health KW - COVID-19 KW - vaccination KW - prevention KW - health education N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e39919 UR - http://dx.doi.org/10.2196/39919 UR - http://www.ncbi.nlm.nih.gov/pubmed/37815862 ID - info:doi/10.2196/39919 ER - TY - JOUR AU - Xu, Stanley AU - Hong, Vennis AU - Sy, S. Lina AU - Bruxvoort, J. Katia AU - Lewin, Bruno AU - Han, Bing AU - Holmquist, J. Kimberly AU - Qian, Lei PY - 2023/10/4 TI - 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 JO - JMIR Public Health Surveill SP - e46318 VL - 9 KW - mRNA COVID-19 vaccines KW - 2-dose primary series KW - vaccines KW - SARS-CoV-2 KW - coronavirus KW - respiratory KW - infectious KW - communicable KW - immunization KW - immunize KW - noncompletion KW - risk factors KW - multiple Poisson regression model KW - COVID-19 KW - vaccination KW - vaccine KW - dose KW - dosing KW - regression KW - risk KW - risks KW - health outcome KW - health outcomes KW - retrospective KW - cohort KW - dosage KW - United States KW - community KW - inoculation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e46318 UR - http://dx.doi.org/10.2196/46318 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792452 ID - info:doi/10.2196/46318 ER - TY - JOUR AU - Buis, R. Lorraine AU - Brown, K. Lindsay AU - Plegue, A. Melissa AU - Kadri, Reema AU - Laurie, R. Anna AU - Guetterman, C. Timothy AU - Vydiswaran, Vinod V. G. AU - Li, Jiazhao AU - Veinot, C. Tiffany PY - 2023/9/29 TI - Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study JO - J Med Internet Res SP - e49804 VL - 25 KW - COVID-19 KW - telemedicine KW - health equity KW - clinical encounters KW - electronic health records N2 - Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. UR - https://www.jmir.org/2023/1/e49804 UR - http://dx.doi.org/10.2196/49804 UR - http://www.ncbi.nlm.nih.gov/pubmed/37773609 ID - info:doi/10.2196/49804 ER - TY - JOUR AU - Ng, Margaret Yee Man AU - Hoffmann Pham, Katherine AU - Luengo-Oroz, Miguel PY - 2023/9/15 TI - Exploring YouTube?s Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories JO - J Med Internet Res SP - e49061 VL - 25 KW - algorithmic auditing KW - antivaccine sentiment KW - crowdsourcing KW - recommendation systems KW - watch history KW - YouTube N2 - Background: Throughout the COVID-19 pandemic, there has been a concern that social media may contribute to vaccine hesitancy due to the wide availability of antivaccine content on social media platforms. YouTube has stated its commitment to removing content that contains misinformation on vaccination. Nevertheless, such claims are difficult to audit. There is a need for more empirical research to evaluate the actual prevalence of antivaccine sentiment on the internet. Objective: This study examines recommendations made by YouTube?s algorithms in order to investigate whether the platform may facilitate the spread of antivaccine sentiment on the internet. We assess the prevalence of antivaccine sentiment in recommended videos and evaluate how real-world users? experiences are different from the personalized recommendations obtained by using synthetic data collection methods, which are often used to study YouTube?s recommendation systems. Methods: We trace trajectories from a credible seed video posted by the World Health Organization to antivaccine videos, following only video links suggested by YouTube?s recommendation system. First, we gamify the process by asking real-world participants to intentionally find an antivaccine video with as few clicks as possible. Having collected crowdsourced trajectory data from respondents from (1) the World Health Organization and United Nations system (nWHO/UN=33) and (2) Amazon Mechanical Turk (nAMT=80), we next compare the recommendations seen by these users to recommended videos that are obtained from (3) the YouTube application programming interface?s RelatedToVideoID parameter (nRTV=40) and (4) from clean browsers without any identifying cookies (nCB=40), which serve as reference points. We develop machine learning methods to classify antivaccine content at scale, enabling us to automatically evaluate 27,074 video recommendations made by YouTube. Results: We found no evidence that YouTube promotes antivaccine content; the average share of antivaccine videos remained well below 6% at all steps in users? recommendation trajectories. However, the watch histories of users significantly affect video recommendations, suggesting that data from the application programming interface or from a clean browser do not offer an accurate picture of the recommendations that real users are seeing. Real users saw slightly more provaccine content as they advanced through their recommendation trajectories, whereas synthetic users were drawn toward irrelevant recommendations as they advanced. Rather than antivaccine content, videos recommended by YouTube are likely to contain health-related content that is not specifically related to vaccination. These videos are usually longer and contain more popular content. Conclusions: Our findings suggest that the common perception that YouTube?s recommendation system acts as a ?rabbit hole? may be inaccurate and that YouTube may instead be following a ?blockbuster? strategy that attempts to engage users by promoting other content that has been reliably successful across the platform. UR - https://www.jmir.org/2023/1/e49061 UR - http://dx.doi.org/10.2196/49061 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713243 ID - info:doi/10.2196/49061 ER - TY - JOUR AU - Lin, Li-Yin AU - Lin, Chun-Ji AU - Kuan, Chen-I AU - Chiou, Hung-Yi PY - 2023/9/12 TI - Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study JO - JMIR Form Res SP - e41364 VL - 7 KW - COVID-19 KW - vaccine acceptance KW - vaccine hesitancy KW - google trends KW - public health KW - vaccination KW - health promotion KW - thematic analysis KW - infoveillance N2 - 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 ???? (vaccine), selected ???? (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. UR - https://formative.jmir.org/2023/1/e41364 UR - http://dx.doi.org/10.2196/41364 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698904 ID - info:doi/10.2196/41364 ER - TY - JOUR AU - Chu, MY Amanda AU - Chong, Y. Andy C. AU - Lai, T. Nick H. AU - Tiwari, Agnes AU - So, P. Mike K. PY - 2023/9/7 TI - Enhancing the Predictive Power of Google Trends Data Through Network Analysis: Infodemiology Study of COVID-19 JO - JMIR Public Health Surveill SP - e42446 VL - 9 KW - internet search volumes KW - network analysis KW - pandemic risk KW - health care analytics KW - network connectedness KW - infodemiology KW - infoveillance KW - mobile phone KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42446 UR - http://dx.doi.org/10.2196/42446 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676701 ID - info:doi/10.2196/42446 ER - TY - JOUR AU - Hummel, Svenja AU - Michelsen, Ina AU - Zafar, Ali AU - Moritz, Steffen AU - Benoy, Charles AU - Lemogne, Cédric AU - Almeida, Rosa AU - Losada, Raquel AU - Ribeiro, Oscar AU - Frisardi, Vincenza AU - Tarricone, Ilaria AU - Ferrari, Silvia AU - Dechent, Frieder AU - Huber, G. Christian AU - Weidt, Steffi AU - Mayer, Gwendolyn AU - Schultz, Jobst-Hendrik PY - 2023/9/6 TI - Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach JO - JMIR Public Health Surveill SP - e45664 VL - 9 KW - COVID-19 KW - mental health KW - health care professionals KW - health care workers KW - pandemic preparedness KW - mixed methods KW - coping KW - stressors KW - psychosocial N2 - 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. UR - https://publichealth.jmir.org/2023/1/e45664 UR - http://dx.doi.org/10.2196/45664 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672320 ID - info:doi/10.2196/45664 ER - TY - JOUR AU - Saha, Amit AU - Andrewartha, Kelly AU - Badman, G. Steven AU - Tangey, Annie AU - Smith, S. Kirsty AU - Sandler, Sergio AU - Ramsay, Stuart AU - Braund, Wilton AU - Manoj-Margison, Stuart AU - Matthews, Susan AU - Shephard, S. Mark D. AU - Guy, Rebecca AU - Causer, Louise PY - 2023/9/1 TI - Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study JO - J Med Internet Res SP - e46701 VL - 25 KW - infectious disease KW - diagnostics KW - POC testing KW - point-of-care KW - connectivity KW - digital health KW - disease surveillance KW - GeneXpert N2 - Background: Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. Objective: The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. Methods: We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. Results: From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5% of test results in 2022. Conclusions: This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future. UR - https://www.jmir.org/2023/1/e46701 UR - http://dx.doi.org/10.2196/46701 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656506 ID - info:doi/10.2196/46701 ER - TY - JOUR AU - Kreslake, M. Jennifer AU - Aarvig, Kathleen AU - Muller-Tabanera, Hope AU - Vallone, M. Donna AU - Hair, C. Elizabeth PY - 2023/8/29 TI - Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study JO - JMIR Public Health Surveill SP - e44950 VL - 9 KW - research methods KW - public health KW - data quality KW - psychosocial factors KW - history KW - COVID-19 KW - social KW - behavioral KW - validation KW - social distancing KW - tracking survey KW - survey KW - pandemic N2 - Background: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. Objective: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. Methods: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google?s Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. Results: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (?=0.90, P<.001) and March 2020 to May 2022 (?=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ?=0.90; P<.001; 18-20 years: ?=0.87; P<.001; 21-24 years: ?=0.88; P<.001), racial or ethnic minorities (?=0.86, P<.001), and respondents with lower socioeconomic status (?=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (?=0.92, P<.001) and retail and recreation (?=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (?=0.68, P<.001) and parks (?=0.62, P<.001). A strong negative correlation was observed for places of residence (?=?0.78, P<.001), and a weak but significant positive correlation was found for workplaces (?=0.24, P<.001). Conclusions: The Transportation Security Administration?s travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States. UR - https://publichealth.jmir.org/2023/1/e44950 UR - http://dx.doi.org/10.2196/44950 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191643 ID - info:doi/10.2196/44950 ER - TY - JOUR AU - Keck, W. James AU - Lindner, Jess AU - Liversedge, Matthew AU - Mijatovic, Blazan AU - Olsson, Cullen AU - Strike, William AU - Noble, Anni AU - Adatorwovor, Reuben AU - Lacy, Parker AU - Smith, Ted AU - Berry, M. Scott PY - 2023/8/29 TI - Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation JO - JMIR Public Health Surveill SP - e44657 VL - 9 KW - wastewater surveillance KW - wastewater-based epidemiology KW - evaluation KW - long-term care facility KW - COVID-19 KW - SARS-CoV-2 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44657 UR - http://dx.doi.org/10.2196/44657 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/44657 ER - TY - JOUR AU - Bisrat, Haileleul AU - Manyazewal, Tsegahun AU - Fekadu, Abebaw PY - 2023/8/28 TI - Mobile Health?Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study JO - Interact J Med Res SP - e43492 VL - 12 KW - mobile health KW - mHealth KW - digital health KW - COVID-19 KW - syndrome assessment KW - surveillance KW - Ethiopia KW - public health KW - syndrome surveillance KW - self-care KW - telemedicine KW - telecom, SARS-CoV-2 N2 - 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 (?), 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 (?=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. UR - https://www.i-jmr.org/2023/1/e43492 UR - http://dx.doi.org/10.2196/43492 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556182 ID - info:doi/10.2196/43492 ER - TY - JOUR AU - Neumann, Ariana AU - König, Hans-Helmut AU - Bokermann, Josephine AU - Hajek, André PY - 2023/8/18 TI - Determinants of Patient Use and Satisfaction With Synchronous Telemental Health Services During the COVID-19 Pandemic: Systematic Review JO - JMIR Ment Health SP - e46148 VL - 10 KW - telemedicine KW - digital health KW - teletherapy KW - mental health KW - use KW - satisfaction N2 - Background: Several recent studies examined patient use and satisfaction with synchronous telemental health services in response to the widespread implementation during the COVID-19 pandemic. However, a systematic review of recent literature on the determinants of these outcomes is missing. Objective: The aim of this systematic review was to give an extensive overview of the literature on and highlight the influential determinants of patient use and satisfaction with synchronous telemental health services during the COVID-19 pandemic. Methods: This review satisfied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was registered in PROSPERO. Peer-reviewed, quantitative studies that observed the determinants of patient use or satisfaction with synchronous telemental health services during the COVID-19 pandemic were included. PubMed, PsycInfo, and Web of Science database searches were conducted in August 2022 for English and German language studies published from 2020 onward. Key steps were performed by 2 reviewers. Determinants were synthesized into major categories informed by the dimensions of the widely used and established Unified Theory of Acceptance and Use of Technology. Results: Of the 20 included studies, 10 studies examined determinants of patient use, 7 examined determinants of patient satisfaction, and 3 observed both outcomes. The quality of the studies was mainly good or fair. There was substantial heterogeneity in the study designs, methods, and findings. Sociodemographic characteristics and health-related determinants were mostly considered. Some of the major dimensions of the Unified Theory of Acceptance and Use of Technology were neglected in recent studies. Although most findings were mixed or nonsignificant, some indications for potential relationships were found (eg, for sex, age, and symptom severity). Conclusions: The findings revealed potential target groups (eg, female and young patients with mild symptoms) for future postpandemic telemental health interventions. However, they also identified patient groups that were harder to reach (eg, older patients with severe symptoms); efforts may be beneficial to address such groups. Future quantitative and qualitative research is needed to secure and expand on recent findings, which could help improve services. Trial Registration: PROSPERO CRD42022351576; https://tinyurl.com/yr6zrva5 UR - https://mental.jmir.org/2023/1/e46148 UR - http://dx.doi.org/10.2196/46148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37594785 ID - info:doi/10.2196/46148 ER - TY - JOUR AU - Deckert, Andreas AU - Anders, Simon AU - Morales, Ivonne AU - De Allegri, Manuela AU - Nguyen, Thi Hoa AU - Souares, Aurélia AU - McMahon, Shannon AU - Meurer, Matthias AU - Burk, Robin AU - Lou, Dan AU - Brugnara, Lucia AU - Sand, Matthias AU - Koeppel, Lisa AU - Maier-Hein, Lena AU - Ross, Tobias AU - Adler, J. Tim AU - Brenner, Stephan AU - Dyer, Christopher AU - Herbst, Konrad AU - Ovchinnikova, Svetlana AU - Marx, Michael AU - Schnitzler, Paul AU - Knop, Michael AU - Bärnighausen, Till AU - Denkinger, M. Claudia PY - 2023/8/17 TI - Comparison of Four Active SARS-CoV-2 Surveillance Strategies in Representative Population Sample Points: Two-Factor Factorial Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e44204 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - randomized controlled trial KW - multiarm KW - cluster sampling KW - surveillance KW - effectiveness KW - pandemic N2 - 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 UR - https://publichealth.jmir.org/2023/1/e44204 UR - http://dx.doi.org/10.2196/44204 UR - http://www.ncbi.nlm.nih.gov/pubmed/37235704 ID - info:doi/10.2196/44204 ER - TY - JOUR AU - Rayo, F. Michael AU - Faulkner, Daria AU - Kline, David AU - Thornhill IV, Thomas AU - Malloy, Samuel AU - Della Vella, Dante AU - Morey, A. Dane AU - Zhang, Net AU - Gonsalves, Gregg PY - 2023/8/15 TI - Using Bandit Algorithms to Maximize SARS-CoV-2 Case-Finding: Evaluation and Feasibility Study JO - JMIR Public Health Surveill SP - e39754 VL - 9 KW - active surveillance KW - bandit algorithms KW - infectious disease KW - community health KW - reinforcement learning KW - COVID-19 KW - SARS-CoV-2 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e39754 UR - http://dx.doi.org/10.2196/39754 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581924 ID - info:doi/10.2196/39754 ER - TY - JOUR AU - Goodman, L. Kimberly AU - Kamke, Kristyn AU - Mullin, M. Tara PY - 2023/8/11 TI - Online Help-Seeking Among Youth Victims of Sexual Violence Before and During COVID-19 (2016-2021): Analysis of Hotline Use Trends JO - JMIR Public Health Surveill SP - e44760 VL - 9 KW - child sexual abuse KW - hotlines KW - COVID-19 KW - help-seeking KW - online services KW - child abuse KW - mental health well-being KW - child support KW - sexual abuse KW - mental health service KW - sexual violence N2 - Background: Three years since the onset of COVID-19, pandemic-related trends in child sexual abuse (CSA) remain poorly understood. Common administrative surveillance metrics may have underestimated abuse during the pandemic, given youths? limited access to mandatory reporters. Research using anonymous service-use data showed increased violence-related online help-seeking but overlooked youth-specific help-seeking for CSA during COVID-19. Understanding pandemic-related trends in CSA can inform abuse detection practices and mental health service provision for youth victims. Objective: The purpose of this study was to harness anonymous help-seeking data from the National Sexual Assault Online Hotline (NSAOH) to glean insights about CSA occurrence in the United States during the COVID-19 pandemic. Methods: We used an archival sample of victims who contacted NSAOH from 2016 to 2021 (n=41,561). We examined differences in the proportion of youth and adult victims contacting NSAOH during the first COVID-19 year (March 2020 to February 2021) compared to the prior year (March 2019 to February 2020; n=11,719). Further, we compared key characteristics of hotline interactions among youth victims during the first COVID-19 year to the prior year (n=5913). Using joinpoint regression analysis, we examined linear trends in the number of monthly sampled youth and adult victims (excluding victims of unknown age) from 2016 to 2021 who discussed any victimization event (n=26,904) and who discussed recent events (ie, events occurring during the pandemic; n=9932). Results: Most youth victims were abused by family members prior to (1013/1677, 60.4%) and after (2658/3661, 72.6%) the onset of COVID-19. The number of youth victims contacting NSAOH spiked in March 2020 and peaked in November 2020 for all youth (slope=28.2, 95% CI 18.7-37.7) and those discussing recent events (slope=17.4, 95% CI 11.1-23.6). We observed a decline in youth victims into spring 2021 for all youth (slope=?56.9, 95% CI ?91.4 to ?22.3) and those discussing recent events (slope=?33.7, 95% 47.3 to -20.0). The number of adult victims discussing any victimization event increased steadily from January 2018 through May 2021 (slope=3.6; 95% CI 2.9-4.2) and then declined (slope=?13.8, 95% CI ?22.8 to ?4.7). Trends were stable for adults discussing recent events. Conclusions: This study extends the use of hotline data to understand the implications of the pandemic on CSA. We observed increased youth help-seeking through the NSAOH coinciding with the onset of COVID-19. Trends persisted when limiting analyses to recent victimization events, suggesting increased help-seeking reflected increased CSA during COVID-19. These findings underscore the utility of anonymous online services for youth currently experiencing abuse. Further, the findings support calls for increased youth mental health services and efforts to incorporate online chat into youth-targeted services. UR - https://publichealth.jmir.org/2023/1/e44760 UR - http://dx.doi.org/10.2196/44760 UR - http://www.ncbi.nlm.nih.gov/pubmed/37566446 ID - info:doi/10.2196/44760 ER - TY - JOUR AU - Sakumoto, Matthew PY - 2023/8/3 TI - Virtual First Emergency Medicine Visits: The Future of Convenient and Efficient Emergency Care JO - J Med Internet Res SP - e47637 VL - 25 KW - telehealth KW - virtual care KW - emergency medicine KW - telemedicine KW - emergency department KW - acute care facilities KW - virtual visit KW - COVID-19 KW - virtual KW - utilization KW - medicine KW - acute illness KW - illness KW - injury KW - patient KW - infection KW - care KW - physician UR - https://www.jmir.org/2023/1/e47637 UR - http://dx.doi.org/10.2196/47637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36976827 ID - info:doi/10.2196/47637 ER - TY - JOUR AU - Potter, Jennifer AU - Watson Gans, Dana AU - Gardner, Alison AU - O'Neill, James AU - Watkins, Christopher AU - Husain, Iltifat PY - 2023/8/3 TI - Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study JO - J Med Internet Res SP - e42840 VL - 25 KW - telehealth KW - virtual care KW - emergency medicine KW - telemedicine KW - emergency department KW - acute care facilities KW - virtual visit KW - COVID-19 KW - virtual KW - utilization KW - medicine KW - acute illness KW - illness KW - injury KW - patient KW - efficacy KW - infection KW - care KW - physician N2 - Background: The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians? (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective: The goal of this study is to investigate how patients? access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods: VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question ?How would you have sought care if a VF visit was not available to you?? Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results: There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included ?Nothing? as free text. Conclusions: VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF?s innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits. UR - https://www.jmir.org/2023/1/e42840 UR - http://dx.doi.org/10.2196/42840 UR - http://www.ncbi.nlm.nih.gov/pubmed/37276547 ID - info:doi/10.2196/42840 ER - TY - JOUR AU - Wu, Jian AU - Ma, Mingze AU - Li, Quanman AU - Guo, Xinghong AU - Tarimo, Silver Clifford AU - Jia, Shiyu AU - Zhou, Xue AU - Wang, Meiyun AU - Gu, Jianqin AU - Miao, Yudong AU - Ye, Beizhu PY - 2023/8/1 TI - Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study JO - JMIR Public Health Surveill SP - e44822 VL - 9 KW - COVID-19 vaccine KW - vaccine hesitancy KW - COVID-19 booster vaccination KW - influencing factors KW - China N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44822 UR - http://dx.doi.org/10.2196/44822 UR - http://www.ncbi.nlm.nih.gov/pubmed/37526963 ID - info:doi/10.2196/44822 ER - TY - JOUR AU - Hwang, Yeon-Mi AU - Piekos, Samantha AU - Sorensen, Tanya AU - Hood, Leroy AU - Hadlock, Jennifer PY - 2023/7/28 TI - Adoption of a National Prophylactic Anticoagulation Guideline for Hospitalized Pregnant Women With COVID-19: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e45586 VL - 9 KW - anticoagulants stillbirth KW - COVID-19 KW - electronic health record KW - low birth weight KW - NIH antithrombotic therapy guideline KW - pregnancy KW - preterm birth KW - SARS-CoV-2 KW - small for gestational age KW - thromboprophylaxis N2 - Background: Both COVID-19 and pregnancy are associated with hypercoagulability. Due to the increased risk for thrombosis, the United States National Institute of Health?s recommendation for prophylactic anticoagulant use for pregnant patients has expanded from patients hospitalized for severe COVID-19 manifestation to all patients hospitalized for the manifestation of COVID-19 (no guideline: before December 26, 2020; first update: December 27, 2022; second update: February 24, 2022-present). However, no study has evaluated this recommendation. Objective: The objective of this study was to characterize prophylactic anticoagulant use among hospitalized pregnant people with COVID-19 from March 20, 2020, to October 19, 2022. Methods: This was a retrospective cohort study in large US health care systems across 7 states. The cohort of interest was pregnant patients who were hospitalized with COVID-19, without previous coagulopathy or contraindication to anticoagulants (n=2767). The treatment group consisted of patients prescribed prophylactic dose anticoagulation between 2 days before and 14 days after COVID-19 treatment onset (n=191). The control group was patients with no anticoagulant exposure between 14 days before and 60 days after COVID-19 treatment onset (n=2534). We ascertained the use of prophylactic anticoagulants with attention to the updates in guidelines and emerging SARS-CoV-2 variants. We propensity score matched the treatment and control group 1:1 on the most important features contributing to the prophylactic anticoagulant administration status classification. Outcome measures included coagulopathy, bleeding, COVID-19?related complications, and maternal-fetal health outcomes. Additionally, the inpatient anticoagulant administration rate was validated in a nationwide population from Truveta, a collective of 700 hospitals across the United States. Results: The overall administration rate of prophylactic anticoagulants was 7% (191/2725). It was lowest after the second guideline update (no guideline: 27/262, 10%; first update: 145/1663, 8.72%; second update: 19/811, 2.3%; P<.001) and during the omicron-dominant period (Wild type: 45/549, 8.2%; Alpha: 18/129, 14%; Delta: 81/507, 16%; and Omicron: 47/1551, 3%; P<.001). Models developed on retrospective data showed that the variable most associated with the administration of inpatient prophylactic anticoagulant was comorbidities prior to SARS-CoV-2 infection. The patients who were administered prophylactic anticoagulant were also more likely to receive supplementary oxygen (57/191, 30% vs 9/188, 5%; P<.001). There was no statistical difference in a new diagnosis of coagulopathy, bleeding, or maternal-fetal health outcomes between those who received treatment and the matched control group. Conclusions: Most hospitalized pregnant patients with COVID-19 did not receive prophylactic anticoagulants across health care systems as recommended by guidelines. Guideline-recommended treatment was administered more frequently to patients with greater COVID-19 illness severity. Given the low rate of administration and differences between treated and untreated cohorts, efficacy could not be assessed. UR - https://publichealth.jmir.org/2023/1/e45586 UR - http://dx.doi.org/10.2196/45586 UR - http://www.ncbi.nlm.nih.gov/pubmed/37311123 ID - info:doi/10.2196/45586 ER - TY - JOUR AU - Marani, Husayn AU - Song, Yunju Melodie AU - Jamieson, Margaret AU - Roerig, Monika AU - Allin, Sara PY - 2023/7/20 TI - Public Officials? Engagement on Social Media During the Rollout of the COVID-19 Vaccine: Content Analysis of Tweets JO - JMIR Infodemiology SP - e41582 VL - 3 KW - Twitter KW - COVID-19 KW - vaccines KW - sentiment analysis KW - public officials N2 - Background: Social media is an important way for governments to communicate with the public. This is particularly true in times of crisis, such as the COVID-19 pandemic, during which government officials played a strong role in promoting public health measures such as vaccines. Objective: In Canada, provincial COVID-19 vaccine rollout was delivered in 3 phases aligned with federal government COVID-19 vaccine guidance for priority populations. In this study, we examined how Canadian public officials used Twitter to engage with the public about vaccine rollout and how this engagement has shaped public response to vaccines across jurisdictions. Methods: We conducted a content analysis of tweets posted between December 28, 2020, and August 31, 2021. Leveraging the social media artificial intelligence tool Brandwatch Analytics, we constructed a list of public officials in 3 jurisdictions (Ontario, Alberta, and British Columbia) organized across 6 public official types and then conducted an English and French keyword search for tweets about vaccine rollout and delivery that mentioned, retweeted, or replied to the public officials. We identified the top 30 tweets with the highest impressions in each jurisdiction in each of the 3 phases (approximately a 26-day window) of the vaccine rollout. The metrics of engagement (impressions, retweets, likes, and replies) from the top 30 tweets per phase in each jurisdiction were extracted for additional annotation. We specifically annotated sentiment toward public officials? vaccine responses (ie, positive, negative, and neutral) in each tweet and annotated the type of social media engagement. A thematic analysis of tweets was then conducted to add nuance to extracted data characterizing sentiment and interaction type. Results: Among the 6 categories of public officials, 142 prominent accounts were included from Ontario, Alberta, and British Columbia. In total, 270 tweets were included in the content analysis and 212 tweets were direct tweets by public officials. Public officials mostly used Twitter for information provision (139/212, 65.6%), followed by horizontal engagement (37/212, 17.5%), citizen engagement (24/212, 11.3%), and public service announcements (12/212, 5.7%). Information provision by government bodies (eg, provincial government and public health authorities) or municipal leaders is more prominent than tweets by other public official groups. Neutral sentiment accounted for 51.5% (139/270) of all the tweets, whereas positive sentiment was the second most common sentiment (117/270, 43.3%). In Ontario, 60% (54/90) of the tweets were positive. Negative sentiment (eg, public officials criticizing vaccine rollout) accounted for 12% (11/90) of all the tweets. Conclusions: As governments continue to promote the uptake of the COVID-19 booster doses, findings from this study are useful in informing how governments can best use social media to engage with the public to achieve democratic goals. UR - https://infodemiology.jmir.org/2023/1/e41582 UR - http://dx.doi.org/10.2196/41582 UR - http://www.ncbi.nlm.nih.gov/pubmed/37315194 ID - info:doi/10.2196/41582 ER - TY - JOUR AU - Yang, Dong-Wook AU - Son, Kyung-Bok PY - 2023/7/13 TI - 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 JO - JMIR Public Health Surveill SP - e46723 VL - 9 KW - community pharmacy KW - pharmaceutical practice KW - COVID-19 KW - South Korea KW - pandemic KW - survey KW - pharmacists KW - pharmacy KW - primary care KW - medicine-centered services N2 - 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. UR - https://publichealth.jmir.org/2023/1/e46723 UR - http://dx.doi.org/10.2196/46723 UR - http://www.ncbi.nlm.nih.gov/pubmed/37390391 ID - info:doi/10.2196/46723 ER - TY - JOUR AU - Hori, Daisuke AU - Takahashi, Tsukasa AU - Ozaki, Akihiko AU - Tabuchi, Takahiro PY - 2023/7/10 TI - The Impact of Priority Settings at the Start of COVID-19 Mass Vaccination on Subsequent Vaccine Uptake in Japan: One-Year Prospective Cohort Study JO - JMIR Public Health Surveill SP - e42143 VL - 9 KW - cohort studies KW - SARS-CoV-2 KW - COVID-19 KW - Japan KW - vaccination KW - vaccination hesitancy KW - vaccines N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42143 UR - http://dx.doi.org/10.2196/42143 UR - http://www.ncbi.nlm.nih.gov/pubmed/37235691 ID - info:doi/10.2196/42143 ER - TY - JOUR AU - Huang, Yiman AU - Zhang, Ling AU - Fu, Jiaqi AU - Wu, Yijin AU - Wang, Hao AU - Xiao, Weijun AU - Xin, You AU - Dai, Zhenwei AU - Si, Mingyu AU - Chen, Xu AU - Jia, Mengmeng AU - Leng, Zhiwei AU - Cui, Dan AU - Su, Xiaoyou PY - 2023/7/3 TI - COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study JO - JMIR Public Health Surveill SP - e42958 VL - 9 KW - COVID-19 KW - COVID-19 survivors KW - vaccine hesitancy KW - complacency KW - confidence KW - convenience KW - cross-sectional questionnaire KW - health education KW - health promotion KW - public health N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42958 UR - http://dx.doi.org/10.2196/42958 UR - http://www.ncbi.nlm.nih.gov/pubmed/37247615 ID - info:doi/10.2196/42958 ER - TY - JOUR AU - Park, Woo Han AU - Yoon, Young Ho PY - 2023/6/29 TI - Global COVID-19 Policy Engagement With Scientific Research Information: Altmetric Data Study JO - J Med Internet Res SP - e46328 VL - 25 KW - altmetrics KW - government policy report KW - citation analysis KW - COVID-19 KW - World Health Organization KW - WHO KW - COVID-19 research KW - online citation network KW - policy domains N2 - Background: Previous studies on COVID-19 scholarly articles have primarily focused on bibliometric characteristics, neglecting the identification of institutional actors that cite recent scientific contributions related to COVID-19 in the policy domain, and their locations. Objective: The purpose of this study was to assess the online citation network and knowledge structure of COVID-19 research across policy domains over 2 years from January 2020 to January 2022, with a particular emphasis on geographical frequency. Two research questions were addressed. The first question was related to who has been the most active in policy engagement with science and research information sharing during the COVID-19 pandemic, particularly in terms of countries and organization types. The second question was related to whether there are significant differences in the types of coronavirus research shared among countries and continents. Methods: The Altmetric database was used to collect policy report citations of scientific articles for 3 topic terms (COVID-19, COVID-19 vaccine, and COVID-19 variants). Altmetric provides the URLs of policy agencies that have cited COVID-19 research. The scientific articles used for Altmetric citations are extracted from journals indexed by PubMed. The numbers of COVID-19, COVID-19 vaccine, and COVID-19 variant research outputs between January 1, 2020, and January 31, 2022, were 216,787, 16,748, and 2777, respectively. The study examined the frequency of citations based on policy institutional domains, such as intergovernmental organizations, national and domestic governmental organizations, and nongovernmental organizations (think tanks and academic institutions). Results: The World Health Organization (WHO) stood out as the most notable institution citing COVID-19?related research outputs. The WHO actively sought and disseminated information regarding the COVID-19 pandemic. The COVID-19 vaccine citation network exhibited the most extensive connections in terms of degree centrality, 2-local eigenvector centrality, and eigenvector centrality among the 3 key terms. The Netherlands, the United States, the United Kingdom, and Australia were the countries that sought and shared the most information on COVID-19 vaccines, likely due to their high numbers of COVID-19 cases. Developing nations, although gaining quicker access to COVID-19 vaccine information, appeared to be relatively isolated from the enriched COVID-19 pandemic content in the global network. Conclusions: The global scientific network ecology during the COVID-19 pandemic revealed distinct types of links primarily centered around the WHO. Western countries demonstrated effective networking practices in constructing these networks. The prominent position of the key term ?COVID-19 vaccine? demonstrates that nation-states align with global authority regardless of their national contexts. In summary, the citation networking practices of policy agencies have the potential to uncover the global knowledge distribution structure as a proxy for the networking strategy employed during a pandemic. UR - https://www.jmir.org/2023/1/e46328 UR - http://dx.doi.org/10.2196/46328 UR - http://www.ncbi.nlm.nih.gov/pubmed/37384384 ID - info:doi/10.2196/46328 ER - TY - JOUR AU - Bonner, Carissa AU - Batcup, Carys AU - Cvejic, Erin AU - Ayre, Julie AU - Pickles, Kristen AU - Copp, Tessa AU - Cornell, Samuel AU - Nickel, Brooke AU - Dhahir, Mustafa AU - McCaffery, Kirsten PY - 2023/6/29 TI - Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy?Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments JO - JMIR Public Health Surveill SP - e40441 VL - 9 KW - behavior change KW - health literacy KW - COVID-19 KW - testing KW - infectious disease KW - public health N2 - 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 UR - https://publichealth.jmir.org/2023/1/e40441 UR - http://dx.doi.org/10.2196/40441 UR - http://www.ncbi.nlm.nih.gov/pubmed/37172319 ID - info:doi/10.2196/40441 ER - TY - JOUR AU - Jaulmes, Luc AU - Yordanov, Youri AU - Descamps, Alexandre AU - Durand-Zaleski, Isabelle AU - Dinh, Aurélien AU - Jourdain, Patrick AU - Dechartres, Agnès PY - 2023/6/23 TI - Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study JO - J Med Internet Res SP - e43980 VL - 25 KW - COVID-19 KW - Covidom KW - home monitoring KW - telehealth KW - tele-surveillance KW - primary outcome KW - remote monitoring KW - digital health intervention KW - emergency medical service KW - patient care KW - digital care KW - mobile phone N2 - Background: Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary. Objective: This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost. Methods: Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-Hôpitaux de Paris). Finally, we reported on user satisfaction. Results: Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was ?54 (US $1=?0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-Hôpitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom. Conclusions: Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19. UR - https://www.jmir.org/2023/1/e43980 UR - http://dx.doi.org/10.2196/43980 UR - http://www.ncbi.nlm.nih.gov/pubmed/37134021 ID - info:doi/10.2196/43980 ER - TY - JOUR AU - Amicosante, Vincenza Anna Maria AU - Rosso, Annalisa AU - Bernardini, Fabio AU - Guglielmi, Elisa AU - Eugeni, Erica AU - Da Re, Filippo AU - Baglio, Giovanni PY - 2023/6/23 TI - COVID-19 Contact Tracing Strategies During the First Wave of the Pandemic: Systematic Review of Published Studies JO - JMIR Public Health Surveill SP - e42678 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - contact tracing KW - public health KW - infectious disease KW - disease control KW - community engagement KW - digital tool N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42678 UR - http://dx.doi.org/10.2196/42678 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351939 ID - info:doi/10.2196/42678 ER - TY - JOUR AU - Sganzerla Martinez, Gustavo AU - Kelvin, J. David PY - 2023/6/22 TI - Convergence in Mobility Data Sets From Apple, Google, and Meta JO - JMIR Public Health Surveill SP - e44286 VL - 9 KW - Google KW - Apple KW - Meta KW - COVID-19 mobility KW - COVID-19 KW - mobility KW - data set KW - data KW - pattern KW - pandemic KW - mobile KW - operating system KW - system KW - validation KW - tool KW - asset N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44286 UR - http://dx.doi.org/10.2196/44286 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347516 ID - info:doi/10.2196/44286 ER - TY - JOUR AU - Wang, Qing AU - Jia, Mengmeng AU - Jiang, Mingyue AU - Liu, Wei AU - Yang, Jin AU - Dai, Peixi AU - Sun, Yanxia AU - Qian, Jie AU - Yang, Weizhong AU - Feng, Luzhao PY - 2023/6/12 TI - Seesaw Effect Between COVID-19 and Influenza From 2020 to 2023 in World Health Organization Regions: Correlation Analysis JO - JMIR Public Health Surveill SP - e44970 VL - 9 KW - COVID-19 KW - influenza KW - negative correlation KW - seesaw effect KW - respiratory infectious disease KW - epidemiological trends N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44970 UR - http://dx.doi.org/10.2196/44970 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191650 ID - info:doi/10.2196/44970 ER - TY - JOUR AU - Garg, M. Kritika AU - Lamba, Vinita AU - Chattopadhyay, Balaji PY - 2023/6/12 TI - Genomic Insights Into the Evolution and Demographic History of the SARS-CoV-2 Omicron Variant: Population Genomics Approach JO - JMIR Bioinform Biotech SP - e40673 VL - 4 KW - SARS-CoV-2 KW - Omicron KW - evolutionary network KW - population subdivision KW - genome evolution KW - COVID-19 KW - microevolution N2 - 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 D60 years old) in the family (aOR 0.685, 95% CI 0.510-0.911), had better knowledge about COVID-19 (aOR 0.942, 95% CI 0.916-0.970), and had mental health disorders (aOR 0.795, 95% CI 0.646-0.975) were less likely to report hesitancy to undergo RAT. Conclusions: Hesitancy to undergo SARS-CoV-2 RAT was low among individuals who were not yet infected with SARS-CoV-2. Efforts should be made to improve the awareness and acceptance of RAT among men, younger adults, individuals with a lower education or salary, families without children and elders, and individuals who access COVID-19 information via traditional media. In a reopening world, our study could inform the development of contextualized mass screening strategies in general and the scale-up of RAT in particular, which remains an indispensable option in emergency preparedness. UR - https://publichealth.jmir.org/2023/1/e43555 UR - http://dx.doi.org/10.2196/43555 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888911 ID - info:doi/10.2196/43555 ER - TY - JOUR AU - Matas, L. Jennifer AU - Landry, G. Latrice AU - Lee, LaTasha AU - Hansel, Shantoy AU - Coudray, S. Makella AU - Mata-McMurry, V. Lina AU - Chalasani, Nishanth AU - Xu, Liou AU - Stair, Taylor AU - Edwards, Christina AU - Puckrein, Gary AU - Meyer, William AU - Wiltz, Gary AU - Sampson, Marian AU - Gregerson, Paul AU - Barron, Charles AU - Marable, Jeffrey AU - Akinboboye, Olakunle AU - Il'yasova, Dora PY - 2023/4/27 TI - Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities: Cross-sectional Study JO - JMIR Public Health Surveill SP - e34163 VL - 9 KW - COVID-19 vaccine KW - vaccine hesitancy KW - underrepresented in research KW - minority populations KW - federally qualified health center (FQHC) KW - public health KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e34163 UR - http://dx.doi.org/10.2196/34163 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811869 ID - info:doi/10.2196/34163 ER - TY - JOUR AU - Ruiz, Sienna AU - Okere, Charles Uzoma AU - Eggers, Michelle AU - O'Leary, Catina AU - Politi, Mary AU - Wan, Fei AU - Housten, J. Ashley PY - 2023/4/27 TI - Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study JO - JMIR Hum Factors SP - e39697 VL - 10 KW - COVID-19 KW - health messaging KW - rural populations KW - urban populations KW - communication KW - health information KW - messaging KW - dissemination KW - health equity KW - prevention KW - implementation N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e39697 UR - http://dx.doi.org/10.2196/39697 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848256 ID - info:doi/10.2196/39697 ER - TY - JOUR AU - Niculaescu, Corina-Elena AU - Sassoon, Karen Isabel AU - Landa-Avila, Cecilia Irma AU - Colak, Ozlem AU - Jun, Thomas Gyuchan AU - Balatsoukas, Panagiotis PY - 2023/4/27 TI - Individual Factors Influencing the Public?s Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey JO - JMIR Form Res SP - e37139 VL - 7 KW - immunity passports KW - immunity certificates KW - vaccine passports KW - COVID-19 KW - health belief model KW - vaccination KW - pandemic KW - cross-sectional survey KW - low income KW - vulnerable population KW - socioeconomic KW - public perception KW - public policy N2 - Background: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. Objective: This study aimed to assess what were the main individual factors influencing people?s perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. Methods: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants? perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents? lifestyle and sociodemographic characteristics. Results: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (?=0.2564; P<.001) and felt safer if vaccinated (?=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed (?=?0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic (?=?0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. Conclusions: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher. UR - https://formative.jmir.org/2023/1/e37139 UR - http://dx.doi.org/10.2196/37139 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920837 ID - info:doi/10.2196/37139 ER - TY - JOUR AU - Wittwer, Salome AU - Paolotti, Daniela AU - Lichand, Guilherme AU - Leal Neto, Onicio PY - 2023/4/26 TI - Participatory Surveillance for COVID-19 Trend Detection in Brazil: Cross-sectional Study JO - JMIR Public Health Surveill SP - e44517 VL - 9 KW - participatory surveillance KW - COVID-19 KW - digital epidemiology KW - coronavirus KW - infectious disease KW - epidemic KW - pandemic KW - SARS-CoV-2 KW - forecast KW - trend KW - reporting KW - self-report KW - surveillance N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44517 UR - http://dx.doi.org/10.2196/44517 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888908 ID - info:doi/10.2196/44517 ER - TY - JOUR AU - Xia, Jizhe AU - Yin, Kun AU - Yue, Yang AU - Li, Qingquan AU - Wang, Xiling AU - Hu, Dongsheng AU - Wang, Xiong AU - Du, Zhanwei AU - Cowling, J. Ben AU - Chen, Erzhen AU - Zhou, Ying PY - 2023/4/26 TI - Impact of Human Mobility on COVID-19 Transmission According to Mobility Distance, Location, and Demographic Factors in the Greater Bay Area of China: Population-Based Study JO - JMIR Public Health Surveill SP - e39588 VL - 9 KW - COVID-19 KW - mobility restriction KW - mobility distance KW - demographic factors KW - locations N2 - Background: Mobility restriction was one of the primary measures used to restrain the spread of COVID-19 globally. Governments implemented and relaxed various mobility restriction measures in the absence of evidence for almost 3 years, which caused severe adverse outcomes in terms of health, society, and economy. Objective: This study aimed to quantify the impact of mobility reduction on COVID-19 transmission according to mobility distance, location, and demographic factors in order to identify hotspots of transmission and guide public health policies. Methods: Large volumes of anonymized aggregated mobile phone position data between January 1 and February 24, 2020, were collected for 9 megacities in the Greater Bay Area, China. A generalized linear model (GLM) was established to test the association between mobility volume (number of trips) and COVID-19 transmission. Subgroup analysis was also performed for sex, age, travel location, and travel distance. Statistical interaction terms were included in a variety of models that express different relations between involved variables. Results: The GLM analysis demonstrated a significant association between the COVID-19 growth rate ratio (GR) and mobility volume. A stratification analysis revealed a higher effect of mobility volume on the COVID-19 GR among people aged 50-59 years (GR decrease of 13.17% per 10% reduction in mobility volume; P<.001) than among other age groups (GR decreases of 7.80%, 10.43%, 7.48%, 8.01%, and 10.43% for those aged ?18, 19-29, 30-39, 40-49, and ?60 years, respectively; P=.02 for the interaction). The impact of mobility reduction on COVID-19 transmission was higher for transit stations and shopping areas (instantaneous reproduction number [Rt] decreases of 0.67 and 0.53 per 10% reduction in mobility volume, respectively) than for workplaces, schools, recreation areas, and other locations (Rt decreases of 0.30, 0.37, 0.44, and 0.32, respectively; P=.02 for the interaction). The association between mobility volume reduction and COVID-19 transmission was lower with decreasing mobility distance as there was a significant interaction between mobility volume and mobility distance with regard to Rt (P<.001 for the interaction). Specifically, the percentage decreases in Rt per 10% reduction in mobility volume were 11.97% when mobility distance increased by 10% (Spring Festival), 6.74% when mobility distance remained unchanged, and 1.52% when mobility distance declined by 10%. Conclusions: The association between mobility reduction and COVID-19 transmission significantly varied according to mobility distance, location, and age. The substantially higher impact of mobility volume on COVID-19 transmission for longer travel distance, certain age groups, and specific travel locations highlights the potential to optimize the effectiveness of mobility restriction strategies. The results from our study demonstrate the power of having a mobility network using mobile phone data for surveillance that can monitor movement at a detailed level to measure the potential impacts of future pandemics. UR - https://publichealth.jmir.org/2023/1/e39588 UR - http://dx.doi.org/10.2196/39588 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848228 ID - info:doi/10.2196/39588 ER - TY - JOUR AU - Mudaranthakam, Pal Dinesh AU - Pepper, Sam AU - Fortney, Tanner AU - Alsup, Alexander AU - Woodward, Jennifer AU - Sykes, Kevin AU - Calhoun, Elizabeth PY - 2023/4/25 TI - The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing JO - JMIR Public Health Surveill SP - e41369 VL - 9 KW - social determinants of health KW - COVID-19 KW - food assistance program KW - public health KW - quality of life KW - well-being KW - health disparity KW - health inequity KW - health policy KW - Kansas KW - social work KW - socioeconomic N2 - Background: Studying patients? social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people?s social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people?s social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19?related policies aimed to improve. Objective: The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Methods: Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. Results: The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Conclusions: Post-COVID-19 responses showed improvement across almost all social needs?related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis. UR - https://publichealth.jmir.org/2023/1/e41369 UR - http://dx.doi.org/10.2196/41369 UR - http://www.ncbi.nlm.nih.gov/pubmed/36977199 ID - info:doi/10.2196/41369 ER - TY - JOUR AU - Ruiz, S. Monica AU - McMahon, V. Mercedes AU - Latif, Hannah AU - Vyas, Amita PY - 2023/4/25 TI - 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 JO - JMIR Public Health Surveill SP - e40138 VL - 9 KW - COVID-19 KW - mask adherence KW - social distancing KW - public health KW - health policy KW - public health mandates N2 - 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. UR - https://publichealth.jmir.org/2023/1/e40138 UR - http://dx.doi.org/10.2196/40138 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888910 ID - info:doi/10.2196/40138 ER - TY - JOUR AU - Dupuy-Zini, Alexandre AU - Audeh, Bissan AU - Gérardin, Christel AU - Duclos, Catherine AU - Gagneux-Brunon, Amandine AU - Bousquet, Cedric PY - 2023/4/24 TI - Users? Reactions to Announced Vaccines Against COVID-19 Before Marketing in France: Analysis of Twitter Posts JO - J Med Internet Res SP - e37237 VL - 25 KW - COVID-19 Vaccines KW - Social Media KW - Deep Learning KW - France KW - Sentiment Analysis N2 - Background: Within a few months, the COVID-19 pandemic had spread to many countries and had been a real challenge for health systems all around the world. This unprecedented crisis has led to a surge of online discussions about potential cures for the disease. Among them, vaccines have been at the heart of the debates and have faced lack of confidence before marketing in France. Objective: This study aims to identify and investigate the opinions of French Twitter users on the announced vaccines against COVID-19 through sentiment analysis. Methods: This study was conducted in 2 phases. First, we filtered a collection of tweets related to COVID-19 available on Twitter from February 2020 to August 2020 with a set of keywords associated with vaccine mistrust using word embeddings. Second, we performed sentiment analysis using deep learning to identify the characteristics of vaccine mistrust. The model was trained on a hand-labeled subset of 4548 tweets. Results: A set of 69 relevant keywords were identified as the semantic concept of the word ?vaccin? (vaccine in French) and focused mainly on conspiracies, pharmaceutical companies, and alternative treatments. Those keywords enabled us to extract nearly 350,000 tweets in French. The sentiment analysis model achieved 0.75 accuracy. The model then predicted 16% of positive tweets, 41% of negative tweets, and 43% of neutral tweets. This allowed us to explore the semantic concepts of positive and negative tweets and to plot the trends of each sentiment. The main negative rhetoric identified from users? tweets was that vaccines are perceived as having a political purpose and that COVID-19 is a commercial argument for the pharmaceutical companies. Conclusions: Twitter might be a useful tool to investigate the arguments for vaccine mistrust because it unveils political criticism contrasting with the usual concerns on adverse drug reactions. As the opposition rhetoric is more consistent and more widely spread than the positive rhetoric, we believe that this research provides effective tools to help health authorities better characterize the risk of vaccine mistrust. UR - https://www.jmir.org/2023/1/e37237 UR - http://dx.doi.org/10.2196/37237 UR - http://www.ncbi.nlm.nih.gov/pubmed/36596215 ID - info:doi/10.2196/37237 ER - TY - JOUR AU - Rich, N. Shannan AU - Richards, Veronica AU - Mavian, Carla AU - Rife Magalis, Brittany AU - Grubaugh, Nathan AU - Rasmussen, A. Sonja AU - Dellicour, Simon AU - Vrancken, Bram AU - Carrington, Christine AU - Fisk-Hoffman, Rebecca AU - Danso-Odei, Demi AU - Chacreton, Daniel AU - Shapiro, Jerne AU - Seraphin, Nancy Marie AU - Hepp, Crystal AU - Black, Allison AU - Dennis, Ann AU - Trovão, Sequeira Nídia AU - Vandamme, Anne-Mieke AU - Rasmussen, Angela AU - Lauzardo, Michael AU - Dean, Natalie AU - Salemi, Marco AU - Prosperi, Mattia PY - 2023/4/21 TI - Application of Phylodynamic Tools to Inform the Public Health Response to COVID-19: Qualitative Analysis of Expert Opinions JO - JMIR Form Res SP - e39409 VL - 7 KW - COVID-19 KW - SARS-CoV-2 KW - molecular epidemiology KW - genomic surveillance KW - variants KW - pandemic KW - phylogenetic KW - genomic KW - epidemiology KW - data KW - virology KW - bioinformatics KW - response KW - phylodynamic KW - monitoring KW - surveillance KW - transmission N2 - Background: In the wake of the SARS-CoV-2 pandemic, scientists have scrambled to collect and analyze SARS-CoV-2 genomic data to inform public health responses to COVID-19 in real time. Open source phylogenetic and data visualization platforms for monitoring SARS-CoV-2 genomic epidemiology have rapidly gained popularity for their ability to illuminate spatial-temporal transmission patterns worldwide. However, the utility of such tools to inform public health decision-making for COVID-19 in real time remains to be explored. Objective: The aim of this study is to convene experts in public health, infectious diseases, virology, and bioinformatics?many of whom were actively engaged in the COVID-19 response?to discuss and report on the application of phylodynamic tools to inform pandemic responses. Methods: In total, 4 focus groups (FGs) occurred between June 2020 and June 2021, covering both the pre- and postvariant strain emergence and vaccination eras of the ongoing COVID-19 crisis. Participants included national and international academic and government researchers, clinicians, public health practitioners, and other stakeholders recruited through purposive and convenience sampling by the study team. Open-ended questions were developed to prompt discussion. FGs I and II concentrated on phylodynamics for the public health practitioner, while FGs III and IV discussed the methodological nuances of phylodynamic inference. Two FGs per topic area to increase data saturation. An iterative, thematic qualitative framework was used for data analysis. Results: We invited 41 experts to the FGs, and 23 (56%) agreed to participate. Across all the FG sessions, 15 (65%) of the participants were female, 17 (74%) were White, and 5 (22%) were Black. Participants were described as molecular epidemiologists (MEs; n=9, 39%), clinician-researchers (n=3, 13%), infectious disease experts (IDs; n=4, 17%), and public health professionals at the local (PHs; n=4, 17%), state (n=2, 9%), and federal (n=1, 4%) levels. They represented multiple countries in Europe, the United States, and the Caribbean. Nine major themes arose from the discussions: (1) translational/implementation science, (2) precision public health, (3) fundamental unknowns, (4) proper scientific communication, (5) methods of epidemiological investigation, (6) sampling bias, (7) interoperability standards, (8) academic/public health partnerships, and (9) resources. Collectively, participants felt that successful uptake of phylodynamic tools to inform the public health response relies on the strength of academic and public health partnerships. They called for interoperability standards in sequence data sharing, urged careful reporting to prevent misinterpretations, imagined that public health responses could be tailored to specific variants, and cited resource issues that would need to be addressed by policy makers in future outbreaks. Conclusions: This study is the first to detail the viewpoints of public health practitioners and molecular epidemiology experts on the use of viral genomic data to inform the response to the COVID-19 pandemic. The data gathered during this study provide important information from experts to help streamline the functionality and use of phylodynamic tools for pandemic responses. UR - https://formative.jmir.org/2023/1/e39409 UR - http://dx.doi.org/10.2196/39409 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848460 ID - info:doi/10.2196/39409 ER - TY - JOUR AU - Kanyangarara, Mufaro AU - Daguise, Virginie AU - Gual-Gonzalez, Lídia AU - Litwin, H. Alain AU - Korte, Jeffrey AU - Ross, Connor AU - Nolan, S. Melissa AU - PY - 2023/4/19 TI - COVID-19 Testing Practices, Preventive Behaviors, and Factors Associated With Test Positivity: Population-Based Statewide Survey Study JO - JMIR Public Health Surveill SP - e34579 VL - 9 KW - SARS-CoV-2 KW - South Carolina KW - surveillance KW - attitude KW - behavior KW - COVID-19 KW - testing KW - prevention KW - United States KW - population KW - survey KW - risk KW - perception KW - risk factor N2 - 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. UR - https://publichealth.jmir.org/2023/1/e34579 UR - http://dx.doi.org/10.2196/34579 UR - http://www.ncbi.nlm.nih.gov/pubmed/36720159 ID - info:doi/10.2196/34579 ER - TY - JOUR AU - Sfaelos, Konstantinos AU - Kontodimas, Stathis AU - Charisiadi, Theodora AU - Chantzara, Nagia AU - Pesiridis, George AU - Tampouratzi, Eleftheria PY - 2023/4/19 TI - Patient Engagement With the Myderma Platform for Psoriasis During the COVID-19 Pandemic JO - JMIR Dermatol SP - e39451 VL - 6 KW - psoriasis KW - social media KW - online health-related information KW - COVID-19 KW - disease awareness KW - disease awareness website KW - digital campaigns KW - patient activation KW - patient engagement KW - COVID-19 pandemic UR - https://derma.jmir.org/2023/1/e39451 UR - http://dx.doi.org/10.2196/39451 UR - http://www.ncbi.nlm.nih.gov/pubmed/37124952 ID - info:doi/10.2196/39451 ER - TY - JOUR AU - Nair, V. Chithira AU - Moni, Merlin AU - Edathadathil, Fabia AU - A, Appukuttan AU - Prasanna, Preetha AU - Pushpa Raghavan, Roshni AU - Sathyapalan, T. Dipu AU - Jayant, Aveek PY - 2023/4/18 TI - Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study JO - JMIR Form Res SP - e40028 VL - 7 KW - COVID-19 KW - follow-up KW - incidence KW - fatigue KW - long COVID KW - post-COVID KW - post-COVID-19 symptoms KW - questionnaire KW - tertiary-care center KW - intensive care KW - symptom monitoring KW - prospective observational study KW - treatment KW - steroid KW - viral therapy KW - postdischarge N2 - Background: Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome. Objective: We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. Methods: A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks. Results: The mean age of the cohort was 55 years and 55% were men. Only 5% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. In addition, 60.8% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8%, followed by dyspnea (20%) and weight loss (16.7%). Female sex (odds ratio [OR] 2.4, 95% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. Conclusions: Overall, 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks. UR - https://formative.jmir.org/2023/1/e40028 UR - http://dx.doi.org/10.2196/40028 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920842 ID - info:doi/10.2196/40028 ER - TY - JOUR AU - Keeble, Matthew AU - Adams, Jean AU - Burgoine, Thomas PY - 2023/4/17 TI - Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis JO - JMIR Public Health Surveill SP - e41822 VL - 9 KW - COVID-19 KW - digital food environment KW - fast foods KW - online food delivery services KW - public health N2 - 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. UR - https://publichealth.jmir.org/2023/1/e41822 UR - http://dx.doi.org/10.2196/41822 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848236 ID - info:doi/10.2196/41822 ER - TY - JOUR AU - Ishizuka-Inoue, Mami AU - Shimoura, Kanako AU - Nagai-Tanima, Momoko AU - Aoyama, Tomoki PY - 2023/4/17 TI - The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study JO - JMIR Form Res SP - e41394 VL - 7 KW - infodemic KW - COVID-19 KW - health literacy KW - fear of COVID-19 KW - cross-sectional study KW - behavior KW - age group KW - misinformation KW - influence KW - prevention KW - disease N2 - Background: COVID-19 prevention behaviors have become part of our lives, and they have been reported to be associated with health literacy, knowledge, and fear. However, the COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion. Objective: This study aims to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group. Methods: A cross-sectional study was conducted among 512 participants aged 20-69 years, recruited from a web-based sample from November 1 to November 5, 2021. A web-based self-administered questionnaire was used to obtain the participants? characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using the Spearman rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as dependent variables; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables. Results: For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (P<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (P<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (P<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age groups 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age groups 50-59 and 60-69 years, only fear of COVID-19 had an impact. Conclusions: The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection. UR - https://formative.jmir.org/2023/1/e41394 UR - http://dx.doi.org/10.2196/41394 UR - http://www.ncbi.nlm.nih.gov/pubmed/37011226 ID - info:doi/10.2196/41394 ER - TY - JOUR AU - Li, Ying AU - Ding, XiWen AU - Aierken, Ayizuhere AU - Pan, YiYang AU - Chen, Yuan AU - Hu, DongBin PY - 2023/4/14 TI - The Role of Community Cohesion in Older Adults During the COVID-19 Epidemic: Cross-sectional Study JO - JMIR Public Health Surveill SP - e45110 VL - 9 KW - community cohesion KW - physical and mental health KW - community services KW - environmental resources KW - COVID-19 epidemic KW - older adults N2 - 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. UR - https://publichealth.jmir.org/2023/1/e45110 UR - http://dx.doi.org/10.2196/45110 UR - http://www.ncbi.nlm.nih.gov/pubmed/36921236 ID - info:doi/10.2196/45110 ER - TY - JOUR AU - Remmel, Christopher AU - Tuli, Gaurav AU - Varrelman, J. Tanner AU - Han, R. Aimee AU - Angkab, Pakkanan AU - Kosiyaporn, Hathairat AU - Netrpukdee, Chanikarn AU - Sorndamrih, Supatnuj AU - Thamarangsi, Thaksaphon AU - Brownstein, S. John AU - Astley, M. Christina PY - 2023/4/13 TI - COVID-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-sectional Online Survey JO - JMIR Public Health Surveill SP - e40186 VL - 9 KW - COVID-19 vaccines KW - Thailand KW - survey KW - vaccines KW - COVID-19 KW - pandemic KW - public health KW - health policy KW - epidemiology KW - social media KW - vaccine hesitancy N2 - 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. UR - https://publichealth.jmir.org/2023/1/e40186 UR - http://dx.doi.org/10.2196/40186 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811852 ID - info:doi/10.2196/40186 ER - TY - JOUR AU - Rahman, Mahmudur Md AU - Mahi, Munawara Atqiya AU - Melamed, Rachel AU - Alam, Ul Mohammad Arif PY - 2023/4/11 TI - Effects of Antidepressants on COVID-19 Outcomes: Retrospective Study on Large-Scale Electronic Health Record Data JO - Interact J Med Res SP - e39455 VL - 12 KW - causal inference KW - treatment effect KW - drug effect KW - COVID-19 outcomes KW - COVID-19 severity KW - drug repurposing KW - COVID-19 KW - depression KW - mental health KW - data mining KW - electronic health record KW - machine learning KW - antidepressant KW - causal inference method N2 - 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. UR - https://www.i-jmr.org/2023/1/e39455 UR - http://dx.doi.org/10.2196/39455 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881541 ID - info:doi/10.2196/39455 ER - TY - JOUR AU - Marques-Cruz, Manuel AU - Nogueira-Leite, Diogo AU - Alves, Miguel João AU - Fernandes, Francisco AU - Fernandes, Miguel José AU - Almeida, Ângelo Miguel AU - Cunha Correia, Patrícia AU - Perestrelo, Paula AU - Cruz-Correia, Ricardo AU - Pita Barros, Pedro PY - 2023/4/6 TI - COVID-19 Contact Tracing as an Indicator for Evaluating a Pandemic Situation: Simulation Study JO - JMIR Public Health Surveill SP - e43836 VL - 9 KW - COVID-19 KW - public health KW - public health surveillance KW - quarantine KW - infection transmission KW - epidemiological models N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43836 UR - http://dx.doi.org/10.2196/43836 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877958 ID - info:doi/10.2196/43836 ER - TY - JOUR AU - Argyropoulos, D. Christos AU - Leckler, Janina AU - Salmanton-García, Jon AU - Constantinou, Marinos AU - Alexandrou, Alexandra AU - Themistocleous, Sophia AU - Noula, Evgenia AU - Shiamakkides, George AU - Nearchou, Andria AU - Stewart, A. Fiona AU - Albus, Kerstin AU - Koniordou, Markela AU - Kopsidas, Ioannis AU - Spivak, Orly AU - Hellemans, Margot AU - Hendrickx, Greet AU - Davis, Joanna Ruth AU - Azzini, Maria Anna AU - Simon, Valle Paula AU - Carcas-Sansuan, Javier Antonio AU - Askling, Hervius Helena AU - Vene, Sirkka AU - Prellezo, Baranda Jana AU - Álvarez-Barco, Elena AU - Macken, J. Alan AU - Di Marzo, Romina AU - Luís, Catarina AU - Olesen, F. Ole AU - Frias Iniesta, A. Jesus AU - Barta, Imre AU - Tóth, Krisztina AU - Akova, Murat AU - Bonten, J. Marc M. AU - Cohen-Kandli, Miriam AU - Cox, Jane Rebecca AU - Sou?ková, Lenka AU - Husa, Petr AU - Jancoriene, Ligita AU - Launay, Odile AU - Lundgren, Jens AU - Mallon, Patrick AU - Armeftis, Charis AU - Marques, Laura AU - Naucler, Pontus AU - Ochando, Jordi AU - Tacconelli, Evelina AU - van Damme, Pierre AU - Zaoutis, Theoklis AU - Hofstraat, Sanne AU - Bruijning-Verhagen, Patricia AU - Zeitlinger, Markus AU - Cornely, A. Oliver AU - Pana, Dorothea Zoi PY - 2023/4/3 TI - Enhancing Public Health Communication Regarding Vaccine Trials: Design and Development of the Pan-European VACCELERATE Toolkit JO - JMIR Public Health Surveill SP - e44491 VL - 9 KW - vaccine trials KW - volunteer registry KW - educational material KW - promotional material KW - patient education KW - health communication KW - health promotion KW - public health KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - pandemic KW - vaccine KW - vaccination KW - hesitancy KW - campaign KW - misinformation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e44491 UR - http://dx.doi.org/10.2196/44491 UR - http://www.ncbi.nlm.nih.gov/pubmed/36878478 ID - info:doi/10.2196/44491 ER - TY - JOUR AU - Chagas, Azevedo Bruno AU - Pagano, Silvina Adriana AU - Prates, Oliveira Raquel AU - Praes, Cordeiro Elisa AU - Ferreguetti, Kícila AU - Vaz, Helena AU - Reis, Nogueira Zilma Silveira AU - Ribeiro, Bonisson Leonardo AU - Ribeiro, Pinho Antonio Luiz AU - Pedroso, Marques Thais AU - Beleigoli, Alline AU - Oliveira, Alves Clara Rodrigues AU - Marcolino, Soriano Milena PY - 2023/4/3 TI - Evaluating User Experience With a Chatbot Designed as a Public Health Response to the COVID-19 Pandemic in Brazil: Mixed Methods Study JO - JMIR Hum Factors SP - e43135 VL - 10 KW - user experience KW - chatbots KW - telehealth KW - COVID-19 KW - human-computer interaction KW - HCI KW - empirical studies in human-computer interaction KW - empirical studies in HCI KW - health care information systems N2 - Background: The potential of chatbots for screening and monitoring COVID-19 was envisioned since the outbreak of the disease. Chatbots can help disseminate up-to-date and trustworthy information, promote healthy social behavior, and support the provision of health care services safely and at scale. In this scenario and in view of its far-reaching postpandemic impact, it is important to evaluate user experience with this kind of application. Objective: We aimed to evaluate the quality of user experience with a COVID-19 chatbot designed by a large telehealth service in Brazil, focusing on the usability of real users and the exploration of strengths and shortcomings of the chatbot, as revealed in reports by participants in simulated scenarios. Methods: We examined a chatbot developed by a multidisciplinary team and used it as a component within the workflow of a local public health care service. The chatbot had 2 core functionalities: assisting web-based screening of COVID-19 symptom severity and providing evidence-based information to the population. From October 2020 to January 2021, we conducted a mixed methods approach and performed a 2-fold evaluation of user experience with our chatbot by following 2 methods: a posttask usability Likert-scale survey presented to all users after concluding their interaction with the bot and an interview with volunteer participants who engaged in a simulated interaction with the bot guided by the interviewer. Results: Usability assessment with 63 users revealed very good scores for chatbot usefulness (4.57), likelihood of being recommended (4.48), ease of use (4.44), and user satisfaction (4.38). Interviews with 15 volunteers provided insights into the strengths and shortcomings of our bot. Comments on the positive aspects and problems reported by users were analyzed in terms of recurrent themes. We identified 6 positive aspects and 15 issues organized in 2 categories: usability of the chatbot and health support offered by it, the former referring to usability of the chatbot and how users can interact with it and the latter referring to the chatbot?s goal in supporting people during the pandemic through the screening process and education to users through informative content. We found 6 themes accounting for what people liked most about our chatbot and why they found it useful?3 themes pertaining to the usability domain and 3 themes regarding health support. Our findings also identified 15 types of problems producing a negative impact on users?10 of them related to the usability of the chatbot and 5 related to the health support it provides. Conclusions: Our results indicate that users had an overall positive experience with the chatbot and found the health support relevant. Nonetheless, qualitative evaluation of the chatbot indicated challenges and directions to be pursued in improving not only our COVID-19 chatbot but also health chatbots in general. UR - https://humanfactors.jmir.org/2023/1/e43135 UR - http://dx.doi.org/10.2196/43135 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634267 ID - info:doi/10.2196/43135 ER - TY - JOUR AU - Tessier, Anne-Julie AU - Moyen, Audrey AU - Lawson, Claire AU - Rappaport, Ilysse Aviva AU - Yousif, Hiba AU - Fleurent-Grégoire, Chloé AU - Lalonde-Bester, Sophie AU - Brazeau, Anne-Sophie AU - Chevalier, Stéphanie PY - 2023/3/30 TI - Lifestyle Behavior Changes and Associated Risk Factors During the COVID-19 Pandemic: Results from the Canadian COVIDiet Online Cohort Study JO - JMIR Public Health Surveill SP - e43786 VL - 9 KW - healthy lifestyle KW - behaviors KW - pandemic KW - COVID-19 KW - public health KW - body image KW - gender KW - stress KW - risk factor KW - physical activity KW - mental well-being KW - depression N2 - Background: The COVID-19 pandemic and related lockdowns have impacted lifestyle behaviors, including eating habits and physical activity; yet, few studies have identified the emerging patterns of such changes and associated risk factors. Objective: This study aims to identify the patterns of weight and lifestyle behavior changes, and the potential risk factors, resulting from the pandemic in Canadian adults. Methods: Analyses were conducted on 1609 adults (18-89 years old; n=1450, 90.1%, women; n=1316, 81.8%, White) of the Canadian COVIDiet study baseline data (May-December 2020). Self-reported current and prepandemic weight, physical activity, smoking status, perceived eating habits, alcohol intake, and sleep quality were collected through online questionnaires. Based on these 6 indicator variables, latent class analysis (LCA) was used to identify lifestyle behavior change patterns. Associations with potential risk factors, including age, gender, ethnicity, education, income, chronic diseases, body image perception, and changes in the stress level, living situation, and work arrangement, were examined with logistic regressions. Results: Participants? mean BMI was 26.1 (SD 6.3) kg/m2. Of the 1609 participants, 980 (60.9%) had a bachelor?s degree or above. Since the pandemic, 563 (35%) had decreased income and 788 (49%) changed their work arrangement. Most participants reported unchanged weight, sleep quality, physical activity level, and smoking and alcohol consumption, yet 708 (44%) reported a perceived decrease in eating habit quality. From LCA, 2 classes of lifestyle behavior change emerged: healthy and less healthy (probability: 0.605 and 0.395, respectively; Bayesian information criterion [BIC]=15574, entropy=4.8). The healthy lifestyle behavior change group more frequently reported unchanged weight, sleep quality, smoking and alcohol intake, unchanged/improved eating habits, and increased physical activity. The less healthy lifestyle behavior change group reported significant weight gain, deteriorated eating habits and sleep quality, unchanged/increased alcohol intake and smoking, and decreased physical activity. Among risk factors, body image dissatisfaction (odds ratio [OR] 8.8, 95% CI 5.3-14.7), depression (OR 1.8, 95% CI 1.3-2.5), increased stress level (OR 3.4, 95% CI 2.0-5.8), and gender minority identity (OR 5.5, 95% CI 1.3-22.3) were associated with adopting less healthy behaviors in adjusted models. Conclusions: The COVID-19 pandemic has appeared to have influenced lifestyle behaviors unfavorably in some but favorably in others. Body image perception, change in stress level, and gender identity are factors associated with behavior change patterns; whether these will sustain over time remains to be studied. Findings provide insights into developing strategies for supporting adults with poorer mental well-being in the postpandemic context and promoting healthful behaviors during future disease outbreaks. Trial Registration: ClinicalTrials.gov NCT04407533; https://clinicaltrials.gov/ct2/show/NCT04407533 UR - https://publichealth.jmir.org/2023/1/e43786 UR - http://dx.doi.org/10.2196/43786 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848226 ID - info:doi/10.2196/43786 ER - TY - JOUR AU - Balakrishnan, Bathmapriya AU - Hamrick, Lucas AU - Alam, Ariful AU - Thompson, Jesse PY - 2023/3/22 TI - Effects of COVID-19 Acute Respiratory Distress Syndrome Intensive Care Unit Survivor Telemedicine Clinic on Patient Readmission, Pain Perception, and Self-Assessed Health Scores: Randomized, Prospective, Single-Center, Exploratory Study JO - JMIR Form Res SP - e43759 VL - 7 KW - acute respiratory distress syndrome KW - aftercare KW - COVID-19 pneumonia KW - critical care KW - survivor KW - telemedicine N2 - Background: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. Objective: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge. Methods: This randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. Results: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants? mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care. Conclusions: This exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population. UR - https://formative.jmir.org/2023/1/e43759 UR - http://dx.doi.org/10.2196/43759 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877802 ID - info:doi/10.2196/43759 ER - TY - JOUR AU - Stacey, Dawn AU - Ludwig, Claire AU - Archambault, Patrick AU - Smith, Maureen AU - Taljaard, Monica AU - Carley, Meg AU - Plourde, Karine AU - Boland, Laura AU - Gogovor, Amédé AU - Graham, Ian AU - Kobewka, Daniel AU - McLean, D. Robert K. AU - Nelson, A. Michelle L. AU - Vanderspank-Wright, Brandi AU - Légaré, France PY - 2023/3/21 TI - Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys JO - JMIR Public Health Surveill SP - e43652 VL - 9 KW - health care decisions KW - decisional conflict KW - decision regret KW - shared decision-making KW - COVID-19 KW - older adults KW - caregivers KW - parents KW - public health decision KW - health care KW - health outcome KW - pandemic preparedness KW - public health policy N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43652 UR - http://dx.doi.org/10.2196/43652 UR - http://www.ncbi.nlm.nih.gov/pubmed/36688986 ID - info:doi/10.2196/43652 ER - TY - JOUR AU - Clarkson, D. Melissa PY - 2023/3/20 TI - Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study JO - JMIR Hum Factors SP - e43819 VL - 10 KW - COVID-19 KW - data visualization KW - data dashboard KW - public health reporting KW - human information interaction KW - transparency KW - trust N2 - 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. UR - https://humanfactors.jmir.org/2023/1/e43819 UR - http://dx.doi.org/10.2196/43819 UR - http://www.ncbi.nlm.nih.gov/pubmed/36696270 ID - info:doi/10.2196/43819 ER - TY - JOUR AU - Torres-Slimming, A. Paola AU - Carcamo, Cesar AU - Martínez-Pérez, Z. Guillermo AU - Mallma, Patricia AU - Pflucker, Cristina AU - Shilton, Sonjelle PY - 2023/3/17 TI - Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study JO - JMIR Form Res SP - e43183 VL - 7 KW - Peru, COVID-19 KW - self-testing KW - diagnostics KW - qualitative research KW - testing KW - virus KW - detection KW - health KW - decision-making KW - public KW - willingness KW - health system N2 - 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. UR - https://formative.jmir.org/2023/1/e43183 UR - http://dx.doi.org/10.2196/43183 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867689 ID - info:doi/10.2196/43183 ER - TY - JOUR AU - Schilling, Josh AU - Klein, Dave AU - Bartholmae, M. Marilyn AU - Shokouhi, Sepideh AU - Toepp, J. Angela AU - Roess, A. Amira AU - Sill, M. Joshua AU - Karpov, V. Matvey AU - Maney, Kathleen AU - Brown, Pearson K. AU - Levy, L. Brian AU - Renshaw, D. Keith AU - Dodani, Sunita AU - Jain, Praduman PY - 2023/3/15 TI - A Digital Health Initiative (COVIDsmart) for Remote Data Collection and Study of COVID-19?s Impact on the State of Virginia: Prospective Cohort Study JO - JMIR Form Res SP - e37550 VL - 7 KW - COVID-19 KW - digital health technology KW - human subjects KW - partnership KW - community health KW - diversity KW - mobile health KW - mHealth KW - medical subject headings KW - MeSH KW - medical informatics KW - internet KW - digital health KW - digital solution KW - digital recruitment KW - precision medicine KW - digital marketing KW - decision-making KW - COVIDsmart N2 - Background: The COVID-19 pandemic has affected people's lives beyond severe and long-term physical health symptoms. Social distancing and quarantine have led to adverse mental health outcomes. COVID-19?induced economic setbacks have also likely exacerbated the psychological distress affecting broader aspects of physical and mental well-being. Remote digital health studies can provide information about the pandemic's socioeconomic, mental, and physical impact. COVIDsmart was a collaborative effort to deploy a complex digital health research study to understand the impact of the pandemic on diverse populations. We describe how digital tools were used to capture the effects of the pandemic on the overall well-being of diverse communities across large geographical areas within the state of Virginia. Objective: The aim is to describe the digital recruitment strategies and data collection tools applied in the COVIDsmart study and share the preliminary study results. Methods: COVIDsmart conducted digital recruitment, e-Consent, and survey collection through a Health Insurance Portability and Accountability Act?compliant digital health platform. This is an alternative to the traditional in-person recruitment and onboarding method used for studies. Participants in Virginia were actively recruited over 3 months using widespread digital marketing strategies. Six months of data were collected remotely on participant demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education or work functioning, social or family functioning, and economic impact. Data were collected using validated questionnaires or surveys, completed in a cyclical fashion and reviewed by an expert panel. To retain a high level of engagement throughout the study, participants were incentivized to stay enrolled and complete more surveys to further their chances of receiving a monthly gift card and one of multiple grand prizes. Results: Virtual recruitment demonstrated relatively high rates of interest in Virginia (N=3737), and 782 (21.1%) consented to participate in the study. The most successful recruitment technique was the effective use of newsletters or emails (n=326, 41.7%). The primary reason for contributing as a study participant was advancing research (n=625, 79.9%), followed by the need to give back to their community (n=507, 64.8%). Incentives were only reported as a reason among 21% (n=164) of the consented participants. Overall, the primary reason for contributing as a study participant was attributed to altruism at 88.6% (n=693). Conclusions: The COVID-19 pandemic has accelerated the need for digital transformation in research. COVIDsmart is a statewide prospective cohort to study the impact of COVID-19 on Virginians' social, physical, and mental health. The study design, project management, and collaborative efforts led to the development of effective digital recruitment, enrollment, and data collection strategies to evaluate the pandemic?s effects on a large, diverse population. These findings may inform effective recruitment techniques across diverse communities and participants' interest in remote digital health studies. UR - https://formative.jmir.org/2023/1/e37550 UR - http://dx.doi.org/10.2196/37550 UR - http://www.ncbi.nlm.nih.gov/pubmed/36795656 ID - info:doi/10.2196/37550 ER - TY - JOUR AU - Shah, B. Ami AU - Oyegun, Eghosa AU - Hampton, Brett William AU - Neri, Antonio AU - Maddox, Nicole AU - Raso, Danielle AU - Sandhu, Paramjit AU - Patel, Anita AU - Koonin, M. Lisa AU - Lee, Leslie AU - Roper, Lauren AU - Whitfield, Geoffrey AU - Siegel, A. David AU - Koumans, H. Emily PY - 2023/3/10 TI - Engagement With the Centers for Disease Control and Prevention Coronavirus Self-Checker and Guidance Provided to Users in the United States From March 23, 2020, to April 19, 2021: Thematic and Trend Analysis JO - J Med Internet Res SP - e39054 VL - 25 KW - COVID-19 KW - automated symptom checker KW - Self-Checker KW - triage KW - medical care KW - online information seeking KW - clinical assessment tool N2 - Background: In 2020, at the onset of the COVID-19 pandemic, the United States experienced surges in healthcare needs, which challenged capacity throughout the healthcare system. Stay-at-home orders in many jurisdictions, cancellation of elective procedures, and closures of outpatient medical offices disrupted patient access to care. To inform symptomatic persons about when to seek care and potentially help alleviate the burden on the healthcare system, Centers for Disease Control and Prevention (CDC) and partners developed the CDC Coronavirus Self-Checker (?Self-Checker?). This interactive tool assists individuals seeking information about COVID-19 to determine the appropriate level of care by asking demographic, clinical, and nonclinical questions during an online ?conversation.? Objective: This paper describes user characteristics, trends in use, and recommendations delivered by the Self-Checker between March 23, 2020, and April 19, 2021, for pursuing appropriate levels of medical care depending on the severity of user symptoms. Methods: User characteristics and trends in completed conversations that resulted in a care message were analyzed. Care messages delivered by the Self-Checker were manually classified into three overarching conversation themes: (1) seek care immediately; (2) take no action, or stay home and self-monitor; and (3) conversation redirected. Trends in 7-day averages of conversations and COVID-19 cases were examined with development and marketing milestones that potentially impacted Self-Checker user engagement. Results: Among 16,718,667 completed conversations, the Self-Checker delivered recommendations for 69.27% (n=11,580,738) of all conversations to ?take no action, or stay home and self-monitor?; 28.8% (n=4,822,138) of conversations to ?seek care immediately?; and 1.89% (n=315,791) of conversations were redirected to other resources without providing any care advice. Among 6.8 million conversations initiated for self-reported sick individuals without life-threatening symptoms, 59.21% resulted in a recommendation to ?take no action, or stay home and self-monitor.? Nearly all individuals (99.8%) who were not sick were also advised to ?take no action, or stay home and self-monitor.? Conclusions: The majority of Self-Checker conversations resulted in advice to take no action, or stay home and self-monitor. This guidance may have reduced patient volume on the medical system; however, future studies evaluating patients? satisfaction, intention to follow the care advice received, course of action, and care modality pursued could clarify the impact of the Self-Checker and similar tools during future public health emergencies. UR - https://www.jmir.org/2023/1/e39054 UR - http://dx.doi.org/10.2196/39054 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745776 ID - info:doi/10.2196/39054 ER - TY - JOUR AU - Wang, Yi AU - Fu, Peipei AU - Li, Jie AU - Gao, Tingting AU - Jing, Zhengyue AU - Wang, Qiong AU - Zhao, Dan AU - Zhou, Chengchao PY - 2023/3/9 TI - 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 JO - JMIR Public Health Surveill SP - e43762 VL - 9 KW - psychological distress KW - frailty KW - multimorbidity KW - community-level social support KW - COVID-19 pandemic KW - psychological KW - rural KW - older adults KW - community KW - support KW - effectiveness N2 - 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 (?=.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 (?=.32, 95% CI 0.22-0.43, P<.001). Further, CSS moderated the aforementioned association (?=?.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 (?=?.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. UR - https://publichealth.jmir.org/2023/1/e43762 UR - http://dx.doi.org/10.2196/43762 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811848 ID - info:doi/10.2196/43762 ER - TY - JOUR AU - Nguyen, Vincent AU - Liu, Yunzhe AU - Mumford, Richard AU - Flanagan, Benjamin AU - Patel, Parth AU - Braithwaite, Isobel AU - Shrotri, Madhumita AU - Byrne, Thomas AU - Beale, Sarah AU - Aryee, Anna AU - Fong, Erica Wing Lam AU - Fragaszy, Ellen AU - Geismar, Cyril AU - Navaratnam, D. Annalan M. AU - Hardelid, Pia AU - Kovar, Jana AU - Pope, Addy AU - Cheng, Tao AU - Hayward, Andrew AU - Aldridge, Robert AU - PY - 2023/3/8 TI - 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 JO - JMIR Public Health Surveill SP - e38072 VL - 9 KW - COVID-19 KW - SARS-CoV-2 KW - vaccination KW - global positioning system KW - GPS KW - movement tracking KW - geographical tracking KW - mobile app KW - health application KW - surveillance KW - public health KW - mHealth KW - mobile surveillance KW - tracking device KW - geolocation N2 - 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. UR - https://publichealth.jmir.org/2023/1/e38072 UR - http://dx.doi.org/10.2196/38072 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884272 ID - info:doi/10.2196/38072 ER - TY - JOUR AU - Elkin, A. Javier AU - McDowell, Michelle AU - Yau, Brian AU - Machiri, Varaidzo Sandra AU - Pal, Shanthi AU - Briand, Sylvie AU - Muneene, Derrick AU - Nguyen, Tim AU - Purnat, D. Tina PY - 2023/3/8 TI - The Good Talk! A Serious Game to Boost People?s Competence to Have Open Conversations About COVID-19: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e40753 VL - 12 KW - vaccine hesitancy KW - communication KW - serious game KW - conversation skills KW - self-efficacy KW - behavioral intentions KW - COVID-19 N2 - Background: Vaccine hesitancy is one of the many factors impeding efforts to control the COVID-19 pandemic. Exacerbated by the COVID-19 infodemic, misinformation has undermined public trust in vaccination, led to greater polarization, and resulted in a high social cost where close social relationships have experienced conflict or disagreements about the public health response. Objective: The purpose of this paper is to describe the theory behind the development of a digital behavioral science intervention?The Good Talk!?designed to target vaccine-hesitant individuals through their close contacts (eg, family, friends, and colleagues) and to describe the methodology of a research study to evaluate its efficacy. Methods: The Good Talk! uses an educational serious game approach to boost the skills and competences of vaccine advocates to have open conversations about COVID-19 with their close contacts who are vaccine hesitant. The game teaches vaccine advocates evidence-based open conversation skills to help them speak with individuals who have opposing points of view or who may ascribe to nonscientifically supported beliefs while retaining trust, identifying common ground, and fostering acceptance and respect of divergent views. The game is currently under development and will be available on the web, free to access for participants worldwide, and accompanied by a promotional campaign to recruit participants through social media channels. This protocol describes the methodology for a randomized controlled trial that will compare participants who play The Good Talk! game with a control group that plays the widely known noneducational game Tetris. The study will evaluate a participant?s open conversation skills, self-efficacy, and behavioral intentions to have an open conversation with a vaccine-hesitant individual both before and after game play. Results: Recruitment will commence in early 2023 and will cease once 450 participants complete the study (225 per group). The primary outcome is improvement in open conversation skills. Secondary outcomes are self-efficacy and behavioral intentions to have an open conversation with a vaccine-hesitant individual. Exploratory analyses will examine the effect of the game on implementation intentions as well as potential covariates or subgroup differences based on sociodemographic information or previous experiences with COVID-19 vaccination conversations. Conclusions: The outcome of the project is to promote more open conversations regarding COVID-19 vaccination. We hope that our approach will encourage more governments and public health experts to engage in their mission to reach their citizens directly with digital health solutions and to consider such interventions as an important tool in infodemic management. International Registered Report Identifier (IRRID): PRR1-10.2196/40753 UR - https://www.researchprotocols.org/2023/1/e40753 UR - http://dx.doi.org/10.2196/40753 UR - http://www.ncbi.nlm.nih.gov/pubmed/36884269 ID - info:doi/10.2196/40753 ER - TY - JOUR AU - Chong, Chun Ka AU - Li, Kehang AU - Guo, Zihao AU - Jia, Min Katherine AU - Leung, Man Eman Yee AU - Zhao, Shi AU - Hung, Tim Chi AU - Yam, Kwan Carrie Ho AU - Chow, Yu Tsz AU - Dong, Dong AU - Wang, Huwen AU - Wei, Yuchen AU - Yeoh, Kiong Eng PY - 2023/3/7 TI - Dining-Out Behavior as a Proxy for the Superspreading Potential of SARS-CoV-2 Infections: Modeling Analysis JO - JMIR Public Health Surveill SP - e44251 VL - 9 KW - COVID-19 KW - contact tracing KW - unlinked KW - superspreading KW - dispersion KW - public health KW - surveillance KW - digital health surveillance KW - digital surveillance KW - disease spread N2 - 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 (?R-sq=9.7%, 95% credible interval: 5.7% to 13.2%) and Rt (?R-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. UR - https://publichealth.jmir.org/2023/1/e44251 UR - http://dx.doi.org/10.2196/44251 UR - http://www.ncbi.nlm.nih.gov/pubmed/36811849 ID - info:doi/10.2196/44251 ER - TY - JOUR AU - Wong, Chi-Sang Martin AU - Huang, Junjie AU - Wong, Yuet-Yan AU - Wong, Lai-Hung Grace AU - Yip, Cheuk-Fung Terry AU - Chan, Ngan-Yin Rachel AU - Chau, Wai-Ho Steven AU - Ng, Siew-Chien AU - Wing, Yun-Kwok AU - Chan, Ka-Leung Francis PY - 2023/3/7 TI - Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study JO - JMIR Public Health Surveill SP - e42315 VL - 9 KW - COVID-19 KW - epidemiology KW - symptom KW - risk factor KW - long COVID KW - multicenter survey KW - general population N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42315 UR - http://dx.doi.org/10.2196/42315 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645453 ID - info:doi/10.2196/42315 ER - TY - JOUR AU - Taube, C. Juliana AU - Susswein, Zachary AU - Bansal, Shweta PY - 2023/3/6 TI - Spatiotemporal Trends in Self-Reported Mask-Wearing Behavior in the United States: Analysis of a Large Cross-sectional Survey JO - JMIR Public Health Surveill SP - e42128 VL - 9 KW - COVID-19 KW - face mask KW - nonpharmaceutical interventions KW - spatiotemporal KW - United States KW - survey bias KW - survey KW - US KW - behavior KW - effectiveness KW - disease KW - decision-making KW - community KW - surveillance N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42128 UR - http://dx.doi.org/10.2196/42128 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877548 ID - info:doi/10.2196/42128 ER - TY - JOUR AU - Marston, Ramsden Hannah AU - Ko, Pei-Chun AU - Girishan Prabhu, Vishnunarayan AU - Freeman, Shannon AU - Ross, Christopher AU - Sharaievska, Iryna AU - Browning, HEM Matthew AU - Earle, Sarah AU - Ivan, Loredana AU - Kanozia, Rubal AU - Öztürk Çal?ko?lu, Halime AU - Arslan, Hasan AU - Bilir-Koca, Burcu AU - Alexandra Silva, Paula AU - Buttigieg, C. Sandra AU - Großschädl, Franziska AU - Schüttengruber, Gerhilde PY - 2023/3/6 TI - Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study JO - JMIR Ment Health SP - e41304 VL - 10 KW - COVID-19 KW - communication KW - gerontology KW - community living KW - technology KW - social media N2 - 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 UR - https://mental.jmir.org/2023/1/e41304 UR - http://dx.doi.org/10.2196/41304 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877558 ID - info:doi/10.2196/41304 ER - TY - JOUR AU - Huguet-Feixa, Agnes AU - Artigues-Barberà, Eva AU - Sol, Joaquim AU - Godoy, Pere AU - Ortega Bravo, Marta AU - PY - 2023/3/6 TI - Effects of the COVID-19 Pandemic on the Decision and Doubts About Vaccination in Catalonia: Online Cross-sectional Questionnaire JO - JMIR Form Res SP - e41799 VL - 7 KW - COVID-19 KW - vaccines KW - vaccine hesitancy KW - anti-vaccine KW - decision-making KW - disease KW - questionnaire KW - electronic KW - pandemic KW - vaccination N2 - Background: Hesitancy to get vaccinated during the COVID-19 pandemic may decrease vaccination coverage and facilitate the occurrence of local or global outbreaks. Objective: The objective of this study was to analyze the impact of the COVID-19 pandemic in Catalonia on 3 aspects: the decision to get vaccinated against COVID-19, changes in opinion about vaccination in general, and the decision to get vaccinated against other diseases. Methods: We performed an observational study with the population of Catalonia aged 18 years or over, obtaining information through a self-completed questionnaire in electronic format. Differences between groups were determined using the chi-square test, Mann-Whitney U test, or the Student t test. Results: We analyzed the answers from 1188 respondents, of which 870 were women, 47.0% (558/1187) had sons or daughters under the age of 14 years, and 71.7% (852/1188) had studied at university. Regarding vaccination, 16.3% (193/1187) stated that they had refused a vaccine on some occasion, 76.3% (907/1188) totally agreed with vaccines, 1.9% (23/1188) were indifferent, and 3.5% (41/1188) and 1.2% (14/1188) slightly or totally disagreed with vaccination, respectively. As a result of the pandemic, 90.8% (1069/1177) stated that they would get vaccinated against COVID-19 when they are asked, while 9.2% (108/1177) stated the opposite. A greater intention to get vaccinated was observed among women; people older than 50 years; people without children under 15 years of age; people with beliefs, culture, or family in favor of vaccination; respondents who had not previously rejected other vaccines, were totally in favor of vaccines, or had not increased their doubts about vaccination; and respondents who had not changed their decision about vaccines as a result of the pandemic. Finally, 30.3% (359/1183) reported an increase in their doubts regarding vaccination, and 13.0% (154/1182) stated that they had changed their decision about routinely recommended vaccines as a result of the pandemic. Conclusions: The population studied was predominantly in favor of vaccination; however, the percentage of people specifically rejecting vaccination against COVID-19 was high. As a result of the pandemic, we detected an increase in doubts about vaccines. Although the final decision about vaccination did not primarily change, some of the respondents did change their opinion about routine vaccinations. This seed of doubt about vaccines may be worrisome as we aim to maintain high vaccination coverage. UR - https://formative.jmir.org/2023/1/e41799 UR - http://dx.doi.org/10.2196/41799 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877561 ID - info:doi/10.2196/41799 ER - TY - JOUR AU - Weger, Rachel AU - Lossio-Ventura, Antonio Juan AU - Rose-McCandlish, Margaret AU - Shaw, S. Jacob AU - Sinclair, Stephen AU - Pereira, Francisco AU - Chung, Y. Joyce AU - Atlas, Yvette Lauren PY - 2023/3/1 TI - Trends in Language Use During the COVID-19 Pandemic and Relationship Between Language Use and Mental Health: Text Analysis Based on Free Responses From a Longitudinal Study JO - JMIR Ment Health SP - e40899 VL - 10 KW - COVID-19 KW - mental health KW - natural language processing KW - sentiment analysis KW - free response KW - qualitative KW - text analysis KW - mental illness KW - text KW - mental state KW - language KW - pandemic KW - age KW - education N2 - Background: The COVID-19 pandemic and its associated restrictions have been a major stressor that has exacerbated mental health worldwide. Qualitative data play a unique role in documenting mental states through both language features and content. Text analysis methods can provide insights into the associations between language use and mental health and reveal relevant themes that emerge organically in open-ended responses. Objective: The aim of this web-based longitudinal study on mental health during the early COVID-19 pandemic was to use text analysis methods to analyze free responses to the question, ?Is there anything else you would like to tell us that might be important that we did not ask about?? Our goals were to determine whether individuals who responded to the item differed from nonresponders, to determine whether there were associations between language use and psychological status, and to characterize the content of responses and how responses changed over time. Methods: A total of 3655 individuals enrolled in the study were asked to complete self-reported measures of mental health and COVID-19 pandemic?related questions every 2 weeks for 6 months. Of these 3655 participants, 2497 (68.32%) provided at least 1 free response (9741 total responses). We used various text analysis methods to measure the links between language use and mental health and to characterize response themes over the first year of the pandemic. Results: Response likelihood was influenced by demographic factors and health status: those who were male, Asian, Black, or Hispanic were less likely to respond, and the odds of responding increased with age and education as well as with a history of physical health conditions. Although mental health treatment history did not influence the overall likelihood of responding, it was associated with more negative sentiment, negative word use, and higher use of first-person singular pronouns. Responses were dynamically influenced by psychological status such that distress and loneliness were positively associated with an individual?s likelihood to respond at a given time point and were associated with more negativity. Finally, the responses were negative in valence overall and exhibited fluctuations linked with external events. The responses covered a variety of topics, with the most common being mental health and emotion, social or physical distancing, and policy and government. Conclusions: Our results identify trends in language use during the first year of the pandemic and suggest that both the content of responses and overall sentiments are linked to mental health. UR - https://mental.jmir.org/2023/1/e40899 UR - http://dx.doi.org/10.2196/40899 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525362 ID - info:doi/10.2196/40899 ER - TY - JOUR AU - Liang, Elisa AU - Kutok, R. Emily AU - Rosen, K. Rochelle AU - Burke, A. Taylor AU - Ranney, L. Megan PY - 2023/2/23 TI - Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents JO - JMIR Ment Health SP - e37711 VL - 10 KW - social media KW - adolescents KW - COVID-19 KW - emotions KW - connectivity N2 - Background: The COVID-19 pandemic provided a unique opportunity to examine social media and technology use during a time in which technology served as adolescents? primary form of socialization. The literature is mixed regarding how increased screen time during this period affected adolescent mental health and well-being. The mechanisms by which screen time use affected adolescent psychosocial outcomes are also unknown. Objective: We aimed to deepen our understanding of how social media and technology use, social connectivity, and emotional well-being intersected during pandemic-related school closures. Methods: English-speaking adolescents aged 13 to 17 years were recruited on Instagram for a brief screening survey; 39 participants were purposefully selected to complete a semistructured interview regarding their social media and technology use during the pandemic. Interview summaries were abstracted from recordings, and deductive codes were created for the primary question stems. These codes were subsequently reviewed for the main themes. Results: The main themes were as follows: adolescent social media and technology use during school closures usually allowed for more and easier social connectivity, but the amount and relative ease of connectivity differed according to purpose and type of use. Emotions, particularly those of stress and happiness, were connected to whether adolescents actively or passively engaged with social media and technology. Conclusions: Our results suggest a nuanced relationship among social media and technology use, adolescent social support, and emotional well-being, including during the pandemic. Specifically, how adolescents use or engage with web-based platforms greatly influences their ability to connect with others and their feelings of stress and happiness. In the context of the COVID-19 pandemic and as technology in general remains at the core of the adolescent experience, future research should continue to examine how adolescents navigate and use web-based spaces in beneficial and harmful ways. This will inform education and interventions that foster healthy social media and technological habits. UR - https://mental.jmir.org/2023/1/e37711 UR - http://dx.doi.org/10.2196/37711 UR - http://www.ncbi.nlm.nih.gov/pubmed/36054613 ID - info:doi/10.2196/37711 ER - TY - JOUR AU - Cellai, Michele AU - Roberts, Jodi AU - Moore, A. Miranda AU - Gandrakota, Nikhila PY - 2023/2/23 TI - Clinical Outcomes After Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: Retrospective Chart Review JO - JMIR Form Res SP - e36023 VL - 7 KW - COVID-19 KW - lung KW - post-acute sequela KW - steroid use KW - ICS KW - pandemic KW - therapy KW - treatment KW - steroid treatment KW - COVID-19 treatment KW - patient outcome KW - pulmonary KW - COVID symptoms KW - telehealth N2 - 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. UR - https://formative.jmir.org/2023/1/e36023 UR - http://dx.doi.org/10.2196/36023 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480687 ID - info:doi/10.2196/36023 ER - TY - JOUR AU - Shin, Hyerine AU - Kim, Ji-Su AU - Lee, HyunHae PY - 2023/2/22 TI - Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study JO - JMIR Public Health Surveill SP - e42677 VL - 9 KW - COVID-19 KW - precautionary behaviors KW - COVID-19 fear KW - health behavior deterioration KW - gender differences N2 - 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. UR - https://publichealth.jmir.org/2023/1/e42677 UR - http://dx.doi.org/10.2196/42677 UR - http://www.ncbi.nlm.nih.gov/pubmed/36716130 ID - info:doi/10.2196/42677 ER - TY - JOUR AU - Yang, Le AU - Wu, Jiadong AU - Mo, Xiaoxiao AU - Chen, Yaqin AU - Huang, Shanshan AU - Zhou, Linlin AU - Dai, Jiaqi AU - Xie, Linna AU - Chen, Siyu AU - Shang, Hao AU - Rao, Beibei AU - Weng, Bingtao AU - Abulimiti, Ayiguli AU - Wu, Siying AU - Xie, Xiaoxu PY - 2023/2/22 TI - Changes in Mobile Health Apps Usage Before and After the COVID-19 Outbreak in China: Semilongitudinal Survey JO - JMIR Public Health Surveill SP - e40552 VL - 9 KW - application KW - China KW - COVID-19 KW - mHealth KW - health management KW - mobile health KW - technology KW - app KW - survey KW - data KW - user KW - user experience KW - vaccination KW - download KW - healthcare KW - development N2 - Background: Mobile health (mHealth) apps are rapidly emerging technologies in China due to strictly controlled medical needs during the COVID-19 pandemic while continuing essential services for chronic diseases. However, there have been no large-scale, systematic efforts to evaluate relevant apps. Objective: We aim to provide a landscape of mHealth apps in China by describing and comparing digital health concerns before and after the COVID-19 outbreak, including mHealth app data flow and user experience, and analyze the impact of COVID-19 on mHealth apps. Methods: We conducted a semilongitudinal survey of 1593 mHealth apps to study the app data flow and clarify usage changes and influencing factors. We selected mHealth apps in app markets, web pages from the Baidu search engine, the 2018 top 100 hospitals with internet hospitals, and online shopping sites with apps that connect to smart devices. For user experience, we recruited residents from a community in southeastern China from October 2019 to November 2019 (before the outbreak) and from June 2020 to August 2020 (after the outbreak) comparing the attention of the population to apps. We also examined associations between app characteristics, functions, and outcomes at specific quantiles of distribution in download changes using quantile regression models. Results: Rehabilitation medical support was the top-ranked functionality, with a median 1.44 million downloads per app prepandemic and a median 2.74 million downloads per app postpandemic. Among the top 10 functions postpandemic, 4 were related to maternal and child health: pregnancy preparation (ranked second; fold change 4.13), women's health (ranked fifth; fold change 5.16), pregnancy (ranked sixth; fold change 5.78), and parenting (ranked tenth; fold change 4.03). Quantile regression models showed that rehabilitation (P75, P90), pregnancy preparation (P90), bodybuilding (P50, P90), and vaccination (P75) were positively associated with an increase in downloads after the outbreak. In the user experience survey, the attention given to health information (prepandemic: 249/375, 66.4%; postpandemic: 146/178, 82.0%; P=.006) steadily increased after the outbreak. Conclusions: mHealth apps are an effective health care approach gaining in popularity among the Chinese population following the COVID-19 outbreak. This research provides direction for subsequent mHealth app development and promotion in the postepidemic era, supporting medical model reformation in China as a reference, which may provide new avenues for designing and evaluating indirect public health interventions such as health education and health promotion. UR - https://publichealth.jmir.org/2023/1/e40552 UR - http://dx.doi.org/10.2196/40552 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634256 ID - info:doi/10.2196/40552 ER - TY - JOUR AU - Yamada, Yosuke AU - Namba, Hideyuki AU - Date, Heiwa AU - Kitayama, Shinobu AU - Nakayama, Yui AU - Kimura, Misaka AU - Fujita, Hiroyuki AU - Miyachi, Motohiko PY - 2023/2/20 TI - 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 JO - JMIR Public Health Surveill SP - e39992 VL - 9 KW - web-based survey KW - social distancing measure KW - transportation KW - physical activity record system KW - physical activity KW - sedentary KW - sleep KW - sleeping time KW - COVID-19 KW - impact KW - pandemic KW - sleeping pattern KW - surveillance KW - demographic KW - regional KW - differences N2 - 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. UR - https://publichealth.jmir.org/2023/1/e39992 UR - http://dx.doi.org/10.2196/39992 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634262 ID - info:doi/10.2196/39992 ER - TY - JOUR AU - Wilhelm, Elisabeth AU - Ballalai, Isabella AU - Belanger, Marie-Eve AU - Benjamin, Peter AU - Bertrand-Ferrandis, Catherine AU - Bezbaruah, Supriya AU - Briand, Sylvie AU - Brooks, Ian AU - Bruns, Richard AU - Bucci, M. Lucie AU - Calleja, Neville AU - Chiou, Howard AU - Devaria, Abhinav AU - Dini, Lorena AU - D'Souza, Hyjel AU - Dunn, G. Adam AU - Eichstaedt, C. Johannes AU - Evers, A. Silvia M. A. AU - Gobat, Nina AU - Gissler, Mika AU - Gonzales, Christian Ian AU - Gruzd, Anatoliy AU - Hess, Sarah AU - Ishizumi, Atsuyoshi AU - John, Oommen AU - Joshi, Ashish AU - Kaluza, Benjamin AU - Khamis, Nagwa AU - Kosinska, Monika AU - Kulkarni, Shibani AU - Lingri, Dimitra AU - Ludolph, Ramona AU - Mackey, Tim AU - Mandi?-Raj?evi?, Stefan AU - Menczer, Filippo AU - Mudaliar, Vijaybabu AU - Murthy, Shruti AU - Nazakat, Syed AU - Nguyen, Tim AU - Nilsen, Jennifer AU - Pallari, Elena AU - Pasternak Taschner, Natalia AU - Petelos, Elena AU - Prinstein, J. Mitchell AU - Roozenbeek, Jon AU - Schneider, Anton AU - Srinivasan, Varadharajan AU - Stevanovi?, Aleksandar AU - Strahwald, Brigitte AU - Syed Abdul, Shabbir AU - Varaidzo Machiri, Sandra AU - van der Linden, Sander AU - Voegeli, Christopher AU - Wardle, Claire AU - Wegwarth, Odette AU - White, K. Becky AU - Willie, Estelle AU - Yau, Brian AU - Purnat, D. Tina PY - 2023/2/20 TI - Measuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference JO - JMIR Infodemiology SP - e44207 VL - 3 KW - COVID-19 KW - infodemic KW - burden of infodemic KW - infodemic management KW - infodemic metrics KW - World Health Organization KW - technical consultation KW - infodemiology N2 - Background: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. Objective: In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. Methods: An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health?implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. Results: The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. Conclusions: Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers. UR - https://infodemiology.jmir.org/2023/1/e44207 UR - http://dx.doi.org/10.2196/44207 UR - http://www.ncbi.nlm.nih.gov/pubmed/37012998 ID - info:doi/10.2196/44207 ER - TY - JOUR AU - Montiel Ishino, Alejandro Francisco AU - Villalobos, Kevin AU - Williams, Faustine PY - 2023/2/17 TI - Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study JO - JMIR Public Health Surveill SP - e38163 VL - 9 KW - substance use KW - COVID-19 KW - US nativity N2 - 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. UR - https://publichealth.jmir.org/2023/1/e38163 UR - http://dx.doi.org/10.2196/38163 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265162 ID - info:doi/10.2196/38163 ER - TY - JOUR AU - Li, Qingfeng AU - Peng, Cheng James AU - Mohan, Diwakar AU - Lake, Brennan AU - Euler, Ruiz Alex AU - Weir, Brian AU - Kan, Lena AU - Yang, Cui AU - Labrique, Alain PY - 2023/2/16 TI - Using Location Intelligence to Evaluate the COVID-19 Vaccination Campaign in the United States: Spatiotemporal Big Data Analysis JO - JMIR Public Health Surveill SP - e39166 VL - 9 KW - COVID-19 vaccine KW - vaccine campaign KW - big data KW - vaccination KW - vaccine KW - COVID-19 KW - uptake KW - effectiveness KW - barriers KW - hesitancy KW - health information N2 - Background: Highly effective COVID-19 vaccines are available and free of charge in the United States. With adequate coverage, their use may help return life back to normal and reduce COVID-19?related hospitalization and death. Many barriers to widespread inoculation have prevented herd immunity, including vaccine hesitancy, lack of vaccine knowledge, and misinformation. The Ad Council and COVID Collaborative have been conducting one of the largest nationwide targeted campaigns (?It?s Up to You?) to communicate vaccine information and encourage timely vaccination across the United States. More than 300 major brands, digital and print media companies, and community-based organizations support the campaigns to reach distinct audiences. Objective: The goal of this study was to use aggregated mobility data to assess the effectiveness of the campaign on COVID-19 vaccine uptake. Methods: Campaign exposure data were collected from the Cuebiq advertising impact measurement platform consisting of about 17 million opted-in and deidentified mobile devices across the country. A Bayesian spatiotemporal hierarchical model was developed to assess campaign effectiveness through estimating the association between county-level campaign exposure and vaccination rates reported by the Centers for Disease Control and Prevention. To minimize potential bias in exposure to the campaign, the model included several control variables (eg, age, race or ethnicity, income, and political affiliation). We also incorporated conditional autoregressive residual models to account for apparent spatiotemporal autocorrelation. Results: The data set covers a panel of 3104 counties from 48 states and the District of Columbia during a period of 22 weeks (March 29 to August 29, 2021). Officially launched in February 2021, the campaign reached about 3% of the anonymous devices on the Cuebiq platform by the end of March, which was the start of the study period. That exposure rate gradually declined to slightly above 1% in August 2021, effectively ending the study period. Results from the Bayesian hierarchical model indicate a statistically significant positive association between campaign exposure and vaccine uptake at the county level. A campaign that reaches everyone would boost the vaccination rate by 2.2% (95% uncertainty interval: 2.0%-2.4%) on a weekly basis, compared to the baseline case of no campaign. Conclusions: The ?It?s Up to You? campaign is effective in promoting COVID-19 vaccine uptake, suggesting that a nationwide targeted mass media campaign with multisectoral collaborations could be an impactful health communication strategy to improve progress against this and future pandemics. Methodologically, the results also show that location intelligence and mobile phone?based monitoring platforms can be effective in measuring impact of large-scale digital campaigns in near real time. UR - https://publichealth.jmir.org/2023/1/e39166 UR - http://dx.doi.org/10.2196/39166 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626835 ID - info:doi/10.2196/39166 ER - TY - JOUR AU - Aolymat, Iman AU - Abdul Kadir, Lina AU - Al Nsour, Mohannad AU - Taha, Hana PY - 2023/2/16 TI - The Impact of the COVID-19 Pandemic on Female Sexual Function in Jordan: Cross-sectional Study JO - JMIR Form Res SP - e40772 VL - 7 KW - COVID-19 KW - pandemic KW - female sexual function KW - sexual dysfunction KW - stress physiology KW - Jordan N2 - Background: Sexual function is a complex physiological process controlled by neurovascular and endocrine mechanisms that are affected by stressful events. The sexual response cycle consists of four main phases, which are sexual desire or libido, arousal or excitement, orgasm, and resolution. The COVID-19 outbreak is one of the most stressful events historically, causing several unpleasant consequences, including major physical and mental disorders, and sexual dysfunction and alteration in sexual behavior are possible anticipated consequences of the pandemic. Moreover, there are social taboos related to sexual behavior in Jordan, and the current knowledge on changes in Jordanian female sexual function during COVID-19 pandemic is limited. Objective: This study aims to evaluate the impact of COVID?19 on women's sexual function during the early COVID-19 pandemic in Jordan. Methods: This is a cross-sectional study that employed a web-based survey to follow 200 female individuals from the general population in Jordan. The survey evaluated sexual function both during COVID-19 and 6 months prior to the pandemic. The primary outcomes investigated in this study were the changes in sexual intercourse frequency and sexual function aspects, including desire, arousal, satisfaction, orgasm, lubrication, and pain during sexual activity. Data were analyzed using paired t test, McNemar test, Pearson correlations, and multiple linear regression using SPSS 25. Results: During the COVID-19 pandemic, the participants? sexual intercourse frequency increased while their sexual satisfaction was significantly changed. The proportion of participants who had 0-2 times per week of sexual intercourse was decreased during the COVID-19 pandemic compared with that before the pandemic (n=90, 45% vs n=103, 51.5%; P=.02). Conversely, the number of female individuals with 3-7 times per week of sexual intercourse increased after the pandemic compared with the prepandemic state (n=103, 51.5% vs n=91, 45.5%; P=.04). Female sexual satisfaction was significantly reduced after the COVID-19 pandemic compared with that before the pandemic (3.39 vs 3.30; P=.049). The other categories of sexual function, including desire, arousal, satisfaction, orgasm, lubrication, and dyspareunia showed no significant changes during the COVID-19 pandemic compared with the previous 6 months. There were no significant differences between the total sexual function mean scores during COVID-19 (15.73) compared with the prepandemic scores (15.85; P=.41). The total score of female sexual function during the pandemic was negatively associated with the participants? age and education level. Correlations between various demographics and sexual function categories during the COVID-19 pandemic were identified. Conclusions: This is the first study exploring female sexual function during the COVID-19 outbreak in Jordan. The results suggest that COVID-19?associated stress is influencing women's sexual function, necessitating the provision of adequate emotional and physiological well-being support for women during similar crises. UR - https://formative.jmir.org/2023/1/e40772 UR - http://dx.doi.org/10.2196/40772 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745774 ID - info:doi/10.2196/40772 ER - TY - JOUR AU - Zhong, Shaoling AU - Yang, Xinhu AU - Pan, Zihua AU - Fan, Yu AU - Chen, Yanan AU - Yu, Xin AU - Zhou, Liang PY - 2023/2/13 TI - The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis JO - JMIR Public Health Surveill SP - e43730 VL - 9 KW - digital medicine KW - COVID-19 KW - mental health services KW - psychological well-being KW - COVID-19 pandemic N2 - Background: After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath. Objective: In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews. Results: This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=?0.49; 95% CI ?0.74 to ?0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=?0.66; 95% CI ?1.23 to ?1.0; P=.02) significantly. Conclusions: The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post?COVID-19 era. Trial Registration: PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym UR - https://publichealth.jmir.org/2023/1/e43730 UR - http://dx.doi.org/10.2196/43730 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634261 ID - info:doi/10.2196/43730 ER - TY - JOUR AU - Zang, Shujie AU - Zhang, Xu AU - Xing, Yuting AU - Chen, Jiaxian AU - Lin, Leesa AU - Hou, Zhiyuan PY - 2023/2/10 TI - Applications of Social Media and Digital Technologies in COVID-19 Vaccination: Scoping Review JO - J Med Internet Res SP - e40057 VL - 25 KW - social media KW - digital health KW - COVID-19 KW - vaccination KW - review N2 - Background: Social media and digital technologies have played essential roles in disseminating information and promoting vaccination during the COVID-19 pandemic. There is a need to summarize the applications and analytical techniques of social media and digital technologies in monitoring vaccine attitudes and administering COVID-19 vaccines. Objective: We aimed to synthesize the global evidence on the applications of social media and digital technologies in COVID-19 vaccination and to explore their avenues to promote COVID-19 vaccination. Methods: We searched 6 databases (PubMed, Scopus, Web of Science, Embase, EBSCO, and IEEE Xplore) for English-language articles from December 2019 to August 2022. The search terms covered keywords relating to social media, digital technology, and COVID-19 vaccines. Articles were included if they provided original descriptions of applications of social media or digital health technologies/solutions in COVID-19 vaccination. Conference abstracts, editorials, letters, commentaries, correspondence articles, study protocols, and reviews were excluded. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS tool) was used to evaluate the quality of social media?related studies. The review was undertaken with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Results: A total of 178 articles were included in our review, including 114 social media articles and 64 digital technology articles. Social media has been applied for sentiment/emotion analysis, topic analysis, behavioral analysis, dissemination and engagement analysis, and information quality analysis around COVID-19 vaccination. Of these, sentiment analysis and topic analysis were the most common, with social media data being primarily analyzed by lexicon-based and machine learning techniques. The accuracy and reliability of information on social media can seriously affect public attitudes toward COVID-19 vaccines, and misinformation often leads to vaccine hesitancy. Digital technologies have been applied to determine the COVID-19 vaccination strategy, predict the vaccination process, optimize vaccine distribution and delivery, provide safe and transparent vaccination certificates, and perform postvaccination surveillance. The applied digital technologies included algorithms, blockchain, mobile health, the Internet of Things, and other technologies, although with some barriers to their popularization. Conclusions: The applications of social media and digital technologies in addressing COVID-19 vaccination?related issues represent an irreversible trend. Attention should be paid to the ethical issues and health inequities arising from the digital divide while applying and promoting these technologies. UR - https://www.jmir.org/2023/1/e40057 UR - http://dx.doi.org/10.2196/40057 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649235 ID - info:doi/10.2196/40057 ER - TY - JOUR AU - Lemaire, Célia AU - Humbert, Christophe AU - Sueur, Cédric AU - Racin, Céline PY - 2023/2/10 TI - Use of Digital Technologies to Maintain Older Adults? Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review JO - JMIR Aging SP - e38593 VL - 6 KW - social isolation KW - COVID-19 pandemic KW - remote care KW - nursing homes KW - social ties KW - digital devices KW - older adults N2 - Background: Digital technologies were implemented to address the disruption of long-term care facility residents? socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents? social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents? perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 UR - https://aging.jmir.org/2023/1/e38593 UR - http://dx.doi.org/10.2196/38593 UR - http://www.ncbi.nlm.nih.gov/pubmed/36599164 ID - info:doi/10.2196/38593 ER - TY - JOUR AU - Catalano, Alberto AU - Dansero, Lucia AU - Gilcrease, Winston AU - Macciotta, Alessandra AU - Saugo, Carlo AU - Manfredi, Luca AU - Gnavi, Roberto AU - Strippoli, Elena AU - Zengarini, Nicolás AU - Caramello, Valeria AU - Costa, Giuseppe AU - Sacerdote, Carlotta AU - Ricceri, Fulvio PY - 2023/2/9 TI - Multimorbidity and SARS-CoV-2?Related Outcomes: Analysis of a Cohort of Italian Patients JO - JMIR Public Health Surveill SP - e41404 VL - 9 KW - multimorbidity KW - SARS-CoV-2 KW - mortality KW - intensive care unit KW - epidemiology KW - COVID-19 KW - pandemic KW - severity KW - cardiovascular KW - respiratory KW - disease KW - risk KW - public health KW - intervention N2 - Background: Since the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples. Objective: The objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab. Methods: Data were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years). Results: Of 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes. Conclusions: Our study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions. UR - https://publichealth.jmir.org/2023/1/e41404 UR - http://dx.doi.org/10.2196/41404 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626821 ID - info:doi/10.2196/41404 ER - TY - JOUR AU - Savira, Feby AU - Orellana, Liliana AU - Hensher, Martin AU - Gao, Lan AU - Sanigorski, Andrew AU - Mc Namara, Kevin AU - Versace, L. Vincent AU - Szakiel, John AU - Swann, Jamie AU - Manias, Elizabeth AU - Peeters, Anna PY - 2023/2/7 TI - Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis JO - J Med Internet Res SP - e39384 VL - 25 KW - telehealth KW - rural KW - Australia KW - COVID-19 KW - eHealth KW - primary care KW - general practitioner KW - GP KW - trend KW - pandemic KW - equity KW - video KW - virtual KW - consultation KW - telephone N2 - Background: In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic. Objective: This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia. Methods: We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed. Results: Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. Conclusions: Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations. UR - https://www.jmir.org/2023/1/e39384 UR - http://dx.doi.org/10.2196/39384 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649230 ID - info:doi/10.2196/39384 ER - TY - JOUR AU - Liu, Xu AU - Wu, Jing AU - Yang, Hongyang AU - Zhao, Fangjie AU - Qin, Yuchen AU - Wu, Jiali AU - Yan, Hongli AU - Xu, Yan AU - Zhang, Lulu PY - 2023/2/7 TI - Caregiver Perceptions of Children?s and Adolescents? Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study JO - JMIR Public Health Surveill SP - e43689 VL - 9 KW - COVID-19 exposure KW - psychosocial function KW - parenting KW - children and adolescents KW - China N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43689 UR - http://dx.doi.org/10.2196/43689 UR - http://www.ncbi.nlm.nih.gov/pubmed/36749625 ID - info:doi/10.2196/43689 ER - TY - JOUR AU - Tran, Xuan Bach AU - Do, Linh Anh AU - Boyer, Laurent AU - Auquier, Pascal AU - Le, Thi Huong AU - Le Vu, Ngoc Minh AU - Dang, Thi Trang Huyen AU - Cao, Minh Khuy AU - Le, Thi Linh Dieu AU - Cu, Ngoc Lam Tung AU - Ly, Viet Bang AU - Nguyen, Thi Duong Anh AU - Nguyen, Duc Manh AU - Latkin, A. Carl AU - Ho, M. Roger C. AU - Ho, H. Cyrus S. AU - Zhang, B. Melvyn W. PY - 2023/1/31 TI - Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e43055 VL - 9 KW - COVID-19 KW - epidemic KW - vaccine KW - booster KW - willingness to take KW - willingness to pay KW - Vietnam KW - policy KW - feasibility KW - acceptability KW - infection KW - vaccination KW - social media KW - intervention N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43055 UR - http://dx.doi.org/10.2196/43055 UR - http://www.ncbi.nlm.nih.gov/pubmed/36599156 ID - info:doi/10.2196/43055 ER - TY - JOUR AU - Sung, Sumi AU - Kim, Hwan Su AU - Lee, Changwoo AU - Kim, Youlim AU - Bae, Seul Ye AU - Chie, Kyu Eui PY - 2023/1/30 TI - 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 JO - JMIR Public Health Surveill SP - e43003 VL - 9 KW - COVID-19 KW - depression KW - anxiety KW - vital signs KW - symptoms KW - electronic health records N2 - 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. UR - https://publichealth.jmir.org/2023/1/e43003 UR - http://dx.doi.org/10.2196/43003 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645439 ID - info:doi/10.2196/43003 ER - TY - JOUR AU - Albayrak, Bilge AU - Cordier, Jane Larissa AU - Greve, Sandra AU - Teschler, Uta AU - Dathe, Anne-Kathrin AU - Felderhoff-Müser, Ursula AU - Hüning, Maria Britta PY - 2023/1/25 TI - Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study JO - JMIR Pediatr Parent SP - e40940 VL - 6 KW - COVID-19 KW - very preterm infant KW - video consultation KW - follow-up care KW - COVID-19 pandemic KW - neurodevelopmental outcome N2 - 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. UR - https://pediatrics.jmir.org/2023/1/e40940 UR - http://dx.doi.org/10.2196/40940 UR - http://www.ncbi.nlm.nih.gov/pubmed/36409307 ID - info:doi/10.2196/40940 ER - TY - JOUR AU - Boaventura, S. Viviane AU - Grave, Malú AU - Cerqueira-Silva, Thiago AU - Carreiro, Roberto AU - Pinheiro, Adélia AU - Coutinho, Alvaro AU - Barral Netto, Manoel PY - 2023/1/24 TI - Syndromic Surveillance Using Structured Telehealth Data: Case Study of the First Wave of COVID-19 in Brazil JO - JMIR Public Health Surveill SP - e40036 VL - 9 KW - telehealth KW - telemedicine KW - disease surveillance KW - mathematical model KW - COVID-19 KW - prediction KW - cases KW - detection KW - monitoring KW - surveillance KW - computational modeling KW - spread KW - transmission KW - disease KW - infectious diseases KW - syndromic N2 - 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. UR - https://publichealth.jmir.org/2023/1/e40036 UR - http://dx.doi.org/10.2196/40036 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692925 ID - info:doi/10.2196/40036 ER - TY - JOUR AU - Park, G. Linda AU - Meyer, L. Oanh AU - Dougan, M. Marcelle AU - Golden, Bethany AU - Ta, Kevin AU - Nam, Bora AU - Tsoh, Y. Janice AU - Tzuang, Marian AU - Park, Ta Van M. PY - 2023/1/23 TI - 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 JO - JMIR Public Health Surveill SP - e35748 VL - 9 KW - health disparities KW - mental health KW - depression KW - anxiety KW - social support technology KW - COVID-19 KW - pandemic KW - disparity KW - support KW - technology KW - physical health KW - race KW - survey KW - population KW - discrimination KW - outcome KW - AAPI N2 - 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. UR - https://publichealth.jmir.org/2023/1/e35748 UR - http://dx.doi.org/10.2196/35748 UR - http://www.ncbi.nlm.nih.gov/pubmed/36395324 ID - info:doi/10.2196/35748 ER - TY - JOUR AU - Wang, Zixin AU - Fang, Yuan AU - Chan, Shing-Fong Paul AU - Yu, Yuen Fuk AU - Sun, Fenghua PY - 2023/1/23 TI - The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys JO - JMIR Aging SP - e42223 VL - 6 KW - COVID-19 KW - physical activity KW - older adults KW - barriers KW - changes KW - repeated random telephone survey KW - China KW - aging KW - elderly population KW - community-dwelling older adults KW - health promotion KW - telehealth N2 - Background: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the ?postpandemic era.? Objective: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. Methods: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. Results: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6% vs 45.9%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. Conclusions: The level of PA increased significantly among older adults after Hong Kong entered the ?postpandemic era.? Different factors influenced older adults? PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. UR - https://aging.jmir.org/2023/1/e42223 UR - http://dx.doi.org/10.2196/42223 UR - http://www.ncbi.nlm.nih.gov/pubmed/36599172 ID - info:doi/10.2196/42223 ER - TY - JOUR AU - Hong, Chong Hye AU - Lee, Hyeonkyeong AU - Lee, Jeong Suk AU - Park, Chang AU - Lee, Mikyung PY - 2023/1/17 TI - The Determinants of Adherence to Public Health and Social Measures Against COVID-19 Among the General Population in South Korea: National Survey Study JO - JMIR Public Health Surveill SP - e35784 VL - 9 KW - COVID-19 KW - preventive measures KW - health literacy KW - trust KW - national survey KW - Tobit regression N2 - Background: The COVID-19 pandemic has created devastating health, social, economic, and political effects that will have long-lasting impacts. Public health efforts to reduce the spread of COVID-19 are the priority of national policies for responding to the pandemic globally. Public health and social measures (PHSMs) have been shown to be effective when used alone or in combination with other measures, reducing the risk of spreading COVID-19. However, there is insufficient evidence on the status of compliance with PHSMs in the general population for the prevention of COVID-19 in public areas, including Korea. Objective: The aim of this study was to assess levels of compliance with the recommended PHSMs against SARS-CoV-2 infection and their predictors among the general population by using national data. Methods: This study was a secondary data analysis of the National Survey of Infectious Disease Preventive Behaviors in Community, which was conducted by the Korea Centers for Disease Control and Prevention Agency (KDCA) between October 12 and October 30, 2020. The primary study was cross-sectional, using stratified sampling via an adjusted proportional allocation method to select representative samples and ensure the stability of samples. The data were collected through phone interviews conducted by trained enumerators using a structured questionnaire. PHSM adherence was measured using a 10-item comprehensive infectious disease prevention behavior (CIDPB) scale, and each sociocognitive factor, including perceived susceptibility to SARS-CoV-2 infection, perceived severity of SARS-CoV-2 infection, perceived confidence in performing preventive behaviors related to COVID-19, information comprehension ability, and trust in information from the KDCA, was measured. A total of 4003 participants were included in the final analysis. Tobit regression and a decision tree analysis were performed to identify the predictors of preventive measures and the target groups for intervention. Results: We discovered that women scored 1.34 points higher on the CIDPB scale than men (P<.001). Compared to the group aged 19 to 29 years, those aged 50 to 59 years and those older than 60 years scored 1.89 and 2.48 points higher on the CIDPB scale (P<.001), respectively. The perceived severity of infection, confidence in preventive behaviors, information comprehension ability, and trust in information from the KDCA were significant positive determinants of CIDPBs (P<.001). The perceived susceptibility to infection showed a significant negative relationship with CIDPBs (P<.001). Conclusions: Female sex, older age, lower income, and sociocognitive factors were found to be significant determinants of adhering to PHSMs. The findings suggest the need for tailored interventions for target groups; specifically, the age group that was the most active at work indicated the highest potential to spread infection. Adequate public health education and health communication for promoting adherence to PHSMs should be emphasized, and behavior change strategies for those with low perceived confidence in performing PHSMs should be prioritized. UR - https://publichealth.jmir.org/2023/1/e35784 UR - http://dx.doi.org/10.2196/35784 UR - http://www.ncbi.nlm.nih.gov/pubmed/36446132 ID - info:doi/10.2196/35784 ER - TY - JOUR AU - van Kessel, Robin AU - Kyriopoulos, Ilias AU - Wong, Han Brian Li AU - Mossialos, Elias PY - 2023/1/16 TI - The Effect of the COVID-19 Pandemic on Digital Health?Seeking Behavior: Big Data Interrupted Time-Series Analysis of Google Trends JO - J Med Internet Res SP - e42401 VL - 25 KW - digital health KW - healthcare seeking behaviour KW - big data KW - real-world data KW - data KW - COVID-19 KW - pandemic KW - Google Trends KW - telehealth N2 - Background: Due to the emergency responses early in the COVID-19 pandemic, the use of digital health in health care increased abruptly. However, it remains unclear whether this introduction was sustained in the long term, especially with patients being able to decide between digital and traditional health services once the latter regained their functionality throughout the COVID-19 pandemic. Objective: We aim to understand how the public interest in digital health changed as proxy for digital health?seeking behavior and to what extent this change was sustainable over time. Methods: We used an interrupted time-series analysis of Google Trends data with break points on March 11, 2020 (declaration of COVID-19 as a pandemic by the World Health Organization), and December 20, 2020 (the announcement of the first COVID-19 vaccines). Nationally representative time-series data from February 2019 to August 2021 were extracted from Google Trends for 6 countries with English as their dominant language: Canada, the United States, the United Kingdom, New Zealand, Australia, and Ireland. We measured the changes in relative search volumes of the keywords online doctor, telehealth, online health, telemedicine, and health app. In doing so, we capture the prepandemic trend, the immediate change due to the announcement of COVID-19 being a pandemic, and the gradual change after the announcement. Results: Digital health search volumes immediately increased in all countries under study after the announcement of COVID-19 being a pandemic. There was some variation in what keywords were used per country. However, searches declined after this immediate spike, sometimes reverting to prepandemic levels. The announcement of COVID-19 vaccines did not consistently impact digital health search volumes in the countries under study. The exception is the search volume of health app, which was observed as either being stable or gradually increasing during the pandemic. Conclusions: Our findings suggest that the increased public interest in digital health associated with the pandemic did not sustain, alluding to remaining structural barriers. Further building of digital health capacity and developing robust digital health governance frameworks remain crucial to facilitating sustainable digital health transformation. UR - https://www.jmir.org/2023/1/e42401 UR - http://dx.doi.org/10.2196/42401 UR - http://www.ncbi.nlm.nih.gov/pubmed/36603152 ID - info:doi/10.2196/42401 ER - TY - JOUR AU - Binka, Mawuena AU - Adu, Asumadu Prince AU - Jeong, Dahn AU - Vadlamudi, Khatri Nirma AU - Velásquez García, Alexander Héctor AU - Mahmood, Bushra AU - Buller-Taylor, Terri AU - Otterstatter, Michael AU - Janjua, Zafar Naveed PY - 2023/1/11 TI - The Impact of Mask Mandates on Face Mask Use During the COVID-19 Pandemic: Longitudinal Survey Study JO - JMIR Public Health Surveill SP - e42616 VL - 9 KW - face mask KW - face covering KW - COVID-19 KW - SARS-CoV-2 KW - outbreak KW - public health KW - health policy KW - trend analysis KW - logistic regression N2 - Background: Face mask use has been associated with declines in COVID-19 incidence rates worldwide. A handful of studies have examined the factors associated with face mask use in North America during the COVID-19 pandemic; however, much less is known about the patterns of face mask use and the impact of mask mandates during this time. This information could have important policy implications, now and in the event of future pandemics. Objective: To address existing knowledge gaps, we assessed face mask usage patterns among British Columbia COVID-19 Population Mixing Patterns (BC-Mix) survey respondents and evaluated the impact of the provincial mask mandate on these usage patterns. Methods: Between September 2020 and July 2022, adult British Columbia residents completed the web-based BC-Mix survey, answering questions on the circumstances surrounding face mask use or lack thereof, movement patterns, and COVID-19?related beliefs. Trends in face mask use over time were assessed, and associated factors were evaluated using multivariable logistic regression. A stratified analysis was done to examine effect modification by the provincial mask mandate. Results: Of the 44,301 respondents, 81.9% reported wearing face masks during the 23-month period. In-store and public transit mask mandates supported monthly face mask usage rates of approximately 80%, which was further bolstered up to 92% with the introduction of the provincial mask mandate. Face mask users mostly visited retail locations (51.8%) and travelled alone by car (49.6%), whereas nonusers mostly traveled by car with others (35.2%) to their destinations?most commonly parks (45.7%). Nonusers of face masks were much more likely to be male than female, especially in retail locations and restaurants, bars, and cafés. In a multivariable logistic regression model adjusted for possible confounders, factors associated with face mask use included age, ethnicity, health region, mode of travel, destination, and time period. The odds of face mask use were 3.68 times greater when the provincial mask mandate was in effect than when it was not (adjusted odds ratio [aOR] 3.68, 95% CI 3.33-4.05). The impact of the mask mandate was greatest in restaurants, bars, or cafés (mandate: aOR 7.35, 95% CI 4.23-12.78 vs no mandate: aOR 2.81, 95% CI 1.50-5.26) and in retail locations (mandate: aOR 19.94, 95% CI 14.86-26.77 vs no mandate: aOR 7.71, 95% CI 5.68-10.46). Conclusions: Study findings provide added insight into the dynamics of face mask use during the COVID-19 pandemic. Mask mandates supported increased and sustained high face mask usage rates during the first 2 years of the pandemic, having the greatest impact in indoor public locations with limited opportunity for physical distancing targeted by these mandates. These findings highlight the utility of mask mandates in supporting high face mask usage rates during the COVID-19 pandemic. UR - https://publichealth.jmir.org/2023/1/e42616 UR - http://dx.doi.org/10.2196/42616 UR - http://www.ncbi.nlm.nih.gov/pubmed/36446134 ID - info:doi/10.2196/42616 ER - TY - JOUR AU - Zhao, Sihong AU - Hu, Simeng AU - Zhou, Xiaoyu AU - Song, Suhang AU - Wang, Qian AU - Zheng, Hongqiu AU - Zhang, Ying AU - Hou, Zhiyuan PY - 2023/1/11 TI - The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review JO - JMIR Public Health Surveill SP - e40201 VL - 9 KW - COVID-19 KW - COVID-19 vaccine KW - misinformation KW - anti-vaccine KW - review KW - social media KW - survey N2 - Background: During the COVID-19 pandemic, infodemic spread even more rapidly than the pandemic itself. The COVID-19 vaccine hesitancy has been prevalent worldwide and hindered pandemic exiting strategies. Misinformation around COVID-19 vaccines is a vital contributor to vaccine hesitancy. However, no evidence systematically summarized COVID-19 vaccine misinformation. Objective: This review aims to synthesize the global evidence on misinformation related to COVID-19 vaccines, including its prevalence, features, influencing factors, impacts, and solutions for combating misinformation. Methods: We performed a systematic review by searching 5 peer-reviewed databases (PubMed, Embase, Web of Science, Scopus, and EBSCO). We included original articles that investigated misinformation related to COVID-19 vaccines and were published in English from January 1, 2020, to August 18, 2022. We excluded publications that did not cover or focus on COVID-19 vaccine misinformation. The Appraisal tool for Cross-Sectional Studies, version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), and Critical Appraisal Skills Programme Checklist were used to assess the study quality. The review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42021288929). Results: Of the 8864 studies identified, 91 observational studies and 11 interventional studies met the inclusion criteria. Misinformation around COVID-19 vaccines covered conspiracy, concerns on vaccine safety and efficacy, no need for vaccines, morality, liberty, and humor. Conspiracy and safety concerns were the most prevalent misinformation. There was a great variation in misinformation prevalence, noted among 2.5%-55.4% in the general population and 6.0%-96.7% in the antivaccine/vaccine hesitant groups from survey-based studies, and in 0.1%-41.3% on general online data and 0.5%-56% on antivaccine/vaccine hesitant data from internet-based studies. Younger age, lower education and economic status, right-wing and conservative ideology, and having psychological problems enhanced beliefs in misinformation. The content, format, and source of misinformation influenced its spread. A 5-step framework was proposed to address vaccine-related misinformation, including identifying misinformation, regulating producers and distributors, cutting production and distribution, supporting target audiences, and disseminating trustworthy information. The debunking messages/videos were found to be effective in several experimental studies. Conclusions: Our review provides comprehensive and up-to-date evidence on COVID-19 vaccine misinformation and helps responses to vaccine infodemic in future pandemics. Trial Registration: PROSPERO CRD42021288929; https://tinyurl.com/2prejtfa UR - https://publichealth.jmir.org/2023/1/e40201 UR - http://dx.doi.org/10.2196/40201 UR - http://www.ncbi.nlm.nih.gov/pubmed/36469911 ID - info:doi/10.2196/40201 ER - TY - JOUR AU - Tong, Chengzhuo AU - Shi, Wenzhong AU - Zhang, Anshu AU - Shi, Zhicheng PY - 2023/1/6 TI - A Spatiotemporal Solution to Control COVID-19 Transmission at the Community Scale for Returning to Normalcy: COVID-19 Symptom Onset Risk Spatiotemporal Analysis JO - JMIR Public Health Surveill SP - e36538 VL - 9 KW - return to normalcy KW - precise prevention and control KW - risk prediction KW - COVID-19 symptom onset KW - symptom KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2023/1/e36538 UR - http://dx.doi.org/10.2196/36538 UR - http://www.ncbi.nlm.nih.gov/pubmed/36508488 ID - info:doi/10.2196/36538 ER - TY - JOUR AU - Malden, E. Deborah AU - Tartof, Y. Sara AU - Ackerson, K. Bradley AU - Hong, Vennis AU - Skarbinski, Jacek AU - Yau, Vincent AU - Qian, Lei AU - Fischer, Heidi AU - Shaw, F. Sally AU - Caparosa, Susan AU - Xie, Fagen PY - 2022/12/30 TI - Natural Language Processing for Improved Characterization of COVID-19 Symptoms: Observational Study of 350,000 Patients in a Large Integrated Health Care System JO - JMIR Public Health Surveill SP - e41529 VL - 8 IS - 12 KW - natural language processing KW - NLP KW - COVID-19 KW - symptoms KW - disease characterization KW - artificial intelligence KW - application KW - data KW - cough KW - fever KW - headache KW - surveillance N2 - Background: Natural language processing (NLP) of unstructured text from electronic medical records (EMR) can improve the characterization of COVID-19 signs and symptoms, but large-scale studies demonstrating the real-world application and validation of NLP for this purpose are limited. Objective: The aim of this paper is to assess the contribution of NLP when identifying COVID-19 signs and symptoms from EMR. Methods: This study was conducted in Kaiser Permanente Southern California, a large integrated health care system using data from all patients with positive SARS-CoV-2 laboratory tests from March 2020 to May 2021. An NLP algorithm was developed to extract free text from EMR on 12 established signs and symptoms of COVID-19, including fever, cough, headache, fatigue, dyspnea, chills, sore throat, myalgia, anosmia, diarrhea, vomiting or nausea, and abdominal pain. The proportion of patients reporting each symptom and the corresponding onset dates were described before and after supplementing structured EMR data with NLP-extracted signs and symptoms. A random sample of 100 chart-reviewed and adjudicated SARS-CoV-2?positive cases were used to validate the algorithm performance. Results: A total of 359,938 patients (mean age 40.4 [SD 19.2] years; 191,630/359,938, 53% female) with confirmed SARS-CoV-2 infection were identified over the study period. The most common signs and symptoms identified through NLP-supplemented analyses were cough (220,631/359,938, 61%), fever (185,618/359,938, 52%), myalgia (153,042/359,938, 43%), and headache (144,705/359,938, 40%). The NLP algorithm identified an additional 55,568 (15%) symptomatic cases that were previously defined as asymptomatic using structured data alone. The proportion of additional cases with each selected symptom identified in NLP-supplemented analysis varied across the selected symptoms, from 29% (63,742/220,631) of all records for cough to 64% (38,884/60,865) of all records with nausea or vomiting. Of the 295,305 symptomatic patients, the median time from symptom onset to testing was 3 days using structured data alone, whereas the NLP algorithm identified signs or symptoms approximately 1 day earlier. When validated against chart-reviewed cases, the NLP algorithm successfully identified signs and symptoms with consistently high sensitivity (ranging from 87% to 100%) and specificity (94% to 100%). Conclusions: These findings demonstrate that NLP can identify and characterize a broad set of COVID-19 signs and symptoms from unstructured EMR data with enhanced detail and timeliness compared with structured data alone. UR - https://publichealth.jmir.org/2022/12/e41529 UR - http://dx.doi.org/10.2196/41529 UR - http://www.ncbi.nlm.nih.gov/pubmed/36446133 ID - info:doi/10.2196/41529 ER - TY - JOUR AU - Bermejo-Peláez, David AU - Marcos-Mencía, Daniel AU - Álamo, Elisa AU - Pérez-Panizo, Nuria AU - Mousa, Adriana AU - Dacal, Elena AU - Lin, Lin AU - Vladimirov, Alexander AU - Cuadrado, Daniel AU - Mateos-Nozal, Jesús AU - Galán, Carlos Juan AU - Romero-Hernandez, Beatriz AU - Cantón, Rafael AU - Luengo-Oroz, Miguel AU - Rodriguez-Dominguez, Mario PY - 2022/12/30 TI - A Smartphone-Based Platform Assisted by Artificial Intelligence for Reading and Reporting Rapid Diagnostic Tests: Evaluation Study in SARS-CoV-2 Lateral Flow Immunoassays JO - JMIR Public Health Surveill SP - e38533 VL - 8 IS - 12 KW - rapid diagnostic test KW - artificial intelligence KW - AI KW - telemedicine platform KW - COVID-19 KW - rapid test KW - diagnostics KW - epidemiology KW - surveillance KW - automatic KW - automated KW - tracking N2 - 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. UR - https://publichealth.jmir.org/2022/12/e38533 UR - http://dx.doi.org/10.2196/38533 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265136 ID - info:doi/10.2196/38533 ER - TY - JOUR AU - White, K. Becky AU - Martin, Annegret AU - White, Angus James PY - 2022/12/27 TI - User Experience of COVID-19 Chatbots: Scoping Review JO - J Med Internet Res SP - e35903 VL - 24 IS - 12 KW - COVID-19 KW - chatbot KW - engagement KW - user experience KW - pandemic KW - global health KW - digital health KW - health information N2 - Background: The COVID-19 pandemic has had global impacts and caused some health systems to experience substantial pressure. The need for accurate health information has been felt widely. Chatbots have great potential to reach people with authoritative information, and a number of chatbots have been quickly developed to disseminate information about COVID-19. However, little is known about user experiences of and perspectives on these tools. Objective: This study aimed to describe what is known about the user experience and user uptake of COVID-19 chatbots. Methods: A scoping review was carried out in June 2021 using keywords to cover the literature concerning chatbots, user engagement, and COVID-19. The search strategy included databases covering health, communication, marketing, and the COVID-19 pandemic specifically, including MEDLINE Ovid, Embase, CINAHL, ACM Digital Library, Emerald, and EBSCO. Studies that assessed the design, marketing, and user features of COVID-19 chatbots or those that explored user perspectives and experience were included. We excluded papers that were not related to COVID-19; did not include any reporting on user perspectives, experience, or the general use of chatbot features or marketing; or where a version was not available in English. The authors independently screened results for inclusion, using both backward and forward citation checking of the included papers. A thematic analysis was carried out with the included papers. Results: A total of 517 papers were sourced from the literature, and 10 were included in the final review. Our scoping review identified a number of factors impacting adoption and engagement including content, trust, digital ability, and acceptability. The papers included discussions about chatbots developed for COVID-19 screening and general COVID-19 information, as well as studies investigating user perceptions and opinions on COVID-19 chatbots. Conclusions: The COVID-19 pandemic presented a unique and specific challenge for digital health interventions. Design and implementation were required at a rapid speed as digital health service adoption accelerated globally. Chatbots for COVID-19 have been developed quickly as the pandemic has challenged health systems. There is a need for more comprehensive and routine reporting of factors impacting adoption and engagement. This paper has shown both the potential of chatbots to reach users in an emergency and the need to better understand how users engage and what they want. UR - https://www.jmir.org/2022/12/e35903 UR - http://dx.doi.org/10.2196/35903 UR - http://www.ncbi.nlm.nih.gov/pubmed/36520624 ID - info:doi/10.2196/35903 ER - TY - JOUR AU - Qasmieh, A. Saba AU - Robertson, M. McKaylee AU - Rane, S. Madhura AU - Shen, Yanhan AU - Zimba, Rebecca AU - Picchio, A. Camila AU - Parcesepe, M. Angela AU - Chang, Mindy AU - Kulkarni, G. Sarah AU - Grov, Christian AU - Nash, Denis PY - 2022/12/27 TI - The Importance of Incorporating At-Home Testing Into SARS-CoV-2 Point Prevalence Estimates: Findings From a US National Cohort, February 2022 JO - JMIR Public Health Surveill SP - e38196 VL - 8 IS - 12 KW - COVID-19 prevalence KW - at-home rapid SARS-CoV-2 tests KW - population-based surveys KW - COVID-19 KW - surveillance KW - public health KW - rapid test KW - Omicron variant KW - point prevalence N2 - 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. UR - https://publichealth.jmir.org/2022/12/e38196 UR - http://dx.doi.org/10.2196/38196 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240020 ID - info:doi/10.2196/38196 ER - TY - JOUR AU - Thornton, M. Gail AU - Kroeker, Emily AU - Fleck, A. Brian AU - Zhong, Lexuan AU - Hartling, Lisa PY - 2022/12/23 TI - The Impact of Heating, Ventilation, and Air-Conditioning Design Features on the Transmission of Viruses, Including SARS-CoV-2: Overview of Reviews JO - Interact J Med Res SP - e37232 VL - 11 IS - 2 KW - COVID-19 KW - public health KW - epidemiology KW - outbreak KW - pandemic KW - environment KW - literature review KW - virus transmission KW - ventilation KW - coronavirus N2 - Background: The COVID-19 or SARS-CoV-2 outbreak was declared a pandemic by the World Health Organization in March 2020. Almost 2 years later (early February 2022), the World Health Organization reported over 383 million cases of the disease caused by the virus, with over 5.6 million deaths worldwide. Debate regarding the routes of transmission was substantial early in the pandemic; however, airborne transmission emerged as an important consideration. Infectious airborne agents can spread within the built environment through heating, ventilation, and air-conditioning (HVAC) systems. Multiple features of HVAC systems can influence transmission (eg, ventilation, filtration, UV radiation, and humidity). Understanding how HVAC features influence airborne transmission is critical to mitigate the spread of infectious agents. Objective: Given the airborne transmission of SARS-CoV-2, an overview of reviews was conducted to understand what is already known from the scientific literature about how virus transmission may be affected by HVAC design features in the built environment. Methods: Ovid MEDLINE and Compendex were searched from inception to January 2021. Two reviewers independently screened the titles, abstracts, and full text of potentially relevant reviews, using a priori inclusion criteria: systematic reviews examining the effects of HVAC design features on virus transmission. Two reviewers independently assessed the methodological quality using AMSTAR2. Results: Searching identified 361 citations, of which 45 (12.5%) were potentially relevant and 7 (2%) were included. Reviews were published between 2007 and 2021 and included 47 virus studies. Two earlier reviews (2007 and 2016) of 21 studies found sufficient evidence that mechanical ventilation (airflow patterns and ventilation rates) plays a role in airborne transmission; however, both found insufficient evidence to quantify the minimum mechanical ventilation requirements. One review (2017) of 9 studies examining humidity and indoor air quality found that influenza virus survival was lowest between 40% and 80% relative humidity; the authors noted that ventilation rates were a confounding variable. Two reviews (2021) examined mitigation strategies for coronavirus transmission, finding that transmission decreased with increasing temperature and relative humidity. One review (2020) identified 14 studies examining coronavirus transmission in air-conditioning systems, finding that HVAC systems played a role in virus spread during previous coronavirus outbreaks. One review (2020) examined virus transmission interventions in public ground transportation, finding ventilation and filtration to be effective. Conclusions: Seven reviews synthesizing 47 studies demonstrated a role for HVAC in mitigating airborne virus transmission. Ventilation, humidity, temperature, and filtration can play a role in the viability and transmission of viruses, including coronaviruses. Recommendations for minimum standards were not possible owing to few studies investigating a given HVAC parameter. This overview examining HVAC design features and their effects on the airborne transmission of viruses serves as a starting point for future systematic reviews and identifying priorities for primary research. UR - https://www.i-jmr.org/2022/2/e37232 UR - http://dx.doi.org/10.2196/37232 UR - http://www.ncbi.nlm.nih.gov/pubmed/36343208 ID - info:doi/10.2196/37232 ER - TY - JOUR AU - Turvy, Alex PY - 2022/12/23 TI - State-Level COVID-19 Symptom Searches and Case Data: Quantitative Analysis of Political Affiliation as a Predictor for Lag Time Using Google Trends and Centers for Disease Control and Prevention Data JO - JMIR Form Res SP - e40825 VL - 6 IS - 12 KW - COVID-19 KW - search trends KW - prediction KW - case KW - political KW - symptom KW - pandemic KW - data KW - google KW - disease KW - prevention KW - model N2 - Background: Across each state, the emergence of the COVID-19 pandemic in the United States was marked by policies and rhetoric that often corresponded to the political party in power. These diverging responses have sparked broad ongoing discussion about how the political leadership of a state may affect not only the COVID-19 case numbers in a given state but also the subjective individual experience of the pandemic. Objective: This study leverages state-level data from Google Search Trends and Centers for Disease Control and Prevention (CDC) daily case data to investigate the temporal relationship between increases in relative search volume for COVID-19 symptoms and corresponding increases in case data. I aimed to identify whether there are state-level differences in patterns of lag time across each of the 4 spikes in the data (RQ1) and whether the political climate in a given state is associated with these differences (RQ2). Methods: Using publicly available data from Google Trends and the CDC, linear mixed modeling was utilized to account for random state-level intercepts. Lag time was operationalized as number of days between a peak (a sustained increase before a sustained decline) in symptom search data and a corresponding spike in case data and was calculated manually for each of the 4 spikes in individual states. Google offers a data set that tracks the relative search incidence of more than 400 potential COVID-19 symptoms, which is normalized on a 0-100 scale. I used the CDC?s definition of the 11 most common COVID-19 symptoms and created a single construct variable that operationalizes symptom searches. To measure political climate, I considered the proportion of 2020 Trump popular votes in a state as well as a dummy variable for the political party that controls the governorship and a continuous variable measuring proportional party control of federal Congressional representatives. Results: The strongest overall fit was for a linear mixed model that included proportion of 2020 Trump votes as the predictive variable of interest and included controls for mean daily cases and deaths as well as population. Additional political climate variables were discarded for lack of model fit. Findings indicated evidence that there are statistically significant differences in lag time by state but that no individual variable measuring political climate was a statistically significant predictor of these differences. Conclusions: Given that there will likely be future pandemics within this political climate, it is important to understand how political leadership affects perceptions of and corresponding responses to public health crises. Although this study did not fully model this relationship, I believe that future research can build on the state-level differences that I identified by approaching the analysis with a different theoretical model, method for calculating lag time, or level of geographic modeling. UR - https://formative.jmir.org/2022/12/e40825 UR - http://dx.doi.org/10.2196/40825 UR - http://www.ncbi.nlm.nih.gov/pubmed/36446048 ID - info:doi/10.2196/40825 ER - TY - JOUR AU - Chen, David AU - Randhawa, S. Gurjit AU - Soltysiak, PM Maximillian AU - de Souza, PE Camila AU - Kari, Lila AU - Singh, M. Shiva AU - Hill, A. Kathleen PY - 2022/12/22 TI - Mutational Patterns Observed in SARS-CoV-2 Genomes Sampled From Successive Epochs Delimited by Major Public Health Events in Ontario, Canada: Genomic Surveillance Study JO - JMIR Bioinform Biotech SP - e42243 VL - 3 IS - 1 KW - SARS-CoV-2 KW - COVID-19 KW - Ontario KW - virus KW - genetics KW - evolution KW - selection KW - mutation KW - epidemiology KW - variant N2 - 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. UR - https://bioinform.jmir.org/2022/1/e42243 UR - http://dx.doi.org/10.2196/42243 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/42243 ER - TY - JOUR AU - Leston, Meredith AU - Elson, H. William AU - Watson, Conall AU - Lakhani, Anissa AU - Aspden, Carole AU - Bankhead, R. Clare AU - Borrow, Ray AU - Button, Elizabeth AU - Byford, Rachel AU - Elliot, J. Alex AU - Fan, Xuejuan AU - Hoang, Uy AU - Linley, Ezra AU - Macartney, Jack AU - Nicholson, D. Brian AU - Okusi, Cecilia AU - Ramsay, Mary AU - Smith, Gillian AU - Smith, Sue AU - Thomas, Mark AU - Todkill, Dan AU - Tsang, SM Ruby AU - Victor, William AU - Williams, J. Alice AU - Williams, John AU - Zambon, Maria AU - Howsam, Gary AU - Amirthalingam, Gayatri AU - Lopez-Bernal, Jamie AU - Hobbs, Richard F. D. AU - de Lusignan, Simon PY - 2022/12/19 TI - 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 JO - JMIR Public Health Surveill SP - e39141 VL - 8 IS - 12 KW - cohort profile KW - computerized medical record systems KW - general practice KW - influenza KW - COVID-19 KW - sentinel surveillance KW - syndromic surveillance KW - serology KW - virology KW - public health KW - digital surveillance KW - vaccination KW - primary care data KW - health data KW - cohort KW - virus KW - immunology KW - surveillance KW - representation KW - uptake KW - outcome KW - hospital KW - sampling KW - monitoring N2 - 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. UR - https://publichealth.jmir.org/2022/12/e39141 UR - http://dx.doi.org/10.2196/39141 UR - http://www.ncbi.nlm.nih.gov/pubmed/36534462 ID - info:doi/10.2196/39141 ER - TY - JOUR AU - Abou-Arraj, Elias Nadeem AU - Maddah, Diana AU - Buhamdan, Vanessa AU - Abbas, Roua AU - Jawad, Kamel Nadine AU - Karaki, Fatima AU - Alami, H. Nael AU - Geldsetzer, Pascal PY - 2022/12/14 TI - Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey JO - JMIR Form Res SP - e36827 VL - 6 IS - 12 KW - Lebanon KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - vaccination KW - vaccine hesitancy KW - vaccine acceptance KW - health care system KW - misinformation KW - public health N2 - 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. UR - https://formative.jmir.org/2022/12/e36827 UR - http://dx.doi.org/10.2196/36827 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383635 ID - info:doi/10.2196/36827 ER - TY - JOUR AU - Xu, Wayne Weiai AU - Tshimula, Marie Jean AU - Dubé, Ève AU - Graham, E. Janice AU - Greyson, Devon AU - MacDonald, E. Noni AU - Meyer, B. Samantha PY - 2022/12/9 TI - Unmasking the Twitter Discourses on Masks During the COVID-19 Pandemic: User Cluster?Based BERT Topic Modeling Approach JO - JMIR Infodemiology SP - e41198 VL - 2 IS - 2 KW - infoveillance KW - data analytics KW - Twitter KW - social media KW - user classification KW - COVID-19 N2 - Background: The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure?s political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation. Objective: We aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework. Methods: We first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals. Results: This study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users. Conclusions: We conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts. UR - https://infodemiology.jmir.org/2022/2/e41198 UR - http://dx.doi.org/10.2196/41198 UR - http://www.ncbi.nlm.nih.gov/pubmed/36536763 ID - info:doi/10.2196/41198 ER - TY - JOUR AU - Thompson, M. Hale AU - Sharma, Brihat AU - Smith, L. Dale AU - Bhalla, Sameer AU - Erondu, Ihuoma AU - Hazra, Aniruddha AU - Ilyas, Yousaf AU - Pachwicewicz, Paul AU - Sheth, K. Neeral AU - Chhabra, Neeraj AU - Karnik, S. Niranjan AU - Afshar, Majid PY - 2022/12/8 TI - 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 JO - JMIR Public Health Surveill SP - e38158 VL - 8 IS - 12 KW - unhealthy opioid use KW - substance misuse KW - COVID-19 KW - severity of illness KW - overdose KW - topic modeling KW - machine learning KW - opioid use KW - pandemic KW - health outcome KW - public health KW - disease severity KW - electronic health record KW - COVID-19 outcome KW - risk factor KW - patient data N2 - 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. UR - https://publichealth.jmir.org/2022/12/e38158 UR - http://dx.doi.org/10.2196/38158 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265163 ID - info:doi/10.2196/38158 ER - TY - JOUR AU - Ngiam, Wen Nerice Heng AU - Yee, Qi Wan AU - Teo, Nigel AU - Yow, Shing Ka AU - Soundararajan, Amrish AU - Lim, Xin Jie AU - Lim, A. Haikel AU - Tey, Angeline AU - Tang, Aaron Kai Wen AU - Tham, Xin Celine Yi AU - Tan, Ying Jamaica Pei AU - Lu, Yinn Si AU - Yoon, Sungwon AU - Ng, Yi Kennedy Yao AU - Low, Leng Lian PY - 2022/12/2 TI - Building Digital Literacy in Older Adults of Low Socioeconomic Status in Singapore (Project Wire Up): Nonrandomized Controlled Trial JO - J Med Internet Res SP - e40341 VL - 24 IS - 12 KW - digital literacy KW - health determinants KW - COVID-19 pandemic KW - social distancing KW - older adults KW - loneliness KW - social connectedness KW - quality of life KW - well-being KW - digital inclusivity KW - web-based KW - information and communication technology N2 - Background: In a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. Objective: We aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. Methods: A nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ?55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. Results: There were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. Conclusions: This study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult?friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes. UR - https://www.jmir.org/2022/12/e40341 UR - http://dx.doi.org/10.2196/40341 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459398 ID - info:doi/10.2196/40341 ER - TY - JOUR AU - Yen, Ming-Fang Amy AU - Chen, Hsiu-Hsi Tony AU - Chang, Wei-Jung AU - Lin, Ting-Yu AU - Jen, Hsiao-Hsuan Grace AU - Hsu, Chen-Yang AU - Wang, Sen-Te AU - Dang, Huong AU - Chen, Li-Sheng Sam PY - 2022/11/25 TI - New Surveillance Metrics for Alerting Community-Acquired Outbreaks of Emerging SARS-CoV-2 Variants Using Imported Case Data: Bayesian Markov Chain Monte Carlo Approach JO - JMIR Public Health Surveill SP - e40866 VL - 8 IS - 11 KW - COVID-19 KW - imported case KW - surveillance metric KW - early detection KW - community-acquired outbreak N2 - 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. UR - https://publichealth.jmir.org/2022/11/e40866 UR - http://dx.doi.org/10.2196/40866 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265134 ID - info:doi/10.2196/40866 ER - TY - JOUR AU - Sikder, Abu AU - Dickhoner, James AU - Kysh, Lynn AU - Musheghyan, Lusine AU - Shekherdimian, Shant AU - Levine, Barry AU - Espinoza, Juan PY - 2022/11/25 TI - International Collaboration to Develop a Remote Monitoring Web App for COVID-19 Patients in Armenia: Design and Development With Agile Methodology JO - JMIR Hum Factors SP - e40110 VL - 9 IS - 4 KW - COVID-19 KW - global health KW - software KW - mHealth KW - Armenia KW - web app KW - home monitoring KW - software development KW - human-centered design KW - remote monitoring KW - patient care N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e40110 UR - http://dx.doi.org/10.2196/40110 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350739 ID - info:doi/10.2196/40110 ER - TY - JOUR AU - Aisyah, Nur Dewi AU - Manikam, Logan AU - Kiasatina, Thifal AU - Naman, Maryan AU - Adisasmito, Wiku AU - Kozlakidis, Zisis PY - 2022/11/22 TI - The Use of a Health Compliance Monitoring System During the COVID-19 Pandemic in Indonesia: Evaluation Study JO - JMIR Public Health Surveill SP - e40089 VL - 8 IS - 11 KW - COVID-19, public health informatics KW - behavioral change KW - digital health KW - public health policy KW - monitoring KW - Asia KW - mask KW - social distance KW - mobile app KW - app KW - transmission KW - policy KW - health compliance N2 - 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. UR - https://publichealth.jmir.org/2022/11/e40089 UR - http://dx.doi.org/10.2196/40089 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219836 ID - info:doi/10.2196/40089 ER - TY - JOUR AU - Tan, Jin Rayner Kay AU - Lim, Mingjie Jane AU - Neo, Min Pearlyn Hui AU - Ong, Ee Suan PY - 2022/11/22 TI - Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study JO - JMIR Hum Factors SP - e39312 VL - 9 IS - 4 KW - health communication KW - infodemic KW - SARS-CoV-2 KW - coronavirus KW - Singapore KW - WhatsApp KW - COVID-19 KW - health information KW - misinformation KW - mobile health KW - smartphone KW - information quality KW - online health information N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e39312 UR - http://dx.doi.org/10.2196/39312 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099011 ID - info:doi/10.2196/39312 ER - TY - JOUR AU - Wang, Dandan AU - Zhou, Yadong AU - Ma, Feicheng PY - 2022/11/18 TI - Opinion Leaders and Structural Hole Spanners Influencing Echo Chambers in Discussions About COVID-19 Vaccines on Social Media in China: Network Analysis JO - J Med Internet Res SP - e40701 VL - 24 IS - 11 KW - COVID-19 KW - COVID-19 vaccine KW - echo chamber KW - opinion leader KW - structural hole spanner KW - topic KW - sentiment KW - social media KW - vaccine hesitancy KW - public health KW - vaccination KW - health promotion KW - online campaign KW - social network analysis N2 - Background: Social media provide an ideal medium for breeding and reinforcing vaccine hesitancy, especially during public health emergencies. Algorithmic recommendation?based technology along with users? selective exposure and group pressure lead to online echo chambers, causing inefficiency in vaccination promotion. Avoiding or breaking echo chambers largely relies on key users? behavior. Objective: With the ultimate goal of eliminating the impact of echo chambers related to vaccine hesitancy on social media during public health emergencies, the aim of this study was to develop a framework to quantify the echo chamber effect in users? topic selection and attitude contagion about COVID-19 vaccines or vaccinations; detect online opinion leaders and structural hole spanners based on network attributes; and explore the relationships of their behavior patterns and network locations, as well as the relationships of network locations and impact on topic-based and attitude-based echo chambers. Methods: We called the Sina Weibo application programming interface to crawl tweets related to the COVID-19 vaccine or vaccination and user information on Weibo, a Chinese social media platform. Adopting social network analysis, we examined the low echo chamber effect based on topics in representational networks of information, according to attitude in communication flow networks of users under different interactive mechanisms (retweeting, commenting). Statistical and visual analyses were used to characterize behavior patterns of key users (opinion leaders, structural hole spanners), and to explore their function in avoiding or breaking topic-based and attitude-based echo chambers. Results: Users showed a low echo chamber effect in vaccine-related topic selection and attitude interaction. For the former, the homophily was more obvious in retweeting than in commenting, whereas the opposite trend was found for the latter. Speakers, replicators, and monologists tended to be opinion leaders, whereas common users, retweeters, and networkers tended to be structural hole spanners. Both leaders and spanners tended to be ?bridgers? to disseminate diverse topics and communicate with users holding cross-cutting attitudes toward COVID-19 vaccines. Moreover, users who tended to echo a single topic could bridge multiple attitudes, while users who focused on diverse topics also tended to serve as bridgers for different attitudes. Conclusions: This study not only revealed a low echo chamber effect in vaccine hesitancy, but further elucidated the underlying reasons from the perspective of users, offering insights for research about the form, degree, and formation of echo chambers, along with depolarization, social capital, stakeholder theory, user portraits, dissemination pattern of topic, and sentiment. Therefore, this work can help to provide strategies for public health and public opinion managers to cooperate toward avoiding or correcting echo chamber chaos and effectively promoting online vaccine campaigns. UR - https://www.jmir.org/2022/11/e40701 UR - http://dx.doi.org/10.2196/40701 UR - http://www.ncbi.nlm.nih.gov/pubmed/36367965 ID - info:doi/10.2196/40701 ER - TY - JOUR AU - Wang, Kai AU - Luan, Zemin AU - Guo, Zihao AU - Ran, Jinjun AU - Tian, Maozai AU - Zhao, Shi PY - 2022/11/18 TI - The Association Between Clinical Severity and Incubation Period of SARS-CoV-2 Delta Variants: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e40751 VL - 8 IS - 11 KW - COVID-19 KW - Delta variant KW - incubation period KW - clinical severity KW - China N2 - 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. UR - https://publichealth.jmir.org/2022/11/e40751 UR - http://dx.doi.org/10.2196/40751 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346940 ID - info:doi/10.2196/40751 ER - TY - JOUR AU - Kim, Jiyong AU - Park, Hun Seong AU - Kim, Moon Jong PY - 2022/11/18 TI - Effect of Comorbidities on the Infection Rate and Severity of COVID-19: Nationwide Cohort Study With Propensity Score Matching JO - JMIR Public Health Surveill SP - e35025 VL - 8 IS - 11 KW - COVID-19 KW - comorbidity KW - infection rate KW - severity of illness index KW - hyperlipidemia N2 - 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. UR - https://publichealth.jmir.org/2022/11/e35025 UR - http://dx.doi.org/10.2196/35025 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265125 ID - info:doi/10.2196/35025 ER - TY - JOUR AU - Ljaji?, Adela AU - Prodanovi?, Nikola AU - Medvecki, Darija AU - Ba?aragin, Bojana AU - Mitrovi?, Jelena PY - 2022/11/17 TI - Uncovering the Reasons Behind COVID-19 Vaccine Hesitancy in Serbia: Sentiment-Based Topic Modeling JO - J Med Internet Res SP - e42261 VL - 24 IS - 11 KW - topic modeling KW - sentiment analysis KW - LDA KW - NMF KW - BERT KW - vaccine hesitancy KW - COVID-19 KW - Twitter KW - Serbian language processing KW - vaccine KW - public health KW - NLP KW - vaccination KW - Serbia N2 - Background: Since the first COVID-19 vaccine appeared, there has been a growing tendency to automatically determine public attitudes toward it. In particular, it was important to find the reasons for vaccine hesitancy, since it was directly correlated with pandemic protraction. Natural language processing (NLP) and public health researchers have turned to social media (eg, Twitter, Reddit, and Facebook) for user-created content from which they can gauge public opinion on vaccination. To automatically process such content, they use a number of NLP techniques, most notably topic modeling. Topic modeling enables the automatic uncovering and grouping of hidden topics in the text. When applied to content that expresses a negative sentiment toward vaccination, it can give direct insight into the reasons for vaccine hesitancy. Objective: This study applies NLP methods to classify vaccination-related tweets by sentiment polarity and uncover the reasons for vaccine hesitancy among the negative tweets in the Serbian language. Methods: To study the attitudes and beliefs behind vaccine hesitancy, we collected 2 batches of tweets that mention some aspects of COVID-19 vaccination. The first batch of 8817 tweets was manually annotated as either relevant or irrelevant regarding the COVID-19 vaccination sentiment, and then the relevant tweets were annotated as positive, negative, or neutral. We used the annotated tweets to train a sequential bidirectional encoder representations from transformers (BERT)-based classifier for 2 tweet classification tasks to augment this initial data set. The first classifier distinguished between relevant and irrelevant tweets. The second classifier used the relevant tweets and classified them as negative, positive, or neutral. This sequential classifier was used to annotate the second batch of tweets. The combined data sets resulted in 3286 tweets with a negative sentiment: 1770 (53.9%) from the manually annotated data set and 1516 (46.1%) as a result of automatic classification. Topic modeling methods (latent Dirichlet allocation [LDA] and nonnegative matrix factorization [NMF]) were applied using the 3286 preprocessed tweets to detect the reasons for vaccine hesitancy. Results: The relevance classifier achieved an F-score of 0.91 and 0.96 for relevant and irrelevant tweets, respectively. The sentiment polarity classifier achieved an F-score of 0.87, 0.85, and 0.85 for negative, neutral, and positive sentiments, respectively. By summarizing the topics obtained in both models, we extracted 5 main groups of reasons for vaccine hesitancy: concern over vaccine side effects, concern over vaccine effectiveness, concern over insufficiently tested vaccines, mistrust of authorities, and conspiracy theories. Conclusions: This paper presents a combination of NLP methods applied to find the reasons for vaccine hesitancy in Serbia. Given these reasons, it is now possible to better understand the concerns of people regarding the vaccination process. UR - https://www.jmir.org/2022/11/e42261 UR - http://dx.doi.org/10.2196/42261 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301673 ID - info:doi/10.2196/42261 ER - TY - JOUR AU - Ackleh-Tingle, V. Jonathan AU - Jordan, M. Natalie AU - Onwubiko, N. Udodirim AU - Chandra, Christina AU - Harton, E. Paige AU - Rentmeester, T. Shelby AU - Chamberlain, T. Allison PY - 2022/11/17 TI - Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices? Websites in the United States: Cross-sectional Website Content Analysis JO - JMIR Form Res SP - e38425 VL - 6 IS - 11 KW - primary care KW - vaccine hesitancy KW - COVID-19 KW - health communications KW - health information KW - health website KW - family practice KW - vaccine information KW - online health KW - health platform KW - online information N2 - Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices? website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8%) had ?10 distinct locations, were unaffiliated with a university (n=838, 87.2%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1%). In total, 550 (57.1%) practices mentioned COVID-19 vaccines on their practices? website home page, specifically, and 726 (75.3%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7% among single-location practices, n=114, 52.5% among practices with 2-9 locations, n=66, 56.4% among practices with 10-19 locations, and n=304, 77.6% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers? influence on established and prospective patients who search the internet for information about COVID-19 vaccines. UR - https://formative.jmir.org/2022/11/e38425 UR - http://dx.doi.org/10.2196/38425 UR - http://www.ncbi.nlm.nih.gov/pubmed/36343211 ID - info:doi/10.2196/38425 ER - TY - JOUR AU - Terada-Hirashima, Junko AU - Izumi, Shinyu AU - Katagiri, Daisuke AU - Uemura, Yukari AU - Mikami, Ayako AU - Sugiura, Wataru AU - Abe, Shinji AU - Azuma, Arata AU - Sugiyama, Haruhito PY - 2022/11/16 TI - Efficacy and Safety of Direct Hemoperfusion Using Polymyxin B-Immobilized Polystyrene Column for Patients With COVID-19: Protocol for an Exploratory Study JO - JMIR Res Protoc SP - e37426 VL - 11 IS - 11 KW - polymyxin B-immobilized fiber column KW - PMX KW - diffuse alveolar damage KW - DAD KW - COVID-19 KW - pneumonia KW - fibrinogenolysis KW - systemic inflammatory response syndrome KW - lung disease KW - lung damage KW - pulmonary KW - treatment KW - prospective intervention KW - health information KW - treatment information KW - therapy KW - COVID-19 therapy N2 - 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 UR - https://www.researchprotocols.org/2022/11/e37426 UR - http://dx.doi.org/10.2196/37426 UR - http://www.ncbi.nlm.nih.gov/pubmed/36126219 ID - info:doi/10.2196/37426 ER - TY - JOUR AU - Udeagu, N. Chi-Chi AU - Pitiranggon, Masha AU - Misra, Kavita AU - Huang, Jamie AU - Terilli, Thomas AU - Ramos, Yasmin AU - Alexander, Martha AU - Kim, Christine AU - Lee, David AU - Blaney, Kathleen AU - Keeley, Chris AU - Long, Theodore AU - Vora, M. Neil PY - 2022/11/15 TI - Outcomes of a Community Engagement and Information Gathering Program to Support Telephone-Based COVID-19 Contact Tracing: Descriptive Analysis JO - JMIR Public Health Surveill SP - e40977 VL - 8 IS - 11 KW - COVID-19 KW - contact tracing KW - home visits KW - community health workers KW - health equity N2 - Background: Contact tracing is an important public health tool for curbing the spread of infectious diseases. Effective and efficient contact tracing involves the rapid identification of individuals with infection and their exposed contacts and ensuring their isolation or quarantine, respectively. Manual contact tracing via telephone call and digital proximity app technology have been key strategies in mitigating the spread of COVID-19. However, many people are not reached for COVID-19 contact tracing due to missing telephone numbers or nonresponse to telephone calls. The New York City COVID-19 Trace program augmented the efforts of telephone-based contact tracers with information gatherers (IGs) to search and obtain telephone numbers or residential addresses, and community engagement specialists (CESs) made home visits to individuals that were not contacted via telephone calls. Objective: The aim of this study was to assess the contribution of information gathering and home visits to the yields of COVID-19 contact tracing in New York City. Methods: IGs looked for phone numbers or addresses when records were missing phone numbers to locate case-patients or contacts. CESs made home visits to case-patients and contacts with no phone numbers or those who were not reached by telephone-based tracers. Contact tracing management software was used to triage and queue assignments for the telephone-based tracers, IGs, and CESs. We measured the outcomes of contact tracing?related tasks performed by the IGs and CESs from July 2020 to June 2021. Results: Of 659,484 cases and 861,566 contact records in the Trace system, 28% (185,485) of cases and 35% (303,550) of contacts were referred to IGs. IGs obtained new phone numbers for 33% (61,804) of case-patients and 11% (31,951) of contacts; 50% (31,019) of the case-patients and 46% (14,604) of the contacts with new phone numbers completed interviews; 25% (167,815) of case-patients and 8% (72,437) of contacts were referred to CESs. CESs attempted 80% (132,781) of case and 69% (49,846) of contact investigations, of which 47% (62,733) and 50% (25,015) respectively, completed interviews. An additional 12,192 contacts were identified following IG investigations and 13,507 following CES interventions. Conclusions: Gathering new or missing locating information and making home visits increased the number of case-patients and contacts interviewed for contact tracing and resulted in additional contacts. When possible, contact tracing programs should add information gathering and home visiting strategies to increase COVID-19 contact tracing coverage and yields as well as promote equity in the delivery of this public health intervention. UR - https://publichealth.jmir.org/2022/11/e40977 UR - http://dx.doi.org/10.2196/40977 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240019 ID - info:doi/10.2196/40977 ER - TY - JOUR AU - Fischer, Aurelie AU - Elbeji, Abir AU - Aguayo, Gloria AU - Fagherazzi, Guy PY - 2022/11/15 TI - Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research JO - Interact J Med Res SP - e40655 VL - 11 IS - 2 KW - vocal biomarker KW - COVID-19 symptoms KW - digital health KW - remote monitoring KW - artificial intelligence KW - voice KW - COVID-19 KW - Long COVID KW - digital health solution KW - voice-based technology KW - health technology KW - health monitoring KW - digital health monitoring KW - health care application KW - remote patient monitoring UR - https://www.i-jmr.org/2022/2/e40655 UR - http://dx.doi.org/10.2196/40655 UR - http://www.ncbi.nlm.nih.gov/pubmed/36378504 ID - info:doi/10.2196/40655 ER - TY - JOUR AU - Nuñez, R. Tania AU - Pallasch, Nina AU - Radtke, Theda PY - 2022/11/15 TI - Students' Emotional Well-being and Academic Functioning Before, During, and After Lockdown in Germany: Cohort Study JO - JMIR Form Res SP - e34388 VL - 6 IS - 11 KW - self-efficacy KW - academic self-concept KW - test anxiety KW - achievement motivation KW - positive and negative affect KW - mobile phone KW - COVID-19 N2 - Background: The COVID-19 lockdowns have led to social detriments and altered learning environments among university students. Recent research indicates that such ramifications may engender various impairments to students? mental health. However, such research has major limitations, such as the lack of a prepandemic control measure, the focus on singular well-being parameters, or the investigation of only the early phases of the pandemic. Objective: To address these research gaps, this comprehensive and nationwide study compared 3 student cohorts (aged 17-48 years) in Germany: a prepandemic cohort (January-February 2020), a postlockdown cohort (May 2020-July 2020), and an intralockdown cohort (January-February 2021) regarding students? general emotional well-being and academic functioning. It was hypothesized that, because of rigorous lockdown-related restrictions, students in the intralockdown cohort would report diminished general emotional well-being compared with the other cohorts. Furthermore, because of ongoing remote learning since the beginning of the pandemic, it was expected that students? academic functioning would decrease across all 3 cohorts. Methods: The data collection was performed over 3 consecutive semesters (fall semester 2019-2020, spring semester 2020, and fall semester 2020-2021). Students were surveyed on the web on various aspects regarding their general emotional well-being (eg, stress and general well-being) and academic functioning (eg, concentration and study-related flow). Data analyses were performed using multivariate ANOVAs. Results: A total of 787 students participated in this study. Results indicated higher general well-being in the postlockdown cohort than in the intralockdown cohort (P=.02). As for students? academic functioning, our results revealed that students in the prepandemic cohort reported higher study-related flow (P=.007) and concentration (P=.001) than those in the intralockdown cohort. In addition, students reported higher flow (P=.04) and concentration (P=.04) in the postlockdown cohort than those in the intralockdown cohort. No cohort effects were revealed for other aspects of general emotional well-being (eg, perceived stress) and academic functioning (eg, procrastination). Conclusions: This study indicates that students? general emotional well-being as well as motivational and attentional components of academic functioning can be impaired owing to the COVID-19 lockdowns and ongoing remote learning formats. The necessity and design of interventional programs remedying such effects in light of the ongoing crisis need to be addressed. UR - https://formative.jmir.org/2022/11/e34388 UR - http://dx.doi.org/10.2196/34388 UR - http://www.ncbi.nlm.nih.gov/pubmed/36228133 ID - info:doi/10.2196/34388 ER - TY - JOUR AU - Kasting, L. Monica AU - Macy, T. Jonathan AU - Grannis, J. Shaun AU - Wiensch, J. Ashley AU - Lavista Ferres, M. Juan AU - Dixon, E. Brian PY - 2022/11/14 TI - Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study JO - JMIR Public Health Surveill SP - e37203 VL - 8 IS - 11 KW - SARS-CoV-2 KW - COVID-19 vaccines KW - vaccination intention KW - vaccine hesitancy KW - Health Belief Model KW - reasoned action approach KW - COVID-19 KW - vaccination KW - public health KW - online survey KW - health intervention KW - logistic regression KW - demographic N2 - 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. UR - https://publichealth.jmir.org/2022/11/e37203 UR - http://dx.doi.org/10.2196/37203 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219842 ID - info:doi/10.2196/37203 ER - TY - JOUR AU - Chen, Xi AU - Yik, Michelle PY - 2022/11/14 TI - The Emotional Anatomy of the Wuhan Lockdown: Sentiment Analysis Using Weibo Data JO - JMIR Form Res SP - e37698 VL - 6 IS - 11 KW - Wuhan lockdown KW - COVID-19 KW - public health emergency KW - emotion KW - circumplex model of affect KW - Weibo KW - jiayou N2 - Background: On January 23, 2020, the city of Wuhan, China, was sealed off in response to the COVID-19 pandemic. Studies have found that the lockdown was associated with both positive and negative emotions, although their findings are not conclusive. In these studies, emotional responses to the Wuhan lockdown were identified using lexicons based on limited emotion types. Objective: This study aims to map Chinese people?s emotional responses to the Wuhan lockdown and compare Wuhan residents? emotions with those of people elsewhere in China by analyzing social media data from Weibo using a lexicon based on the circumplex model of affect. Methods: Social media posts on Weibo from 2 weeks before to 2 weeks after the Wuhan lockdown was imposed (January 9, 2020, to February 6, 2020) were collected. Each post was coded using a valence score and an arousal score. To map emotional trajectories during the study period, we used a data set of 359,190 posts. To compare the immediate emotional responses to the lockdown and its longer-term emotional impact on Wuhan residents (n=1236) and non-Hubei residents (n=12,714), we used a second data set of 57,685 posts for multilevel modeling analyses. Results: Most posts (248,757/359,190, 69.25%) made during the studied lockdown period indicated a pleasant mood with low arousal. A gradual increase in both valence and arousal before the lockdown was observed. The posts after the lockdown was imposed had higher valence and arousal than prelockdown posts. On the day of lockdown, the non-Hubei group had a temporarily boosted valence (?20=0.118; SE 0.021; P<.001) and arousal (?30=0.293; SE 0.022; P<.001). Compared with non-Hubei residents, the Wuhan group had smaller increases in valence (?21=?0.172; SE 0.052; P<.001) and arousal (?31=?0.262; SE 0.053; P<.001) on the day of lockdown. Weibo users? emotional valence (?40=0.000; SE 0.001; P=.71) and arousal (?40=0.001; SE 0.001; P=.56) remained stable over the 2 weeks after the lockdown was imposed regardless of geographical location (valence: ?41=?0.004, SE 0.003, and P=.16; arousal: ?41=0.003, SE 0.003, and P=.26). Conclusions: During the early stages of the pandemic, most Weibo posts indicated a pleasant mood with low arousal. The overall increase in the posts? valence and arousal after the lockdown announcement might indicate collective cohesion and mutual support in web-based communities during a public health crisis. Compared with the temporary increases in valence and arousal of non-Hubei users on the day of lockdown, Wuhan residents? emotions were less affected by the announcement. Overall, our data suggest that Weibo users were not influenced by the lockdown measures in the 2 weeks after the lockdown announcement. Our findings offer policy makers insights into the usefulness of social connections in maintaining the psychological well-being of people affected by a lockdown. UR - https://formative.jmir.org/2022/11/e37698 UR - http://dx.doi.org/10.2196/37698 UR - http://www.ncbi.nlm.nih.gov/pubmed/36166650 ID - info:doi/10.2196/37698 ER - TY - JOUR AU - Daniore, Paola AU - Nittas, Vasileios AU - Ballouz, Tala AU - Menges, Dominik AU - Moser, André AU - Höglinger, Marc AU - Villiger, Petra AU - Schmitz-Grosz, Krisztina AU - Von Wyl, Viktor PY - 2022/11/11 TI - Performance of the Swiss Digital Contact-Tracing App Over Various SARS-CoV-2 Pandemic Waves: Repeated Cross-sectional Analyses JO - JMIR Public Health Surveill SP - e41004 VL - 8 IS - 11 KW - digital contact tracing KW - exposure notification KW - COVID-19 KW - SARS-CoV-2 KW - public health KW - surveillance KW - digital proximity KW - contact-tracing app KW - mobile app KW - Switzerland KW - variant of concern KW - SwissCovid app KW - digital tool N2 - 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. UR - https://publichealth.jmir.org/2022/11/e41004 UR - http://dx.doi.org/10.2196/41004 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219833 ID - info:doi/10.2196/41004 ER - TY - JOUR AU - Tennant, Ryan AU - Tetui, Moses AU - Grindrod, Kelly AU - Burns, M. Catherine PY - 2022/11/10 TI - Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study JO - JMIR Hum Factors SP - e39670 VL - 9 IS - 4 KW - cognitive work analysis KW - contextual design KW - COVID-19 KW - decision making KW - health care system KW - pandemic KW - vaccination clinics KW - workplace stress N2 - 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. UR - https://humanfactors.jmir.org/2022/4/e39670 UR - http://dx.doi.org/10.2196/39670 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219839 ID - info:doi/10.2196/39670 ER - TY - JOUR AU - Kwan, Ho Tsz AU - Wong, Sze Ngai AU - Chan, Pok Chin AU - Yeoh, Kiong Eng AU - Wong, Yeung-shan Samuel AU - Lee, Shan Shui PY - 2022/11/9 TI - Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation JO - JMIR Public Health Surveill SP - e40175 VL - 8 IS - 11 KW - COVID-19 KW - SARS-CoV-2 antigen testing KW - COVID-19 vaccine KW - mass screening KW - antigen test KW - epidemiology KW - Omicron KW - Hong Kong KW - public health KW - outbreak KW - epidemic KW - screening KW - transmission KW - online KW - vaccination KW - vaccines KW - surveillance N2 - 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. UR - https://publichealth.jmir.org/2022/11/e40175 UR - http://dx.doi.org/10.2196/40175 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240027 ID - info:doi/10.2196/40175 ER - TY - JOUR AU - Kshirsagar, Meghana AU - Nasir, Md AU - Mukherjee, Sumit AU - Becker, Nicholas AU - Dodhia, Rahul AU - Weeks, B. William AU - Ferres, Lavista Juan AU - Richardson, Barbra PY - 2022/11/8 TI - The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data JO - JMIR Public Health Surveill SP - e38898 VL - 8 IS - 11 KW - breakthroughs KW - vaccines KW - Pfizer KW - Moderna KW - Janssen KW - SARS-CoV-2 KW - COVID-19 KW - coronavirus KW - infectious disease KW - viral infection KW - vaccination KW - breakthrough infection KW - public health KW - health policy KW - decision making KW - booster vaccine KW - mortality KW - hospitalization KW - healthcare system N2 - 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. UR - https://publichealth.jmir.org/2022/11/e38898 UR - http://dx.doi.org/10.2196/38898 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265135 ID - info:doi/10.2196/38898 ER - TY - JOUR AU - Dehesh, Paria AU - Baradaran, Reza Hamid AU - Eshrati, Babak AU - Motevalian, Abbas Seyed AU - Salehi, Masoud AU - Donyavi, Tahereh PY - 2022/11/8 TI - The Relationship Between Population-Level SARS-CoV-2 Cycle Threshold Values and Trend of COVID-19 Infection: Longitudinal Study JO - JMIR Public Health Surveill SP - e36424 VL - 8 IS - 11 KW - cycle threshold value KW - COVID-19 KW - trend KW - surveillance KW - epidemiology KW - disease surveillance KW - digital surveillance KW - prediction model KW - epidemic modeling KW - health system KW - infectious disease N2 - 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 (?=?16.87, P<.001) and the daily number of deaths from COVID-19 (?=?1.52, P=.03). There was a significant association between Ct lag (23 days) and the number of COVID-19 hospitalizations (?=?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. UR - https://publichealth.jmir.org/2022/11/e36424 UR - http://dx.doi.org/10.2196/36424 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240022 ID - info:doi/10.2196/36424 ER - TY - JOUR AU - Sourander, Saana AU - Sourander, Andre AU - Hinkka-Yli-Salomäki, Susanna AU - Ristkari, Terja AU - Kurki, Marjo PY - 2022/11/2 TI - An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study JO - JMIR Pediatr Parent SP - e40614 VL - 5 IS - 4 KW - parent training KW - disruptive behavior KW - child psychopathology KW - child functioning KW - internet-based KW - COVID-19 pandemic KW - COVID-19 KW - mental health KW - psychological well-being KW - digital health KW - parenting KW - telehealth KW - behavioral problem KW - psychopathology N2 - Background: There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings. Objective: This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland. Methods: In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents. Results: We found that 44 (88%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90%), this dropped to 58% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90%), 42 (93%) reported high satisfaction in the skills and 44 (98%) in the professionalism of the family coaches. Conclusions: The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic. UR - https://pediatrics.jmir.org/2022/4/e40614 UR - http://dx.doi.org/10.2196/40614 UR - http://www.ncbi.nlm.nih.gov/pubmed/36194895 ID - info:doi/10.2196/40614 ER - TY - JOUR AU - Fuster-Casanovas, Aïna AU - Das, Ronnie AU - Vidal-Alaball, Josep AU - Lopez Segui, Francesc AU - Ahmed, Wasim PY - 2022/10/28 TI - The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis JO - JMIR Public Health Surveill SP - e38153 VL - 8 IS - 10 KW - Twitter KW - social media KW - COVID-19 KW - misinformation KW - vaccination KW - public health KW - vaccine hesitancy KW - infodemiology KW - health campaign KW - content analysis KW - social network KW - layout algorithm N2 - 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. UR - https://publichealth.jmir.org/2022/10/e38153 UR - http://dx.doi.org/10.2196/38153 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219832 ID - info:doi/10.2196/38153 ER - TY - JOUR AU - Liu, MingXin AU - Zhou, SiYu AU - Jin, Qun AU - Nishimura, Shoji AU - Ogihara, Atsushi PY - 2022/10/27 TI - Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post?COVID-19 Pandemic Era: Experience and Comparative Study JO - JMIR Public Health Surveill SP - e40233 VL - 8 IS - 10 KW - COVID-19 KW - contact-tracing app KW - digital contact tracing KW - mobile phone N2 - 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. UR - https://publichealth.jmir.org/2022/10/e40233 UR - http://dx.doi.org/10.2196/40233 UR - http://www.ncbi.nlm.nih.gov/pubmed/36190741 ID - info:doi/10.2196/40233 ER - TY - JOUR AU - Mikuteit, Marie AU - Heinemann, Stephanie AU - Roder, Sascha AU - Niewolik, Jacqueline AU - Schröder, Dominik AU - Vahldiek, Kai AU - Klawitter, Sandra AU - Cossmann, Anne AU - Bergemann, Torsten AU - Degen, Chantal AU - Klawonn, Frank AU - Behrens, Norbert Georg Martin AU - Müller, Frank AU - Dopfer-Jablonka, Alexandra AU - Steffens, Sandra PY - 2022/10/26 TI - Long-term Consequences of COVID-19 and the Pandemic: Protocol for a Web-Based, Longitudinal Observational Study (DEFEAT) JO - JMIR Res Protoc SP - e38718 VL - 11 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - long COVID KW - post?COVID-19 KW - long haulers KW - pandemic KW - long-term effects KW - symptoms KW - long-term KW - risk factors KW - Germany KW - population study KW - quality of life KW - social participation KW - engagement N2 - 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 UR - https://www.researchprotocols.org/2022/10/e38718 UR - http://dx.doi.org/10.2196/38718 UR - http://www.ncbi.nlm.nih.gov/pubmed/36108134 ID - info:doi/10.2196/38718 ER - TY - JOUR AU - Pallavicini, Federica AU - Pepe, Alessandro AU - Clerici, Massimo AU - Mantovani, Fabrizia PY - 2022/10/25 TI - Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review JO - JMIR Serious Games SP - e35000 VL - 10 IS - 4 KW - virtual reality KW - medicine KW - mental health KW - physical health KW - education KW - training KW - COVID-19 N2 - 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/ UR - https://games.jmir.org/2022/4/e35000 UR - http://dx.doi.org/10.2196/35000 UR - http://www.ncbi.nlm.nih.gov/pubmed/36282554 ID - info:doi/10.2196/35000 ER - TY - JOUR AU - van Kampen, Katherine AU - Laski, Jeremi AU - Herman, Gabrielle AU - Chan, M. Teresa PY - 2022/10/25 TI - Investigating COVID-19 Vaccine Communication and Misinformation on TikTok: Cross-sectional Study JO - JMIR Infodemiology SP - e38316 VL - 2 IS - 2 KW - TikTok KW - COVID-19 vaccines KW - vaccinations KW - misinformation KW - COVID-19 KW - Infodemiology KW - social media KW - health information KW - content analysis KW - vaccine hesitancy KW - public health KW - web-based health information N2 - Background: The COVID-19 pandemic has highlighted the need for reliable information, especially around vaccines. Vaccine hesitancy is a growing concern and a great threat to broader public health. The prevalence of social media within our daily lives emphasizes the importance of accurately analyzing how health information is being disseminated to the public. TikTok is of particular interest, as it is an emerging social media platform that young adults may be increasingly using to access health information. Objective: The objective of this study was to examine and describe the content within the top 100 TikToks trending with the hashtag #covidvaccine. Methods: The top 250 most viewed TikToks with the hashtag #covidvaccine were batch downloaded on July 1, 2021, with their respective metadata. Each TikTok was subsequently viewed and encoded by 2 independent reviewers. Coding continued until 100 TikToks could be included based on language and content. Descriptive features were recorded including health care professional (HCP) status of creator, verification of HCP status, genre, and misinformation addressed. Primary inclusion criteria were any TikToks in English with discussion of a COVID-19 vaccine. Results: Of 102 videos included, the median number of plays was 1,700,000, with median shares of 9224 and 62,200 followers. Upon analysis, 14.7% (15/102) of TikToks included HCPs, of which 80% (12/102) could be verified via social media or regulatory body search; 100% (15/15) of HCP-created TikToks supported vaccine use, and overall, 81.3% (83/102) of all TikToks (created by either a layperson or an HCP) supported vaccine use. Conclusions: As the pandemic continues, vaccine hesitancy poses a threat to lifting restrictions, and discovering reasons for this hesitancy is important to public health measures. This study summarizes the discourse around vaccine use on TikTok. Importantly, it opens a frank discussion about the necessity to incorporate new social media platforms into medical education, so we might ensure our trainees are ready to engage with patients on novel platforms. UR - https://infodemiology.jmir.org/2022/2/e38316 UR - http://dx.doi.org/10.2196/38316 UR - http://www.ncbi.nlm.nih.gov/pubmed/36338548 ID - info:doi/10.2196/38316 ER - TY - JOUR AU - Woodward, F. Sean AU - Bari, Sumra AU - Vike, Nicole AU - Lalvani, Shamal AU - Stetsiv, Khrystyna AU - Kim, Woo Byoung AU - Stefanopoulos, Leandros AU - Maglaveras, Nicos AU - Breiter, Hans AU - Katsaggelos, K. Aggelos PY - 2022/10/25 TI - Anxiety, Post?COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study JO - JMIR Form Res SP - e36656 VL - 6 IS - 10 KW - COVID-19 KW - post?COVID-19 syndrome KW - suicidality KW - depression KW - Patient Health Questionnaire-9 KW - PHQ-9 KW - State Trait Anxiety Index KW - STAI N2 - Background: Although the mental health impacts of COVID-19 on the general population have been well studied, studies of the long-term impacts of COVID-19 on infected individuals are relatively new. To date, depression, anxiety, and neurological symptoms associated with post?COVID-19 syndrome (PCS) have been observed in the months following COVID-19 recovery. Suicidal thoughts and behavior (STB) have also been preliminarily proposed as sequelae of COVID-19. Objective: We asked 3 questions. First, do participants reporting a history of COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9 [PHQ-9]) or state anxiety (State Trait Anxiety Index) screens than those who do not? Second, do participants reporting a COVID-19 diagnosis score higher on PCS-related PHQ-9 items? Third, do participants reporting a COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher in STB before, during, or after the first year of the pandemic? Methods: This preliminary study analyzed responses to a COVID-19 and mental health questionnaire obtained from a US population sample, whose data were collected between February 2021 and March 2021. We used the Mann-Whitney U test to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19 and those denying one, as well as between participants claiming severe COVID-19 symptoms in a close relative and those denying them. Where significant differences existed, we created linear regression models to predict the scores based on COVID-19 response as well as demographics to identify potential confounding factors in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about 3 different time intervals (i.e., past 1 year or more, past 1 month to 1 year, and past 1 month), we developed repeated-measures ANOVAs to determine whether scores tended to vary over time. Results: We found greater total depression (PHQ-9) and state anxiety (State Trait Anxiety Index) scores in those with COVID-19 history than those without (Bonferroni P=.001 and Bonferroni P=.004) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ-9 items) that overlapped with the symptoms of PCS (all Bonferroni Ps<.05). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all Bonferroni Ps<.05). Conclusions: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery. Moreover, our findings suggest that depression diagnoses associated with COVID-19 history relate to PCS symptoms, and that STB associated with COVID-19 in some cases precede infection. UR - https://formative.jmir.org/2022/10/e36656 UR - http://dx.doi.org/10.2196/36656 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763757 ID - info:doi/10.2196/36656 ER - TY - JOUR AU - van der Ploeg, Tjeerd AU - Gobbens, J. Robbert J. PY - 2022/10/20 TI - Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation JO - JMIR Public Health Surveill SP - e38450 VL - 8 IS - 10 KW - municipality properties KW - data merging KW - modeling technique KW - variable selection KW - prediction model KW - public health KW - COVID-19 KW - surveillance KW - static data KW - Dutch public domain KW - pandemic KW - Wuhan KW - virus KW - public KW - infections KW - fever KW - cough KW - congestion KW - fatigue KW - symptoms KW - pneumonia KW - dyspnea KW - death N2 - 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 ?m (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. UR - https://publichealth.jmir.org/2022/10/e38450 UR - http://dx.doi.org/10.2196/38450 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219835 ID - info:doi/10.2196/38450 ER - TY - JOUR AU - Herbert, Carly AU - Broach, John AU - Heetderks, William AU - Qashu, Felicia AU - Gibson, Laura AU - Pretz, Caitlin AU - Woods, Kelsey AU - Kheterpal, Vik AU - Suvarna, Thejas AU - Nowak, Christopher AU - Lazar, Peter AU - Ayturk, Didem AU - Barton, Bruce AU - Achenbach, Chad AU - Murphy, Robert AU - McManus, David AU - Soni, Apurv PY - 2022/10/18 TI - Feasibility of At-Home Serial Testing Using Over-the-Counter SARS-CoV-2 Tests With a Digital Smartphone App for Assistance: Longitudinal Cohort Study JO - JMIR Form Res SP - e35426 VL - 6 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - rapid tests KW - MyDataHelps smartphone app KW - mHealth KW - mobile health KW - serial self-testing KW - digital health KW - pandemic KW - self test N2 - Background: The ongoing SARS-CoV-2 pandemic necessitates the development of accurate, rapid, and affordable diagnostics to help curb disease transmission, morbidity, and mortality. Rapid antigen tests are important tools for scaling up testing for SARS-CoV-2; however, little is known about individuals? use of rapid antigen tests at home and how to facilitate the user experience. Objective: This study aimed to describe the feasibility and acceptability of serial self-testing with rapid antigen tests for SARS-CoV-2, including need for assistance and the reliability of self-interpretation. Methods: A total of 206 adults in the United States with smartphones were enrolled in this single-arm feasibility study in February and March 2021. All participants were asked to self-test for COVID-19 at home using rapid antigen tests daily for 14 days and use a smartphone app for testing assistance and to report their results. The main outcomes were adherence to the testing schedule, the acceptability of testing and smartphone app experiences, and the reliability of participants versus study team?s interpretation of test results. Descriptive statistics were used to report the acceptability, adherence, overall rating, and experience of using the at-home test and MyDataHelps app. The usability, acceptability, adherence, and quality of at-home testing were analyzed across different sociodemographic, age, and educational attainment groups. Results: Of the 206 enrolled participants, 189 (91.7%) and 159 (77.2%) completed testing and follow-up surveys, respectively. In total, 51.3% (97/189) of study participants were women, the average age was 40.7 years, 34.4% (65/189) were non-White, and 82% (155/189) had a bachelor?s degree or higher. Most (n=133/206, 64.6%) participants showed high testing adherence, meaning they completed over 75% of the assigned tests. Participants? interpretations of test results demonstrated high agreement (2106/2130, 98.9%) with the study verified results, with a ? score of 0.29 (P<.001). Participants reported high satisfaction with self-testing and the smartphone app, with 98.7% (157/159) reporting that they would recommend the self-test and smartphone app to others. These results were consistent across age, race/ethnicity, and gender. Conclusions: Participants? high adherence to the recommended testing schedule, significant reliability between participants and study staff?s test interpretation, and the acceptability of the smartphone app and self-test indicate that self-tests for SARS-CoV-2 with a smartphone app for assistance and reporting is a highly feasible testing modality among a diverse population of adults in the United States. UR - https://formative.jmir.org/2022/10/e35426 UR - http://dx.doi.org/10.2196/35426 UR - http://www.ncbi.nlm.nih.gov/pubmed/36041004 ID - info:doi/10.2196/35426 ER - TY - JOUR AU - Melton, A. Chad AU - White, M. Brianna AU - Davis, L. Robert AU - Bednarczyk, A. Robert AU - Shaban-Nejad, Arash PY - 2022/10/17 TI - Fine-tuned Sentiment Analysis of COVID-19 Vaccine?Related Social Media Data: Comparative Study JO - J Med Internet Res SP - e40408 VL - 24 IS - 10 KW - sentiment analysis KW - DistilRoBERTa KW - natural language processing KW - social media KW - Twitter KW - Reddit KW - COVID-19 KW - vaccination KW - vaccine KW - content analysis KW - public health KW - surveillance KW - misinformation KW - infodemiology KW - information quality N2 - Background: The emergence of the novel coronavirus (COVID-19) and the necessary separation of populations have led to an unprecedented number of new social media users seeking information related to the pandemic. Currently, with an estimated 4.5 billion users worldwide, social media data offer an opportunity for near real-time analysis of large bodies of text related to disease outbreaks and vaccination. These analyses can be used by officials to develop appropriate public health messaging, digital interventions, educational materials, and policies. Objective: Our study investigated and compared public sentiment related to COVID-19 vaccines expressed on 2 popular social media platforms?Reddit and Twitter?harvested from January 1, 2020, to March 1, 2022. Methods: To accomplish this task, we created a fine-tuned DistilRoBERTa model to predict the sentiments of approximately 9.5 million tweets and 70 thousand Reddit comments. To fine-tune our model, our team manually labeled the sentiment of 3600 tweets and then augmented our data set through back-translation. Text sentiment for each social media platform was then classified with our fine-tuned model using Python programming language and the Hugging Face sentiment analysis pipeline. Results: Our results determined that the average sentiment expressed on Twitter was more negative (5,215,830/9,518,270, 54.8%) than positive, and the sentiment expressed on Reddit was more positive (42,316/67,962, 62.3%) than negative. Although the average sentiment was found to vary between these social media platforms, both platforms displayed similar behavior related to the sentiment shared at key vaccine-related developments during the pandemic. Conclusions: Considering this similar trend in shared sentiment demonstrated across social media platforms, Twitter and Reddit continue to be valuable data sources that public health officials can use to strengthen vaccine confidence and combat misinformation. As the spread of misinformation poses a range of psychological and psychosocial risks (anxiety and fear, etc), there is an urgency in understanding the public perspective and attitude toward shared falsities. Comprehensive educational delivery systems tailored to a population?s expressed sentiments that facilitate digital literacy, health information?seeking behavior, and precision health promotion could aid in clarifying such misinformation. UR - https://www.jmir.org/2022/10/e40408 UR - http://dx.doi.org/10.2196/40408 UR - http://www.ncbi.nlm.nih.gov/pubmed/36174192 ID - info:doi/10.2196/40408 ER - TY - JOUR AU - Grepmeier, Eva-Maria AU - Pawellek, Maja AU - Curbach, Janina AU - Sommoggy, von Julia AU - Drewitz, Philipp Karl AU - Hasenpusch, Claudia AU - Bitzer, Maria Eva AU - Apfelbacher, Christian AU - Matterne, Uwe PY - 2022/10/17 TI - Health Literacy in Health Professionals Two Years into the COVID-19 Pandemic: Results From a Scoping Review JO - JMIR Med Educ SP - e39023 VL - 8 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - health competence KW - COVID-19?related health literacy KW - health care worker N2 - Background: Health literacy (HL) is an important public health goal but also crucial in individuals providing medical care. During the pandemic, COVID-19?related HL of health professionals (HPs) has gained momentum; it helps to minimize the risk of self-infection, on the one hand, and to protect patients and relatives from infection, on the other. However, comprehensive information about the levels of individual pandemic-related HL in HPs is scarce. Objective: In this paper, we aimed at describing the extent of existing research on HL (concept) conducted in HPs (population) in the COVID-19 pandemic (context). The review intends to map the literature on HL in HPs, thereby highlighting research gaps. Methods: This scoping review was conducted using the methodology of Khalil et al (2016). This involved an electronic search of PubMed (MEDLINE) and PsycInfo and a hand search. The included studies were iteratively examined to find items representing the four HL dimensions of access, understand, critically appraise, and apply COVID-19?related health information. Results: The search yielded a total of 3875 references. Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19?related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19?related HL outcome. Conclusions: High levels of COVID-19?related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19?related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary. Trial Registration: Open Science Framework dbfa5; https://osf.io/dbfa5/ UR - https://mededu.jmir.org/2022/4/e39023 UR - http://dx.doi.org/10.2196/39023 UR - http://www.ncbi.nlm.nih.gov/pubmed/36179148 ID - info:doi/10.2196/39023 ER - TY - JOUR AU - Dubé, Eve AU - MacDonald, E. Shannon AU - Manca, Terra AU - Bettinger, A. Julie AU - Driedger, Michelle S. AU - Graham, Janice AU - Greyson, Devon AU - MacDonald, E. Noni AU - Meyer, Samantha AU - Roch, Geneviève AU - Vivion, Maryline AU - Aylsworth, Laura AU - Witteman, O. Holly AU - Gélinas-Gascon, Félix AU - Marques Sathler Guimaraes, Lucas AU - Hakim, Hina AU - Gagnon, Dominique AU - Béchard, Benoît AU - Gramaccia, A. Julie AU - Khoury, Richard AU - Tremblay, Sébastien PY - 2022/10/17 TI - Understanding the Influence of Web-Based Information, Misinformation, Disinformation, and Reinformation on COVID-19 Vaccine Acceptance: Protocol for a Multicomponent Study JO - JMIR Res Protoc SP - e41012 VL - 11 IS - 10 KW - vaccine hesitancy KW - COVID-19 KW - misinformation KW - vaccine decisions KW - disinformation KW - online KW - vaccine KW - vaccination N2 - Background: The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people?s decision to refuse or delay recommended vaccination for themselves or their children. Objective: The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines. Methods: Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature. Results: As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months. Conclusions: The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them. International Registered Report Identifier (IRRID): DERR1-10.2196/41012 UR - https://www.researchprotocols.org/2022/10/e41012 UR - http://dx.doi.org/10.2196/41012 UR - http://www.ncbi.nlm.nih.gov/pubmed/36191171 ID - info:doi/10.2196/41012 ER - TY - JOUR AU - Mittone, F. Diletta AU - Bailey, P. Caitlin AU - Eddy, L. Ebony AU - Napolitano, A. Melissa AU - Vyas, Amita PY - 2022/10/14 TI - Women?s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Pediatr Parent SP - e41356 VL - 5 IS - 4 KW - telehealth KW - COVID-19 KW - maternal-child health KW - Perinatal KW - pediatrics KW - telemedicine KW - pregnancy KW - women's health KW - patient outcome N2 - Background: Since March 2020, the need to reduce patients? exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. Objective: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. Methods: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. Results: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ? US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P?.049). Conclusions: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic. UR - https://pediatrics.jmir.org/2022/4/e41356 UR - http://dx.doi.org/10.2196/41356 UR - http://www.ncbi.nlm.nih.gov/pubmed/36125862 ID - info:doi/10.2196/41356 ER - TY - JOUR AU - Harding, L. Jessica AU - Patel, A. Shivani AU - Davis, Teaniese AU - Patzer, E. Rachel AU - McDonald, Bennett AU - Walker-Williams, Doraina AU - Jagannathan, Ram AU - Teunis, Larissa AU - Gander, Jennifer PY - 2022/10/6 TI - Understanding Racial Disparities in COVID-19?Related Complications: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e38914 VL - 11 IS - 10 KW - COVID-19 KW - social determinants of health KW - race KW - mixed methods KW - equity KW - disparity KW - health KW - pandemic KW - disease severity KW - mortality KW - racial KW - ethnicity KW - complications N2 - 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 UR - https://www.researchprotocols.org/2022/10/e38914 UR - http://dx.doi.org/10.2196/38914 UR - http://www.ncbi.nlm.nih.gov/pubmed/36166652 ID - info:doi/10.2196/38914 ER - TY - JOUR AU - Alhuzali, Hassan AU - Zhang, Tianlin AU - Ananiadou, Sophia PY - 2022/10/5 TI - Emotions and Topics Expressed on Twitter During the COVID-19 Pandemic in the United Kingdom: Comparative Geolocation and Text Mining Analysis JO - J Med Internet Res SP - e40323 VL - 24 IS - 10 KW - Twitter KW - COVID-19 KW - geolocation KW - emotion detection KW - sentiment analysis KW - topic modeling KW - social media KW - natural language processing KW - deep learning N2 - Background: In recent years, the COVID-19 pandemic has brought great changes to public health, society, and the economy. Social media provide a platform for people to discuss health concerns, living conditions, and policies during the epidemic, allowing policymakers to use this content to analyze the public emotions and attitudes for decision-making. Objective: The aim of this study was to use deep learning?based methods to understand public emotions on topics related to the COVID-19 pandemic in the United Kingdom through a comparative geolocation and text mining analysis on Twitter. Methods: Over 500,000 tweets related to COVID-19 from 48 different cities in the United Kingdom were extracted, with the data covering the period of the last 2 years (from February 2020 to November 2021). We leveraged three advanced deep learning?based models for topic modeling to geospatially analyze the sentiment, emotion, and topics of tweets in the United Kingdom: SenticNet 6 for sentiment analysis, SpanEmo for emotion recognition, and combined topic modeling (CTM). Results: We observed a significant change in the number of tweets as the epidemiological situation and vaccination situation shifted over the 2 years. There was a sharp increase in the number of tweets from January 2020 to February 2020 due to the outbreak of COVID-19 in the United Kingdom. Then, the number of tweets gradually declined as of February 2020. Moreover, with identification of the COVID-19 Omicron variant in the United Kingdom in November 2021, the number of tweets grew again. Our findings reveal people?s attitudes and emotions toward topics related to COVID-19. For sentiment, approximately 60% of tweets were positive, 20% were neutral, and 20% were negative. For emotion, people tended to express highly positive emotions in the beginning of 2020, while expressing highly negative emotions over time toward the end of 2021. The topics also changed during the pandemic. Conclusions: Through large-scale text mining of Twitter, our study found meaningful differences in public emotions and topics regarding the COVID-19 pandemic among different UK cities. Furthermore, efficient location-based and time-based comparative analysis can be used to track people?s thoughts and feelings, and to understand their behaviors. Based on our analysis, positive attitudes were common during the pandemic; optimism and anticipation were the dominant emotions. With the outbreak and epidemiological change, the government developed control measures and vaccination policies, and the topics also shifted over time. Overall, the proportion and expressions of emojis, sentiments, emotions, and topics varied geographically and temporally. Therefore, our approach of exploring public emotions and topics on the pandemic from Twitter can potentially lead to informing how public policies are received in a particular geographical area. UR - https://www.jmir.org/2022/10/e40323 UR - http://dx.doi.org/10.2196/40323 UR - http://www.ncbi.nlm.nih.gov/pubmed/36150046 ID - info:doi/10.2196/40323 ER - TY - JOUR AU - Muthuka, John AU - Kiptoo, Michael AU - Oluoch, Kelly AU - Nzioki, Mativo Japheth AU - Nyamai, Musangi Everlyn PY - 2022/10/4 TI - Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis JO - JMIR Pediatr Parent SP - e31579 VL - 5 IS - 4 KW - COVID-19 KW - pandemic KW - pregnancy KW - maternal health KW - cytokine KW - cytokine storm KW - immune response KW - infectious disease KW - coronavirus KW - respiratory KW - virus KW - pregnant N2 - 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. UR - https://pediatrics.jmir.org/2022/4/e31579 UR - http://dx.doi.org/10.2196/31579 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319475 ID - info:doi/10.2196/31579 ER - TY - JOUR AU - Ma, Huiting AU - Yiu, Y. Kristy C. AU - Baral, D. Stefan AU - Fahim, Christine AU - Moloney, Gary AU - Darvin, Dariya AU - Landsman, David AU - Chan, K. Adrienne AU - Straus, Sharon AU - Mishra, Sharmistha PY - 2022/10/4 TI - COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study JO - JMIR Public Health Surveill SP - e34927 VL - 8 IS - 10 KW - long-term care KW - nursing home KW - staff KW - essential worker KW - retirement home KW - shelter KW - congregate living KW - COVID-19 KW - observational KW - risk KW - transmission KW - elderly KW - older adults KW - retirement KW - nurse KW - health care worker KW - congregate KW - trend KW - geography KW - Canada KW - Toronto N2 - 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. UR - https://publichealth.jmir.org/2022/10/e34927 UR - http://dx.doi.org/10.2196/34927 UR - http://www.ncbi.nlm.nih.gov/pubmed/35867901 ID - info:doi/10.2196/34927 ER - TY - JOUR AU - San Torcuato, Maider AU - Bautista-Puig, Núria AU - Arrizabalaga, Olatz AU - Méndez, Eva PY - 2022/10/3 TI - Tracking Openness and Topic Evolution of COVID-19 Publications January 2020-March 2021: Comprehensive Bibliometric and Topic Modeling Analysis JO - J Med Internet Res SP - e40011 VL - 24 IS - 10 KW - COVID-19 KW - open access KW - OA KW - SARS-CoV-2 KW - scholarly communication KW - topic modeling KW - research KW - dissemination KW - accessibility KW - scientometry KW - publications KW - communication KW - research topics N2 - Background: The COVID-19 outbreak highlighted the importance of rapid access to research. Objective: The aim of this study was to investigate research communication related to COVID-19, the level of openness of papers, and the main topics of research into this disease. Methods: Open access (OA) uptake (typologies, license use) and the topic evolution of publications were analyzed from the start of the pandemic (January 1, 2020) until the end of a year of widespread lockdown (March 1, 2021). Results: The sample included 95,605 publications; 94.1% were published in an OA form, 44% of which were published as Bronze OA. Among these OA publications, 42% do not have a license, which can limit the number of citations and thus the impact. Using a topic modeling approach, we found that articles in Hybrid and Green OA publications are more focused on patients and their effects, whereas the strategy to combat the pandemic adopted by different countries was the main topic of articles selecting publication via the Gold OA route. Conclusions: Although OA scientific production has increased, some weaknesses in OA practice, such as lack of licensing or under-researched topics, still hold back its effective use for further research. UR - https://www.jmir.org/2022/10/e40011 UR - http://dx.doi.org/10.2196/40011 UR - http://www.ncbi.nlm.nih.gov/pubmed/36190742 ID - info:doi/10.2196/40011 ER - TY - JOUR AU - Tetteh, Kwabena Emmanuel AU - Combs, Todd AU - Geng, Hsing Elvin AU - McKay, Ruth Virginia PY - 2022/9/30 TI - Public Health Information Seeking, Trust, and COVID-19 Prevention Behaviors: Cross-sectional Study JO - J Med Internet Res SP - e37846 VL - 24 IS - 9 KW - COVID-19 KW - public health KW - health communication KW - trust and mistrust KW - disease prevention KW - health measure KW - health information KW - cross-sectional study KW - Health Belief Model N2 - Background: Preventative health measures such as shelter in place and mask wearing have been widely encouraged to curb the spread of the COVID-19 disease. People?s attitudes toward preventative behaviors may be dependent on their sources of information and trust in the information. Objective: The aim of this study was to understand the relationship between trusting in COVID-19 information and preventative behaviors in a racially and politically diverse metropolitan area in the United States. Methods: We conducted a web-based cross-sectional survey of residents in St. Louis City and County in Missouri. Individuals aged ?18 years were eligible to participate. Participants were recruited using a convenience sampling approach through social media and email. The Health Belief Model and the Socioecological Model informed instrument development, as well as COVID-19?related questions from the Centers for Disease Control and Prevention. We performed an ordinary least squares linear regression model to estimate social distancing practices, perceptions, and trust in COVID-19 information sources. Results: Of the 1650 eligible participants, the majority (n=1381, 83.7%) had sought or received COVID-19?related information from a public health agency, the Centers for Disease Control and Prevention, or both. Regression analysis showed a 1% increase in preventative behaviors for every 12% increase in trust in governmental health agencies. At their lowest levels of trust, women were 68% more likely to engage in preventative behaviors than men. Overall, those aged 18-45 years without vulnerable medical conditions were the least likely to engage in preventative behaviors. Conclusions: Trust in COVID-19 information increases an individual?s likelihood of practicing preventative behaviors. Effective health communication strategies should be used to effectively disseminate health information during disease outbreaks. UR - https://www.jmir.org/2022/9/e37846 UR - http://dx.doi.org/10.2196/37846 UR - http://www.ncbi.nlm.nih.gov/pubmed/36084197 ID - info:doi/10.2196/37846 ER - TY - JOUR AU - Hota, Bala AU - Casey, Paul AU - McIntyre, F. Anne AU - Khan, Jawad AU - Rab, Shafiq AU - Chopra, Aneesh AU - Lateef, Omar AU - Layden, E. Jennifer PY - 2022/9/27 TI - A Standard-Based Citywide Health Information Exchange for Public Health in Response to COVID-19: Development Study JO - JMIR Public Health Surveill SP - e35973 VL - 8 IS - 9 KW - public health KW - informatics KW - surveillance KW - disease surveillance KW - epidemiology KW - health data KW - electronic health record KW - data hub KW - acute care hospital KW - COVID-19 KW - pandemic KW - data governance N2 - Background: Disease surveillance is a critical function of public health, provides essential information about the disease burden and the clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by electronic health record (EHR) meaningful use should enable rapid health care data exchange in the setting of disruptive health care events, such as a pandemic. In reality, access to data remains challenging and, even if available, often lacks conformity to regulated standards. Objective: We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We described the technical and operational components, governance model, and timelines required to implement the public health order that mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluated the data sources, infrastructure requirements, and the completeness of data supplied to the platform and the capacity to link these sources. Methods: Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems?a regional data hub to enhance public health surveillance. A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. We measured the completeness of each feed and the match rate between feeds. Results: Data from 88,906 persons from CCDA records among 14 facilities and 408,741 persons from ELR records among 88 facilities were submitted. Most (n=448,380, 90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability. Conclusions: We described the development of a citywide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment those feeds with CCDA documents, establish secure transfer methods for data exchange, develop a cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and the disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHRs and a potential template for future use of standards to improve public health surveillance. UR - https://publichealth.jmir.org/2022/9/e35973 UR - http://dx.doi.org/10.2196/35973 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544440 ID - info:doi/10.2196/35973 ER - TY - JOUR AU - Soon, Siang Marcus Khai AU - Martinengo, Laura AU - Lu, Junde AU - Car, Tudor Lorainne AU - Chia, Khng Clement Luck PY - 2022/9/27 TI - The Use of Telegram in Surgical Education: Exploratory Study JO - JMIR Med Educ SP - e35983 VL - 8 IS - 3 KW - COVID-19 KW - undergraduate medical education KW - distance education KW - social media KW - Telegram KW - general surgery KW - messaging apps N2 - Background: The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram?s role in medical education remains relatively unexplored. Objective: This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. Methods: A Telegram channel ?Telegram Education for Surgery Learning and Application (TESLA)? was created to supplement medical students? learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. Results: Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. Conclusions: The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy. UR - https://mededu.jmir.org/2022/3/e35983 UR - http://dx.doi.org/10.2196/35983 UR - http://www.ncbi.nlm.nih.gov/pubmed/36099020 ID - info:doi/10.2196/35983 ER - TY - JOUR AU - Winston, Luke AU - McCann, Michael AU - Onofrei, George PY - 2022/9/27 TI - Exploring Socioeconomic Status as a Global Determinant of COVID-19 Prevalence, Using Exploratory Data Analytic and Supervised Machine Learning Techniques: Algorithm Development and Validation Study JO - JMIR Form Res SP - e35114 VL - 6 IS - 9 KW - COVID-19 KW - machine learning KW - data analysis KW - epidemiology KW - human development index N2 - Background: The COVID-19 pandemic represents the most unprecedented global challenge in recent times. As the global community attempts to manage the pandemic in the long term, it is pivotal to understand what factors drive prevalence rates and to predict the future trajectory of the virus. Objective: This study had 2 objectives. First, it tested the statistical relationship between socioeconomic status and COVID-19 prevalence. Second, it used machine learning techniques to predict cumulative COVID-19 cases in a multicountry sample of 182 countries. Taken together, these objectives will shed light on socioeconomic status as a global risk factor of the COVID-19 pandemic. Methods: This research used exploratory data analysis and supervised machine learning methods. Exploratory analysis included variable distribution, variable correlations, and outlier detection. Following this, the following 3 supervised regression techniques were applied: linear regression, random forest, and adaptive boosting (AdaBoost). Results were evaluated using k-fold cross-validation and subsequently compared to analyze algorithmic suitability. The analysis involved 2 models. First, the algorithms were trained to predict 2021 COVID-19 prevalence using only 2020 reported case data. Following this, socioeconomic indicators were added as features and the algorithms were trained again. The Human Development Index (HDI) metrics of life expectancy, mean years of schooling, expected years of schooling, and gross national income were used to approximate socioeconomic status. Results: All variables correlated positively with the 2021 COVID-19 prevalence, with R2 values ranging from 0.55 to 0.85. Using socioeconomic indicators, COVID-19 prevalence was predicted with a reasonable degree of accuracy. Using 2020 reported case rates as a lone predictor to predict 2021 prevalence rates, the average predictive accuracy of the algorithms was low (R2=0.543). When socioeconomic indicators were added alongside 2020 prevalence rates as features, the average predictive performance improved considerably (R2=0.721) and all error statistics decreased. Thus, adding socioeconomic indicators alongside 2020 reported case data optimized the prediction of COVID-19 prevalence to a considerable degree. Linear regression was the strongest learner with R2=0.693 on the first model and R2=0.763 on the second model, followed by random forest (0.481 and 0.722) and AdaBoost (0.454 and 0.679). Following this, the second model was retrained using a selection of additional COVID-19 risk factors (population density, median age, and vaccination uptake) instead of the HDI metrics. However, average accuracy dropped to 0.649, which highlights the value of socioeconomic status as a predictor of COVID-19 cases in the chosen sample. Conclusions: The results show that socioeconomic status is an important variable to consider in future epidemiological modeling, and highlights the reality of the COVID-19 pandemic as a social phenomenon and a health care phenomenon. This paper also puts forward new considerations about the application of statistical and machine learning techniques to understand and combat the COVID-19 pandemic. UR - https://formative.jmir.org/2022/9/e35114 UR - http://dx.doi.org/10.2196/35114 UR - http://www.ncbi.nlm.nih.gov/pubmed/36001798 ID - info:doi/10.2196/35114 ER - TY - JOUR AU - Kumar, Ashutosh AU - Asghar, Adil AU - Dwivedi, Prakhar AU - Kumar, Gopichand AU - Narayan, K. Ravi AU - Jha, K. Rakesh AU - Parashar, Rakesh AU - Sahni, Chetan AU - Pandey, N. Sada PY - 2022/9/22 TI - A Bioinformatics Tool for Predicting Future COVID-19 Waves Based on a Retrospective Analysis of the Second Wave in India: Model Development Study JO - JMIR Bioinform Biotech SP - e36860 VL - 3 IS - 1 KW - COVID-19 KW - epidemiology KW - genomic surveillance KW - second wave KW - SARS-CoV-2 N2 - 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. UR - https://bioinform.jmir.org/2022/1/e36860 UR - http://dx.doi.org/10.2196/36860 UR - http://www.ncbi.nlm.nih.gov/pubmed/36193192 ID - info:doi/10.2196/36860 ER - TY - JOUR AU - Meskó, Bertalan PY - 2022/9/19 TI - COVID-19?s Impact on Digital Health Adoption: The Growing Gap Between a Technological and a Cultural Transformation JO - JMIR Hum Factors SP - e38926 VL - 9 IS - 3 KW - COVID-19 KW - digital health KW - future KW - cultural transformation KW - medical information KW - technology adoption KW - health care KW - physician burnout KW - burnout UR - https://humanfactors.jmir.org/2022/3/e38926 UR - http://dx.doi.org/10.2196/38926 UR - http://www.ncbi.nlm.nih.gov/pubmed/36121692 ID - info:doi/10.2196/38926 ER - TY - JOUR AU - Nunes, Nuno AU - Adamo, Greta AU - Ribeiro, Miguel AU - R Gouveia, Bruna AU - Rubio Gouveia, Elvio AU - Teixeira, Pedro AU - Nisi, Valentina PY - 2022/9/14 TI - 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 JO - JMIR Hum Factors SP - e35434 VL - 9 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - UTAUT KW - empirical study KW - structural equation modeling KW - confirmatory factor analysis KW - security KW - privacy KW - global health KW - technology solution KW - research model KW - technology acceptance KW - digital health KW - mobile health N2 - 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. UR - https://humanfactors.jmir.org/2022/3/e35434 UR - http://dx.doi.org/10.2196/35434 UR - http://www.ncbi.nlm.nih.gov/pubmed/35862671 ID - info:doi/10.2196/35434 ER - TY - JOUR AU - Brehon, Katelyn AU - Niemeläinen, Riikka AU - Hall, Mark AU - Bostick, P. Geoff AU - Brown, A. Cary AU - Wieler, Marguerite AU - Gross, P. Douglas PY - 2022/9/14 TI - Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study JO - JMIR Rehabil Assist Technol SP - e39883 VL - 9 IS - 3 KW - compensation and redress KW - postacute COVID-19 syndrome KW - long COVID KW - COVID-19 KW - rehabilitation KW - return-to-work KW - health outcome KW - occupational health KW - patient-reported outcome KW - anxiety disorder N2 - Background: Emerging evidence suggests that worldwide, between 30% and 50% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed. Objective: This study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program. Methods: A cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW. Results: The sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=?3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender. Conclusions: Workers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation. UR - https://rehab.jmir.org/2022/3/e39883 UR - http://dx.doi.org/10.2196/39883 UR - http://www.ncbi.nlm.nih.gov/pubmed/36094442 ID - info:doi/10.2196/39883 ER - TY - JOUR AU - Liu, W. Andrew AU - Odisho, Y. Anobel AU - Brown III, William AU - Gonzales, Ralph AU - Neinstein, B. Aaron AU - Judson, J. Timothy PY - 2022/9/13 TI - Patient Experience and Feedback After Using an Electronic Health Record?Integrated COVID-19 Symptom Checker: Survey Study JO - JMIR Hum Factors SP - e40064 VL - 9 IS - 3 KW - COVID-19 KW - patient portals KW - digital health KW - diagnostic self evaluation KW - medical informatics KW - internet KW - telemedicine KW - triage KW - feedback KW - medical records systems KW - San Francisco KW - user experience KW - user satisfaction KW - self-triage KW - symptom checker KW - health system KW - workflow KW - integration KW - electronic health record N2 - 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. UR - https://humanfactors.jmir.org/2022/3/e40064 UR - http://dx.doi.org/10.2196/40064 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960593 ID - info:doi/10.2196/40064 ER - TY - JOUR AU - Landry, Megan AU - Vyas, Amita AU - Nagaraj, Nitasha AU - Sardon Jr, A. Gary AU - Bornstein, Sydney AU - Latif, Hannah AU - Kucherlapaty, Padmini AU - McDonnell, Karen AU - Castel, Amanda AU - Goldman, Lynn PY - 2022/9/13 TI - The Characteristics of Student SARS-CoV-2 Cases on an Urban University Campus: Observational Study JO - Interact J Med Res SP - e39230 VL - 11 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - college KW - university KW - students KW - young adult KW - youth KW - communicable disease KW - prevention KW - school health KW - outbreak prevention KW - contact tracing KW - pandemic N2 - Background: Academic institutions are central hubs for young adults, laden with academic and social interactions and communal living arrangements, heightening the risk of transmission of many communicable diseases, including COVID-19. Shortly after the start of the fall 2020 academic year, institutions of higher learning were identified as hot spots for rises in COVID-19 incidence among young adults. Objective: This study aims to identify the characteristics of student SARS-CoV-2 cases, identify the extent to which the student population adhered to preventative strategies, and examine behaviors that would put them at higher risk of contracting or spreading COVID-19. Methods: This observational study comprises 1175 university students at The George Washington University in Washington, DC, with a confirmed COVID-19 diagnosis between August 3, 2020, and November 30, 2021. Case investigation and contact tracing tools were developed by the Campus COVID-19 Support Team and captured in REDCap (Research Electronic Data Capture). Trained case investigators were notified of a case and attempted to contact all cases within 24 hours of the case receiving their lab result. Associations between case characteristics and number of contacts were examined using Wilcoxon rank sum tests. Knowledge of exposure, behaviors since exposure, student residence status, and fraternity and sorority life affiliation were examined using chi-square tests. Results: Positive student cases reported a median of 3 close contacts, and 84.6% (993/1175) reported at least one symptom with a median of 4 COVID-19 symptoms. Congestion (628/1175, 53.4%), cough (530/1175, 45.1%), and headache (484/1175, 41.2%) were the most frequently reported symptoms. Moreover, 36% (415/1160) reported that they did not know how they were exposed to the virus. Among those aware of contact with a COVID-19 confirmed case, 55.1% (109/198) reported the contact was a close friend or family member, and 25.3% (50/198) reported that it was someone with whom they lived. Athlete (vs nonathlete; P<.001), on-campus (vs off-campus; P<.001), and undergraduate (vs graduate; P=.01) students all reported a significantly higher number of contacts. Students living on campus were more likely to report attending campus events in the 2 days prior to symptom onset or positive test result (P=.004). Students with fraternity or sorority affiliation were more likely to report attending campus events in the 2 days prior to symptom onset or positive test result (P<.001). Conclusions: COVID-19 cases have not yet stabilized to a predictable state, but this study provides case characteristics and insights for how academic institutions might prepare to mitigate outbreaks on their campuses as the world plans for the transition from pandemic to endemic COVID-19. UR - https://www.i-jmr.org/2022/2/e39230 UR - http://dx.doi.org/10.2196/39230 UR - http://www.ncbi.nlm.nih.gov/pubmed/36037255 ID - info:doi/10.2196/39230 ER - TY - JOUR AU - Rodriguez-Blazquez, Carmen AU - Romay-Barja, Maria AU - Falcon, Maria AU - Ayala, Alba AU - Forjaz, João Maria PY - 2022/9/8 TI - Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study JO - JMIR Public Health Surveill SP - e34675 VL - 8 IS - 9 KW - COVID-19 KW - pandemic fatigue KW - psychometric properties KW - Rasch analysis KW - validation KW - online survey KW - pandemic KW - fatigue KW - mental health KW - information seeking KW - health information N2 - 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; ?25=8.06, P=.15). The CPFS showed good fit to the Rasch model (? 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. UR - https://publichealth.jmir.org/2022/9/e34675 UR - http://dx.doi.org/10.2196/34675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35785547 ID - info:doi/10.2196/34675 ER - TY - JOUR AU - Seifarth, Jack AU - Pinaire, Megan AU - Zicker, John AU - Singh, Inder AU - Bloch, Danielle PY - 2022/9/8 TI - Circulating Illness and Changes in Thermometer Use Behavior: Series of Cross-sectional Analyses JO - JMIR Form Res SP - e37509 VL - 6 IS - 9 KW - thermometer KW - health behavior KW - influenza KW - COVID-19 KW - fever KW - surveillance KW - perceived risk KW - percent positivity KW - smart technology KW - smart thermometer KW - population demography KW - older adult KW - elderly population KW - health monitoring N2 - Background: Temperature-taking behaviors vary with levels of circulating infectious illness; however, little is known about how these behaviors differ by demographic characteristics. Populations with higher perceived risks of illness are more likely to adopt protective health behaviors. Objective: We investigated differences in temperature-taking frequency and the proportion of readings that were feverish among demographic groups (age, gender, urban/rural status) over influenza offseason; influenza season; and waves 1, 2, and 3 of the COVID-19 pandemic. Methods: Using data from smart thermometers collected from May 1, 2019, to February 28, 2021, across the United States, we calculated the frequency of temperature-taking and the proportion of temperature readings that were feverish. Mixed-effects negative binomial and mixed-effects logistic regression analyses were performed to identify demographic characteristics associated with temperature-taking frequency and the proportion of feverish readings, respectively. Separate models were fit over five study periods: influenza offseason (n=122,480), influenza season (n=174,191), wave 1 of COVID-19 (n=350,385), wave 2 (n=366,489), and wave 3 (n=391,578). Results: Both temperature-taking frequency and the proportion of feverish readings differed by study period (ANOVA P<.001) and were the highest during influenza season. During all periods, children aged 2-5 years and 6-11 years had significantly higher frequencies of temperature-taking than users aged 19-30 years, and children had the highest proportion of feverish readings of all age groups, after adjusting for covariates. During wave 1 of COVID-19, users over the age of 60 years had 1.79 times (95% CI 1.76-1.83) the rate of temperature-taking as users aged 19-30 years and 74% lower odds (95% CI 72%-75%) of a reading being feverish. Across all periods, men had significantly lower temperature-taking frequency and significantly higher odds of having a feverish reading compared to women. Users living in urban areas had significantly higher frequencies of temperature-taking than rural users during all periods, except wave 2 of COVID-19, and urban users had higher odds of a reading being feverish in all study periods except wave 1 of COVID-19. Conclusions: Temperature-taking behavior and the proportion of readings that were feverish are associated with both population disease levels and individual demographic characteristics. Differences in the health behavior of temperature-taking may reflect changes in both perceived and actual illness risk. Specifically, older adults may have experienced an increase in perceived risk during the first three waves of COVID-19, leading to increased rates of temperature monitoring, even when their odds of fever were lower than those of younger adults. Men?s perceived risk of circulating infectious illnesses such as influenza and COVID-19 may be lower than that of women, since men took their temperature less frequently and each temperature had a higher odds of being feverish across all study periods. Infectious disease surveillance should recognize and incorporate how behavior impacts illness monitoring and testing. UR - https://formative.jmir.org/2022/9/e37509 UR - http://dx.doi.org/10.2196/37509 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998174 ID - info:doi/10.2196/37509 ER - TY - JOUR AU - Minian, Nadia AU - Gayapersad, Allison AU - Saiva, Anika AU - Dragonetti, Rosa AU - Kidd, A. Sean AU - Strudwick, Gillian AU - Selby, Peter PY - 2022/8/26 TI - An e?Mental Health Resource for COVID-19?Associated Stress Reduction: Mixed Methods Study of Reach, Usability, and User Perceptions JO - JMIR Ment Health SP - e39885 VL - 9 IS - 8 KW - COVID-19 KW - website KW - stress KW - mental health KW - eHealth KW - internet-based intervention KW - mixed methods evaluation KW - usability KW - digital health KW - health informatics N2 - Background: COVID-19 and its public health response are having a profound effect on people?s mental health. To provide support during these times, Canada?s largest mental health and addiction teaching hospital (Centre for Addiction and Mental Health [CAMH]) launched the Mental Health and COVID-19 Pandemic website on March 18, 2020. This website was designed to be a nonstigmatizing psychoeducational resource for people experiencing mild to moderate distress due to COVID-19 and the public health response to the pandemic. Objective: The aim of this study was to examine the reach, usability, and user perceptions of the CAMH Mental Health and COVID-19 Pandemic website. Methods: This study used a mixed methods sequential explanatory design approach, which consisted of the following 2 distinct phases: (1) quantitative data collection and analysis and (2) qualitative semistructured interviews. In phase 1, we analyzed Google Analytics data to understand how many people visited the website and which were the most visited pages. We conducted a survey to identify users? sociodemographic backgrounds, and assess the usability of the website using the System Usability Scale and users? subjective stress levels using the Perceived Stress Scale (PSS-10). For phase 2, we conducted semistructured interviews to explore user experiences; user motivation, engagement, satisfaction, and perception of the stress reduction strategies; reflections of the website?s functionality, ease of use, navigation, and design; and recommendations for improvement. Results: Google Analytics results showed 146,978 unique users from June 2020 to March 2021. Most users were from Canada (130,066, 88.5%). Between February 20, 2021, and June 4, 2021, 152 users completed the survey. Most users identified as white, female, and having at least a college degree. Based on the PSS-10 scores, most participants were experiencing moderate to high stress when they visited the website. Users rated the usability of the website as acceptable. Ten users completed in-depth interviews between May 2021 and June 2021. Positive feedback related to the content was that the website was a trustworthy source of mental health information with helpful evidence-based stress reduction strategies. Areas for improvement included the text heavy design of the website, wider dissemination/marketing, and greater accessibility of the website to meet the needs of diverse populations. Conclusions: Adding stress reduction resources to a website from a well-respected institution may be a practical method to increase awareness and access to evidence-based stress reduction resources during times of crisis, where there is severe disruption to usual health care contacts. Efforts to ensure that these resources are more widely accessed, especially by diverse populations, are needed. UR - https://mental.jmir.org/2022/8/e39885 UR - http://dx.doi.org/10.2196/39885 UR - http://www.ncbi.nlm.nih.gov/pubmed/35960596 ID - info:doi/10.2196/39885 ER - TY - JOUR AU - Palmer, Tanner AU - Benson, Scott L. AU - Porucznik, Christina AU - Gren, H. Lisa PY - 2022/8/24 TI - Impact of COVID-19 Social Distancing Mandates on Gastrointestinal Pathogen Positivity: Secondary Data Analysis JO - JMIR Public Health Surveill SP - e34757 VL - 8 IS - 8 KW - social distancing KW - gastrointestinal KW - COVID-19 KW - gastroenteritis KW - surveillance KW - epidemiology KW - pathogen transmission KW - respiratory pathogen KW - public health KW - pathogen outbreak KW - outbreak KW - surveillance tool KW - diagnostic database N2 - 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. UR - https://publichealth.jmir.org/2022/8/e34757 UR - http://dx.doi.org/10.2196/34757 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507923 ID - info:doi/10.2196/34757 ER - TY - JOUR AU - Chikersal, Prerna AU - Venkatesh, Shruthi AU - Masown, Karman AU - Walker, Elizabeth AU - Quraishi, Danyal AU - Dey, Anind AU - Goel, Mayank AU - Xia, Zongqi PY - 2022/8/24 TI - Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping JO - JMIR Ment Health SP - e38495 VL - 9 IS - 8 KW - mobile sensing KW - sensor KW - sensing KW - mobile health KW - mHealth KW - algorithm KW - multiple sclerosis KW - disability KW - mental health KW - depression KW - sleep KW - fatigue KW - tiredness KW - predict KW - machine learning KW - feature selection KW - neurological disorder KW - COVID-19 KW - isolation KW - behavior change KW - health outcome KW - fitness KW - movement KW - physical activity KW - exercise KW - tracker KW - digital phenotyping N2 - Background: The COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS). Objective: We presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic. Methods: First, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period. Results: Using data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84). Conclusions: Our approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes. UR - https://mental.jmir.org/2022/8/e38495 UR - http://dx.doi.org/10.2196/38495 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849686 ID - info:doi/10.2196/38495 ER - TY - JOUR AU - Bradwell, Hannah AU - Edwards, J. Katie AU - Winnington, Rhona AU - Thill, Serge AU - Allgar, Victoria AU - Jones, B. Ray PY - 2022/8/24 TI - Implementing Affordable Socially Assistive Pet Robots in Care Homes Before and During the COVID-19 Pandemic: Stratified Cluster Randomized Controlled Trial and Mixed Methods Study JO - JMIR Aging SP - e38864 VL - 5 IS - 3 KW - social robots KW - companion robots KW - well-being KW - older adults KW - dementia KW - robot pets KW - COVID-19 N2 - Background: Robot pets may assist in the challenges of supporting an aging population with growing dementia prevalence. Prior work has focused on the impacts of the robot seal Paro on older adult well-being, but recent studies have suggested the good acceptability and implementation feasibility of more affordable devices (Joy for All [JfA] cats and dogs). Objective: We aimed to address the limited effectiveness research on JfA devices. Methods: We conducted an 8-month, stratified, cluster randomized controlled trial in 8 care homes in Cornwall, United Kingdom. Over 4 months, 4 care homes each received 2 JfA devices (1 cat and 1 dog; intervention group), and 4 homes received care as usual (control group). Psychometrics were collected before and after the intervention to compare the change from baseline to follow-up between the groups. In the final 4 months, all 8 care homes received devices, but only qualitative data were collected owing to COVID-19 and reduced capacity. The primary outcome was neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI] Nursing Home version). Care provider burden was a secondary outcome (occupational disruptiveness NPI subscale), alongside the Challenging Behavior scale, the Holden communication scale, the Campaign to End Loneliness questionnaire, and medication use. Qualitative data were collected through care staff observation calendars and end-of-study interviews to understand use, experience, and impact. We also collected demographic data and assessed dementia severity. In total, 253 residents had robot interaction opportunities, and 83 were consented for direct data collection. Results: There was a significant difference in the total change from baseline to follow-up between the intervention and control groups for NPI (P<.001) and occupational disruptiveness (P=.03). Neuropsychiatric symptoms increased in the control group and decreased in the intervention group. No significant difference was seen for communication issues or challenging behavior. For NPI subdomains, there were significant differences from baseline to follow-up in delusions (P=.03), depression (P=.01), anxiety (P=.001), elation (P=.02), and apathy (P=.009), all of which decreased in the intervention group and increased slightly in the control group. The summative impact results suggested that most residents (46/54, 85%) who interacted with robots experienced a positive impact. Those who interacted had significantly higher dementia severity scores (P=.001). The qualitative results suggested good adoption, acceptability, and suitability for subjectively lonely individuals and lack of a novelty effect through sustained use, and demonstrated that the reasons for use were entertainment, anxiety, and agitation. Conclusions: Affordable robot pets hold potential for improving the well-being of care home residents and people with dementia, including reducing neuropsychiatric symptoms and occupational disruptiveness. This work suggests no novelty effect and contributes toward understanding robot pet suitability. Moreover, interactions were more common among residents with more moderate/severe dementia and those subjectively lonely. Trial Registration: ClinicalTrials.gov NCT04168463; https://www.clinicaltrials.gov/ct2/show/NCT04168463 UR - https://aging.jmir.org/2022/3/e38864 UR - http://dx.doi.org/10.2196/38864 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830959 ID - info:doi/10.2196/38864 ER - TY - JOUR AU - Zangani, Caroline AU - Ostinelli, G. Edoardo AU - Smith, A. Katharine AU - Hong, W. James S. AU - Macdonald, Orla AU - Reen, Gurpreet AU - Reid, Katherine AU - Vincent, Charles AU - Syed Sheriff, Rebecca AU - Harrison, J. Paul AU - Hawton, Keith AU - Pitman, Alexandra AU - Bale, Rob AU - Fazel, Seena AU - Geddes, R. John AU - Cipriani, Andrea PY - 2022/8/22 TI - Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review JO - JMIR Ment Health SP - e38600 VL - 9 IS - 8 KW - COVID-19 KW - coronavirus KW - mental health services KW - telemental health KW - telepsychiatry KW - face-to-face N2 - Background: The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. Objective: We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. Methods: We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country?s COVID-19 Stringency Index, which reflects the stringency of a government?s response to COVID-19 restrictions at a specific time. Results: Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries? face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. Conclusions: During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients? preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users. UR - https://mental.jmir.org/2022/8/e38600 UR - http://dx.doi.org/10.2196/38600 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994310 ID - info:doi/10.2196/38600 ER - TY - JOUR AU - Choudhury, Renoa AU - Park, Joon-Hyuk AU - Thiamwong, Ladda AU - Xie, Rui AU - Stout, R. Jeffrey PY - 2022/8/22 TI - Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Aging SP - e38172 VL - 5 IS - 3 KW - physical activity KW - older women KW - COVID-19 KW - sedentary behavior KW - wrist-worn accelerometers KW - ActiGraph KW - aging KW - elderly population KW - women's health KW - digital health KW - frail KW - healthy lifestyle N2 - 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 UR - https://aging.jmir.org/2022/3/e38172 UR - http://dx.doi.org/10.2196/38172 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994346 ID - info:doi/10.2196/38172 ER - TY - JOUR AU - Grodberg, David AU - Bridgewater, Jesse AU - Loo, Theoren AU - Bravata, Dena PY - 2022/8/18 TI - Examining the Relationship Between Pediatric Behavioral Health and Parent Productivity Through a Parent-Reported Survey in the Time of COVID-19: Exploratory Study JO - JMIR Form Res SP - e37285 VL - 6 IS - 8 KW - adolescent KW - child, family health KW - mental health KW - behavioral health KW - stress KW - protective factors KW - productivity KW - COVID-19 N2 - Background: Pediatric behavioral health needs skyrocketed during the COVID-19 pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families? behavioral health needs. Objective: The aim of this study is to investigate the associations of known pediatric behavioral health risk factors and parents? reports of workplace productivity. Methods: A clinical research team at Brightline?a virtual, pediatric behavioral health solution?drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents? reports of workplace productivity. Results: Participants (N=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children?s behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents? workplace productivity. Conclusions: This survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first step in understanding the relationship between these variables. The results from this study can empower parents by providing insights to help manage their child?s behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers. UR - https://formative.jmir.org/2022/8/e37285 UR - http://dx.doi.org/10.2196/37285 UR - http://www.ncbi.nlm.nih.gov/pubmed/35616439 ID - info:doi/10.2196/37285 ER - TY - JOUR AU - Pollock Star, Ariel AU - Bachner, G. Yaacov AU - Cohen, Bar AU - Haglili, Ophir AU - O'Rourke, Norm PY - 2022/8/18 TI - Social Media Use and Well-being With Bipolar Disorder During the COVID-19 Pandemic: Path Analysis JO - JMIR Form Res SP - e39519 VL - 6 IS - 8 KW - bipolar disorder KW - COVID-19 KW - life satisfaction KW - loneliness KW - social media use KW - social media KW - Facebook KW - social support KW - mental health KW - mental illness KW - mental disorder KW - social media advertising KW - advertising KW - advertisement KW - mania KW - hypo/mania KW - manic KW - depressive KW - depression N2 - Background: Reliable and consistent social support is associated with the mental health and well-being of persons with severe mental illness, including bipolar disorder (BD). Yet the COVID-19 pandemic and associated social distancing measures (eg, shelter in place) reduced access to regular social contacts, while social media use (SMU) increased concomitantly. Little is currently known about associations between the well-being of adults with BD and different types of SMU (eg, passive and active). Objective: For this study, we had two goals. First, we report descriptive information regarding SMU by persons with BD during COVID-19 (all platforms). Specific to Facebook, we next developed and tested a hypothesized model to identify direct and indirect associations between BD symptoms, social support, loneliness, life satisfaction, and SMU. Responses were collected during the global spread of the Delta variant and prior/concurrent with the Omicron variant, 20 months after the World Health Organization declared COVID-19 a global pandemic. Methods: Over 8 weeks, we obtained responses from an international sample of 102 adults with BD using the Qualtrics online platform. Most had previously participated in the BADAS (Bipolar Affective Disorders and older Adults) Study (n=89, 87.3%); the remainder were recruited specifically for this research (n=13, 2.7%). The subsamples did not differ in age (t100=1.64; P=.10), gender (?22=0.2; P=.90), socioeconomic status (?26=9.9; P=.13), or time since BD diagnosis (t97=1.27; P=.21). Both were recruited using social media advertising micro-targeted to adults with BD. On average, participants were 53.96 (SD 13.22, range 20-77) years of age, they had completed 15.4 (SD 4.28) years of education, and were diagnosed with BD 19.6 (SD 10.31) years ago. Path analyses were performed to develop and test our hypothesized model. Results: Almost all participants (n=95, 93.1%) reported having both Facebook and LinkedIn accounts; 91.2% (n=93) reported regular use of either or both. During the pandemic, most (n=62, 60.8%) reported accessing social media several times a day; 36.3% (n=37) reported using social media more often since the emergence of COVID-19. Specific to Facebook, the model we hypothesized differed somewhat from what emerged. The resulting model suggests that symptoms of depression predict loneliness and, inversely, social support and life satisfaction. Social support predicts social Facebook use, whereas passive Facebook use predicts life satisfaction. Symptoms of depression emerged as indirect predictors of SMU via social support. Conclusions: Our findings suggest that the operational definition of passive-active SMU requires further analysis and refinement. In contrast to theory, passive Facebook use appears positively associated with well-being among certain populations. Longitudinal data collection over multiple points is required to identify associations between BD symptoms, SMU, and well-being over time. UR - https://formative.jmir.org/2022/8/e39519 UR - http://dx.doi.org/10.2196/39519 UR - http://www.ncbi.nlm.nih.gov/pubmed/35980726 ID - info:doi/10.2196/39519 ER - TY - JOUR AU - Lessard, David AU - Engler, Kim AU - Ma, Yuanchao AU - Rodriguez Cruz, Adriana AU - Vicente, Serge AU - AU - Kronfli, Nadine AU - Barkati, Sapha AU - Brouillette, Marie-Josée AU - Cox, Joseph AU - Kildea, John AU - Hijal, Tarek AU - Pomey, Marie-Pascale AU - Bartlett, J. Susan AU - Asselah, Jamil AU - Lebouché, Bertrand PY - 2022/8/18 TI - Remote Follow-up of Self-isolating Patients With COVID-19 Using a Patient Portal: Protocol for a Mixed Methods Pilot Study (Opal-COVID Study) JO - JMIR Res Protoc SP - e35760 VL - 11 IS - 8 KW - SARS-CoV-2 KW - coronavirus KW - infectious disease KW - implementation science KW - Canada KW - patient portal KW - telehealth KW - telemedicine KW - app KW - health information technology KW - remote monitoring KW - mobile phone N2 - Background: People with COVID-19 are instructed to self-isolate at home. During self-isolation, they may experience anxiety and insufficient care. Patient portals can allow patients to self-monitor and remotely share their health status with health care professionals, but little data are available on their feasibility. Objective: This paper presents the protocol of the Opal-COVID Study. Its objectives are to assess the implementation of the Opal patient portal for distance monitoring of self-isolating patients with COVID-19, identify influences on the intervention?s implementation, and describe service and patient outcomes of this intervention. Methods: This mixed methods pilot study aims to recruit 50 patient participants with COVID-19 tested at the McGill University Health Centre (Montreal, Canada) for 14 days of follow-up. With access to an existing patient portal through a smartphone app, patients will complete a daily self-assessment of symptoms, vital signs, and mental health monitored by a nurse, and receive teleconsultations as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden), and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, on recruitment, retention, and fidelity, as well as on the frequency and nature of contacts with health care professionals. The statistical analyses for objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As for the qualitative analyses, for objective 2 (influences on implementation), semistructured qualitative interviews will be conducted with 4 groups of stakeholders (ie, patient participants, health care professionals, technology developers, and study administrators) and submitted for content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers to and facilitators of implementation. For objective 3 (service outcomes), reasons for contacting health care professionals through Opal will also be submitted for content analysis. Results: Between December 2020 and March 2021, a total of 51 patient participants were recruited. Qualitative interviews were conducted with 39 stakeholders from April to September 2021. Delays were experienced owing to measures taken at the McGill University Health Centre to address COVID-19. The quantitative and qualitative analyses began in May 2022. As of June 2022, a total of 2 manuscripts (on the implementation and the patient outcomes) were being prepared, and 3 conference presentations had been given on the study?s methods. Conclusions: This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal?based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. Trial Registration: ClinicalTrials.gov NCT04978233; https://clinicaltrials.gov/ct2/show/NCT04978233 International Registered Report Identifier (IRRID): DERR1-10.2196/35760 UR - https://www.researchprotocols.org/2022/8/e35760 UR - http://dx.doi.org/10.2196/35760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35820054 ID - info:doi/10.2196/35760 ER - TY - JOUR AU - Meza-Torres, Bernardo AU - Delanerolle, Gayathri AU - Okusi, Cecilia AU - Mayor, Nikhil AU - Anand, Sneha AU - Macartney, Jack AU - Gatenby, Piers AU - Glampson, Ben AU - Chapman, Martin AU - Curcin, Vasa AU - Mayer, Erik AU - Joy, Mark AU - Greenhalgh, Trisha AU - Delaney, Brendan AU - de Lusignan, Simon PY - 2022/8/16 TI - Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study JO - JMIR Public Health Surveill SP - e37668 VL - 8 IS - 8 KW - medical record systems KW - computerized KW - Systematized Nomenclature of Medicine KW - post?acute COVID-19 syndrome KW - phenotype KW - COVID-19 KW - post?COVID-19 syndrome KW - long COVID KW - ethnicity KW - social class KW - general practitioners KW - data accuracy KW - data extracts KW - biomedical ontologies KW - SARS-CoV-2 KW - hospitalization N2 - 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. UR - https://publichealth.jmir.org/2022/8/e37668 UR - http://dx.doi.org/10.2196/37668 UR - http://www.ncbi.nlm.nih.gov/pubmed/35605170 ID - info:doi/10.2196/37668 ER - TY - JOUR AU - Zhang, Yimin AU - Liu, Taoran AU - He, Zonglin AU - Chan, Ngai Sze AU - Akinwunmi, Babatunde AU - Huang, Jian AU - Wong, Tak-Hap AU - Zhang, P. Casper J. AU - Ming, Wai-Kit PY - 2022/8/16 TI - Preferences for Attributes of Initial COVID-19 Diagnosis in the United States and China During the Pandemic: Discrete Choice Experiment With Propensity Score Matching JO - JMIR Public Health Surveill SP - e37422 VL - 8 IS - 8 KW - COVID-19 KW - public health KW - discrete choice experiment KW - patient preference KW - propensity score matching KW - patients with fever N2 - 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. UR - https://publichealth.jmir.org/2022/8/e37422 UR - http://dx.doi.org/10.2196/37422 UR - http://www.ncbi.nlm.nih.gov/pubmed/35759683 ID - info:doi/10.2196/37422 ER - TY - JOUR AU - Mayor, Nikhil AU - Meza-Torres, Bernardo AU - Okusi, Cecilia AU - Delanerolle, Gayathri AU - Chapman, Martin AU - Wang, Wenjuan AU - Anand, Sneha AU - Feher, Michael AU - Macartney, Jack AU - Byford, Rachel AU - Joy, Mark AU - Gatenby, Piers AU - Curcin, Vasa AU - Greenhalgh, Trisha AU - Delaney, Brendan AU - de Lusignan, Simon PY - 2022/8/11 TI - Developing a Long COVID Phenotype for Postacute COVID-19 in a National Primary Care Sentinel Cohort: Observational Retrospective Database Analysis JO - JMIR Public Health Surveill SP - e36989 VL - 8 IS - 8 KW - medical record systems KW - computerized KW - Systematized Nomenclature of Medicine KW - postacute COVID-19 syndrome KW - phenotype KW - COVID-19 KW - long COVID KW - ethnicity KW - social class KW - general practitioners KW - data accuracy KW - data extracts KW - biomedical ontologies KW - SARS-CoV-2 KW - hospitalization KW - epidemiology KW - surveillance KW - public health KW - BioPortal KW - electronic health record KW - disease management KW - digital tool N2 - 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. UR - https://publichealth.jmir.org/2022/8/e36989 UR - http://dx.doi.org/10.2196/36989 UR - http://www.ncbi.nlm.nih.gov/pubmed/35861678 ID - info:doi/10.2196/36989 ER - TY - JOUR AU - Chen, Wenwen AU - Flanagan, Ashley AU - Nippak, MD Pria AU - Nicin, Michael AU - Sinha, K. Samir PY - 2022/8/10 TI - Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Aging SP - e34952 VL - 5 IS - 3 KW - telemedicine KW - virtual care visit KW - geriatric care professionals KW - aging population KW - Consolidated Framework for Implementation Research KW - geriatric care KW - older adults KW - elderly care KW - telehealth KW - digital health KW - COVID-19 KW - pandemic KW - technology usability N2 - Background: Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective: This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods: This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions: This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families. UR - https://aging.jmir.org/2022/3/e34952 UR - http://dx.doi.org/10.2196/34952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830331 ID - info:doi/10.2196/34952 ER - TY - JOUR AU - Luo, Wei AU - Liu, Zhaoyin AU - Zhou, Yuxuan AU - Zhao, Yumin AU - Li, Elita Yunyue AU - Masrur, Arif AU - Yu, Manzhu PY - 2022/8/9 TI - 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 JO - JMIR Public Health Surveill SP - e35840 VL - 8 IS - 8 KW - COVID-19 KW - Delta variant KW - space-time scan KW - intervention KW - Southeast Asia N2 - 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. UR - https://publichealth.jmir.org/2022/8/e35840 UR - http://dx.doi.org/10.2196/35840 UR - http://www.ncbi.nlm.nih.gov/pubmed/35861674 ID - info:doi/10.2196/35840 ER - TY - JOUR AU - Mousavi, Avah Zahra AU - Lai, Jocelyn AU - Simon, Katharine AU - Rivera, P. Alexander AU - Yunusova, Asal AU - Hu, Sirui AU - Labbaf, Sina AU - Jafarlou, Salar AU - Dutt, D. Nikil AU - Jain, C. Ramesh AU - Rahmani, M. Amir AU - Borelli, L. Jessica PY - 2022/8/5 TI - Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study JO - JMIR Form Res SP - e33964 VL - 6 IS - 8 KW - sleep KW - objective sleep outcomes KW - COVID-19 KW - affect variability KW - affect dynamics N2 - Background: Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant. Objective: In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic. Methods: College student participants (N=20; female: 13/20, 65%) wore an Oura ring (?ura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day. Results: Participants with a higher sleep onset latency (b=?1.09, SE 0.36; P=.006) and TST (b=?0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=?0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04). Conclusions: Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health. UR - https://formative.jmir.org/2022/8/e33964 UR - http://dx.doi.org/10.2196/33964 UR - http://www.ncbi.nlm.nih.gov/pubmed/35816447 ID - info:doi/10.2196/33964 ER - TY - JOUR AU - Jeong, Heejin AU - Bayro, Allison AU - Umesh, Patipati Sai AU - Mamgain, Kaushal AU - Lee, Moontae PY - 2022/8/4 TI - Social Media Users? Perceptions of a Wearable Mixed Reality Headset During the COVID-19 Pandemic: Aspect-Based Sentiment Analysis JO - JMIR Serious Games SP - e36850 VL - 10 IS - 3 KW - HoloLens 2 KW - sentiment analysis KW - natural language processing, Twitter KW - COVID-19 KW - usability evaluation N2 - Background: Mixed reality (MR) devices provide real-time environments for physical-digital interactions across many domains. Owing to the unprecedented COVID-19 pandemic, MR technologies have supported many new use cases in the health care industry, enabling social distancing practices to minimize the risk of contact and transmission. Despite their novelty and increasing popularity, public evaluations are sparse and often rely on social interactions among users, developers, researchers, and potential buyers. Objective: The purpose of this study is to use aspect-based sentiment analysis to explore changes in sentiment during the onset of the COVID-19 pandemic as new use cases emerged in the health care industry; to characterize net insights for MR developers, researchers, and users; and to analyze the features of HoloLens 2 (Microsoft Corporation) that are helpful for certain fields and purposes. Methods: To investigate the user sentiment, we collected 8492 tweets on a wearable MR headset, HoloLens 2, during the initial 10 months since its release in late 2019, coinciding with the onset of the pandemic. Human annotators rated the individual tweets as positive, negative, neutral, or inconclusive. Furthermore, by hiring an interannotator to ensure agreements between the annotators, we used various word vector representations to measure the impact of specific words on sentiment ratings. Following the sentiment classification for each tweet, we trained a model for sentiment analysis via supervised learning. Results: The results of our sentiment analysis showed that the bag-of-words tokenizing method using a random forest supervised learning approach produced the highest accuracy of the test set at 81.29%. Furthermore, the results showed an apparent change in sentiment during the COVID-19 pandemic period. During the onset of the pandemic, consumer goods were severely affected, which aligns with a drop in both positive and negative sentiment. Following this, there is a sudden spike in positive sentiment, hypothesized to be caused by the new use cases of the device in health care education and training. This pandemic also aligns with drastic changes in the increased number of practical insights for MR developers, researchers, and users and positive net sentiments toward the HoloLens 2 characteristics. Conclusions: Our approach suggests a simple yet effective way to survey public opinion about new hardware devices quickly. The findings of this study contribute to a holistic understanding of public perception and acceptance of MR technologies during the COVID-19 pandemic and highlight several new implementations of HoloLens 2 in health care. We hope that these findings will inspire new use cases and technological features. UR - https://games.jmir.org/2022/3/e36850 UR - http://dx.doi.org/10.2196/36850 UR - http://www.ncbi.nlm.nih.gov/pubmed/35708916 ID - info:doi/10.2196/36850 ER - TY - JOUR AU - Smith, E. Gillian AU - Harcourt, E. Sally AU - Hoang, Uy AU - Lemanska, Agnieszka AU - Elliot, J. Alex AU - Morbey, A. Roger AU - Hughes, E. Helen AU - Lake, Iain AU - Edeghere, Obaghe AU - Oliver, Isabel AU - Sherlock, Julian AU - Amlôt, Richard AU - de Lusignan, Simon PY - 2022/8/3 TI - Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e32347 VL - 8 IS - 8 KW - pandemic KW - public health KW - syndromic surveillance KW - mental health KW - anxiety KW - sleep problems KW - COVID-19 KW - health care KW - health surveillance KW - health care service N2 - 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. UR - https://publichealth.jmir.org/2022/8/e32347 UR - http://dx.doi.org/10.2196/32347 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486809 ID - info:doi/10.2196/32347 ER - TY - JOUR AU - Kuroki, Makoto AU - Yamamoto, Kiyoshi AU - Goldfinch, Shaun PY - 2022/8/2 TI - Factors Influencing the Adoption of Voluntary Nonpharmaceutical Interventions to Control COVID-19 in Japan: Cross-sectional Study JO - JMIR Form Res SP - e34268 VL - 6 IS - 8 KW - COVID-19 KW - nonpharmaceutical interventions KW - social distancing KW - phone tracing KW - trust in government KW - confidence in scientists N2 - Background: Trust in government is seen to facilitate crisis management and policy instrument adoption across numerous studies. However, in Japan, public support for government handling of the COVID-19 pandemic and trust in the government is low, yet the adoption of voluntary nondigital nonpharmaceutical interventions (NPIs) is high. This is an important tension this study seeks to unravel. Objective: The aim of this study is to understand the antecedents of nondigital NPI and tracking app adoption in the COVID-19 pandemic in Japan. Methods: A commercial company was contracted to deliver an online survey of 1248 Japanese citizens in December 2020. A quota technique was used to deliver a sample representative in terms of gender, age, residence, income, and education. Results: The adoption of voluntary nondigital NPIs is predicted by confidence in public health scientists and a favoring of infection control over reducing economic and social costs. A novel and unexpected finding is that trust in government does not predict nondigital NPI use. Perceived risk and knowledge of infection did not increase the use of nondigital NPIs. Education and income were not significant factors, although female and older respondents demonstrated greater compliance. For the adoption of a phone tracking app, trust in government is important, as is urban residence, albeit with a lower use of the app compared to nondigital NPIs. Conclusions: Voluntary compliance in the adoption of nondigital NPIs?if skillfully led by trusted scientific experts and in accord with societal norms?can be effectively achieved. We provide evidence that trust in government is effective in encouraging the use of the Japanese tracking app. Moreover, the technical efficacy of digital initiatives and perceptions of such will unsurprisingly affect citizen support and use of digital tools. UR - https://formative.jmir.org/2022/8/e34268 UR - http://dx.doi.org/10.2196/34268 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916697 ID - info:doi/10.2196/34268 ER - TY - JOUR AU - Bastien, Laurianne AU - Boke, Naz Bilun AU - Mettler, Jessica AU - Zito, Stephanie AU - Di Genova, Lina AU - Romano, Vera AU - Lewis, P. Stephen AU - Whitley, Rob AU - Iyer, N. Srividya AU - Heath, L. Nancy PY - 2022/7/22 TI - Peer-Presented Versus Mental Health Service Provider?Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial JO - JMIR Ment Health SP - e34168 VL - 9 IS - 7 KW - web-based mental health outreach KW - resilience building KW - university student KW - peer-presented KW - mental health service provider?presented KW - mental health KW - outreach KW - resilience KW - student KW - service provider KW - randomized controlled trial N2 - 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 UR - https://mental.jmir.org/2022/7/e34168 UR - http://dx.doi.org/10.2196/34168 UR - http://www.ncbi.nlm.nih.gov/pubmed/35762935 ID - info:doi/10.2196/34168 ER - TY - JOUR AU - Stockham, Nathaniel AU - Washington, Peter AU - Chrisman, Brianna AU - Paskov, Kelley AU - Jung, Jae-Yoon AU - Wall, Paul Dennis PY - 2022/7/21 TI - Causal Modeling to Mitigate Selection Bias and Unmeasured Confounding in Internet-Based Epidemiology of COVID-19: Model Development and Validation JO - JMIR Public Health Surveill SP - e31306 VL - 8 IS - 7 KW - selection bias KW - COVID-19 KW - epidemiology KW - causality KW - sensitivity analysis KW - public health KW - surveillance KW - method KW - epidemiologic research design KW - model KW - bias KW - development KW - validation KW - utility KW - implementation KW - sensitivity KW - design KW - research N2 - 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. UR - https://publichealth.jmir.org/2022/7/e31306 UR - http://dx.doi.org/10.2196/31306 UR - http://www.ncbi.nlm.nih.gov/pubmed/35605128 ID - info:doi/10.2196/31306 ER - TY - JOUR AU - Spain, Debbie AU - Stewart, R. Gavin AU - Mason, David AU - Milner, Victoria AU - Fairhurst, Bryony AU - Robinson, Janine AU - Gillan, Nicola AU - Ensum, Ian AU - Stark, Eloise AU - Happe, Francesca PY - 2022/7/20 TI - Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals JO - JMIR Ment Health SP - e37901 VL - 9 IS - 7 KW - autism KW - COVID-19 pandemic KW - autism diagnostic assessment KW - telehealth KW - health professionals KW - clinical supervision KW - training KW - COVID-19 N2 - Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals? experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals? experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods. UR - https://mental.jmir.org/2022/7/e37901 UR - http://dx.doi.org/10.2196/37901 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857358 ID - info:doi/10.2196/37901 ER - TY - JOUR AU - Megahed, M. Fadel AU - Jones-Farmer, Allison L. AU - Ma, Yinjiao AU - Rigdon, E. Steven PY - 2022/7/19 TI - Explaining the Varying Patterns of COVID-19 Deaths Across the United States: 2-Stage Time Series Clustering Framework JO - JMIR Public Health Surveill SP - e32164 VL - 8 IS - 7 KW - explanatory modeling KW - multinomial regression KW - SARS-CoV-2 KW - COVID-19 KW - socioeconomic analyses KW - time series analysis N2 - Background: Socially vulnerable communities are at increased risk for adverse health outcomes during a pandemic. Although this association has been established for H1N1, Middle East respiratory syndrome (MERS), and COVID-19 outbreaks, understanding the factors influencing the outbreak pattern for different communities remains limited. Objective: Our 3 objectives are to determine how many distinct clusters of time series there are for COVID-19 deaths in 3108 contiguous counties in the United States, how the clusters are geographically distributed, and what factors influence the probability of cluster membership. Methods: We proposed a 2-stage data analytic framework that can account for different levels of temporal aggregation for the pandemic outcomes and community-level predictors. Specifically, we used time-series clustering to identify clusters with similar outcome patterns for the 3108 contiguous US counties. Multinomial logistic regression was used to explain the relationship between community-level predictors and cluster assignment. We analyzed county-level confirmed COVID-19 deaths from Sunday, March 1, 2020, to Saturday, February 27, 2021. Results: Four distinct patterns of deaths were observed across the contiguous US counties. The multinomial regression model correctly classified 1904 (61.25%) of the counties? outbreak patterns/clusters. Conclusions: Our results provide evidence that county-level patterns of COVID-19 deaths are different and can be explained in part by social and political predictors. UR - https://publichealth.jmir.org/2022/7/e32164 UR - http://dx.doi.org/10.2196/32164 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476722 ID - info:doi/10.2196/32164 ER - TY - JOUR AU - Otridge, Jeremy AU - Ogden, L. Cynthia AU - Bernstein, T. Kyle AU - Knuth, Martha AU - Fishman, Julie AU - Brooks, T. John PY - 2022/7/15 TI - Publication and Impact of Preprints Included in the First 100 Editions of the CDC COVID-19 Science Update: Content Analysis JO - JMIR Public Health Surveill SP - e35276 VL - 8 IS - 7 KW - preprints KW - preprint KW - publishing KW - publish KW - bioRxiv KW - medRxiv KW - Centers for Disease Control and Prevention KW - CDC KW - preprint server KW - public health KW - health information KW - COVID-19 KW - pandemic KW - publication KW - Altmetric attention score KW - Altmetric KW - attention score KW - citation count KW - citation KW - science update KW - decision-making N2 - 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. UR - https://publichealth.jmir.org/2022/7/e35276 UR - http://dx.doi.org/10.2196/35276 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544426 ID - info:doi/10.2196/35276 ER - TY - JOUR AU - Garrett, M. Paul AU - White, P. Joshua AU - Dennis, Simon AU - Lewandowsky, Stephan AU - Yang, Cheng-Ta AU - Okan, Yasmina AU - Perfors, Andrew AU - Little, R. Daniel AU - Kozyreva, Anastasia AU - Lorenz-Spreen, Philipp AU - Kusumi, Takashi AU - Kashima, Yoshihisa PY - 2022/7/15 TI - Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys JO - JMIR Public Health Surveill SP - e32969 VL - 8 IS - 7 KW - COVID-19 KW - immunity passport KW - vaccination passport KW - cross-cultural KW - health policy KW - digital certificates KW - SARS-CoV-2 KW - vaccine KW - policy KW - international N2 - 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. UR - https://publichealth.jmir.org/2022/7/e32969 UR - http://dx.doi.org/10.2196/32969 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377317 ID - info:doi/10.2196/32969 ER - TY - JOUR AU - Hanson, L. Bridget AU - Finley, Kari AU - Otto, Jay AU - Ward, J. Nicholas PY - 2022/7/13 TI - Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study JO - JMIR Hum Factors SP - e37454 VL - 9 IS - 3 KW - behavioral beliefs KW - health literacy KW - vaccination KW - trusted sources KW - social media KW - vaccine hesitancy KW - health information KW - masking KW - healthcare KW - public health KW - health beliefs N2 - 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. UR - https://humanfactors.jmir.org/2022/3/e37454 UR - http://dx.doi.org/10.2196/37454 UR - http://www.ncbi.nlm.nih.gov/pubmed/35830238 ID - info:doi/10.2196/37454 ER - TY - JOUR AU - Tesfa, Aschalew Getanew AU - Yehualashet, Emwodew Delelegn AU - Ewune, Ali Helen AU - Zemeskel, Getnet Addisu AU - Kalayou, Hayelom Mulugeta AU - Seboka, Tariku Binyam PY - 2022/7/13 TI - eHealth Literacy and its Associated Factors Among Health Professionals During the COVID-19 Pandemic in Resource-Limited Settings: Cross-sectional Study JO - JMIR Form Res SP - e36206 VL - 6 IS - 7 KW - eHealth literacy KW - COVID-19 KW - health information KW - health literacy N2 - Background: The COVID-19 pandemic has wreaked havoc on health care systems and governments worldwide. Although eHealth literacy is acknowledged as a critical component of public health, it was overlooked during the pandemic. To assist patients and their families, health professionals should be knowledgeable about online health information resources and capable of evaluating relevant online information. In a resource-constrained situation, the level of eHealth literacy among health professionals is not well documented. Objective: The aim of this study was to assess the eHealth literacy level and its associated factors among health professionals working in Amhara regional state teaching hospitals, Ethiopia. Methods: A self-administered questionnaire was used in an institutional-based cross-sectional study design. Descriptive statistics were calculated to describe eHealth literacy statements and key variables using SPSS v.24. Bivariable and multivariable logistic regression models were fit to identify factors related to eHealth literacy. Variables with P<.05 were declared to be statistically significant predictors. Results: A total of 383 participants completed and returned the questionnaire with a response rate of 90.5%. Health professionals demonstrated a moderate level of eHealth literacy (mean 29.21). Most of the professionals were aware of the available health resources located on the internet, and know how to search and locate these resources. However, they lack the ability to distinguish high-quality health resources from low-quality resources. Factors that were significantly associated with eHealth literacy were computer access, computer knowledge, perceived ease of use, and perceived usefulness of eHealth information resources. Conclusions: It is crucial to provide training and support to health care workers on how to find, interpret, and, most importantly, evaluate the quality of health information found on the internet to improve their eHealth literacy level. Further research is needed to explore the role of eHealth literacy in mitigating pandemics in developing countries. UR - https://formative.jmir.org/2022/7/e36206 UR - http://dx.doi.org/10.2196/36206 UR - http://www.ncbi.nlm.nih.gov/pubmed/35737897 ID - info:doi/10.2196/36206 ER - TY - JOUR AU - Ishikawa, Tomoki AU - Sato, Jumpei AU - Hattori, Junko AU - Goda, Kazuo AU - Kitsuregawa, Masaru AU - Mitsutake, Naohiro PY - 2022/7/12 TI - The Association Between Telehealth Utilization and Policy Responses on COVID-19 in Japan: Interrupted Time-Series Analysis JO - Interact J Med Res SP - e39181 VL - 11 IS - 2 KW - telehealth KW - COVID-19 KW - health services research KW - interrupted time series N2 - Background: Telehealth using telephones or online communication is being promoted as a policy initiative in several countries. However, there is a lack of research on telehealth utilization in a country such as Japan that offers free access to medical care and regulates telehealth provision?particularly with respect to COVID-19. Objective: The present study aimed to clarify telehealth utilization, the characteristics of patients and medical institutions using telehealth, and the changes to telehealth in Japan in order to support the formulation of policy strategies for telehealth provision. Methods: Using a medical administrative claim database of the National Health Insurance and Advanced Elderly Medical Service System in Mie Prefecture, we investigated patients who used telehealth from January 2017 to September 2021. We examined telehealth utilization with respect to both patients and medical institutions, and we determined their characteristics. Using April 2020 as the reference time point for COVID-19, we conducted an interrupted time-series analysis (ITSA) to assess changes in the monthly proportion of telehealth users to beneficiaries. Results: The number of telehealth users before the reference time point was 13,618, and after the reference time point, it was 28,853. Several diseases and conditions were associated with an increase in telehealth utilization. Telehealth consultations were mostly conducted by telephone and for prescriptions. The ITSA results showed a sharp increase in the proportion of telehealth use to beneficiaries after the reference time point (rate ratio 2.97; 95% CI 2.14-2.31). However, no apparent change in the trend of increasing or decreasing telehealth use was evident after the reference time point (rate ratio 1.00; 95% CI 1.00-1.01). Conclusions: We observed a sharp increase in telehealth utilization after April 2020, but no change in the trend of telehealth use was evident. We identified changes in the characteristics of patients and providers using telehealth. UR - https://www.i-jmr.org/2022/2/e39181 UR - http://dx.doi.org/10.2196/39181 UR - http://www.ncbi.nlm.nih.gov/pubmed/35752952 ID - info:doi/10.2196/39181 ER - TY - JOUR AU - Xi, JuZhe AU - Gao, YuHan AU - Lyu, Na AU - She, Zhuang AU - Wang, XinYue AU - Zhang, Xin-An AU - Yu, XiaoYu AU - Ji, WeiDong AU - Wei, MengSheng AU - Dai, WeiHui AU - Qian, Xuesheng PY - 2022/7/8 TI - Effect of the ?Art Coloring? Online Coloring Game on Subjective Well-Being Increase and Anxiety Reduction During the COVID-19 Pandemic: Development and Evaluation JO - JMIR Serious Games SP - e37026 VL - 10 IS - 3 KW - coloring game KW - online intervention KW - mental health KW - COVID-19 pandemic KW - gamification KW - game-based intervention KW - commercially released game N2 - 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 ?2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ?2=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. UR - https://games.jmir.org/2022/3/e37026 UR - http://dx.doi.org/10.2196/37026 UR - http://www.ncbi.nlm.nih.gov/pubmed/35575761 ID - info:doi/10.2196/37026 ER - TY - JOUR AU - Jiang, Chao AU - Ngo, Victoria AU - Chapman, Richard AU - Yu, Yue AU - Liu, Hongfang AU - Jiang, Guoqian AU - Zong, Nansu PY - 2022/7/6 TI - Deep Denoising of Raw Biomedical Knowledge Graph From COVID-19 Literature, LitCovid, and Pubtator: Framework Development and Validation JO - J Med Internet Res SP - e38584 VL - 24 IS - 7 KW - adversarial generative network KW - knowledge graph KW - deep denoising KW - machine learning KW - COVID-19 KW - biomedical KW - neural network KW - network model KW - training data N2 - Background: Multiple types of biomedical associations of knowledge graphs, including COVID-19?related ones, are constructed based on co-occurring biomedical entities retrieved from recent literature. However, the applications derived from these raw graphs (eg, association predictions among genes, drugs, and diseases) have a high probability of false-positive predictions as co-occurrences in the literature do not always mean there is a true biomedical association between two entities. Objective: Data quality plays an important role in training deep neural network models; however, most of the current work in this area has been focused on improving a model?s performance with the assumption that the preprocessed data are clean. Here, we studied how to remove noise from raw knowledge graphs with limited labeled information. Methods: The proposed framework used generative-based deep neural networks to generate a graph that can distinguish the unknown associations in the raw training graph. Two generative adversarial network models, NetGAN and Cross-Entropy Low-rank Logits (CELL), were adopted for the edge classification (ie, link prediction), leveraging unlabeled link information based on a real knowledge graph built from LitCovid and Pubtator. Results: The performance of link prediction, especially in the extreme case of training data versus test data at a ratio of 1:9, demonstrated that the proposed method still achieved favorable results (area under the receiver operating characteristic curve >0.8 for the synthetic data set and 0.7 for the real data set), despite the limited amount of testing data available. Conclusions: Our preliminary findings showed the proposed framework achieved promising results for removing noise during data preprocessing of the biomedical knowledge graph, potentially improving the performance of downstream applications by providing cleaner data. UR - https://www.jmir.org/2022/7/e38584 UR - http://dx.doi.org/10.2196/38584 UR - http://www.ncbi.nlm.nih.gov/pubmed/35658098 ID - info:doi/10.2196/38584 ER - TY - JOUR AU - Francombe, Joseph AU - Ali, Gemma-Claire AU - Gloinson, Ryen Emily AU - Feijao, Carolina AU - Morley, I. Katherine AU - Gunashekar, Salil AU - de Carvalho Gomes, Helena PY - 2022/7/6 TI - 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 JO - JMIR Public Health Surveill SP - e34605 VL - 8 IS - 7 KW - digital technologies KW - COVID-19 KW - key public health functions KW - scoping review KW - digital health KW - pandemic KW - surveillance KW - mobile phone N2 - 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. UR - https://publichealth.jmir.org/2022/7/e34605 UR - http://dx.doi.org/10.2196/34605 UR - http://www.ncbi.nlm.nih.gov/pubmed/35605152 ID - info:doi/10.2196/34605 ER - TY - JOUR AU - Pugmire, Juliana AU - Lever Taylor, Jessie AU - Wilkes, Matt AU - Wolfberg, Adam AU - Zahradka, Nicole PY - 2022/7/5 TI - Participant Experiences of a COVID-19 Virtual Clinical Study Using the Current Health Remote Monitoring Platform: Case Study and Qualitative Analysis JO - JMIR Form Res SP - e37567 VL - 6 IS - 7 KW - virtual trial designs KW - virtual enrollment KW - digitalized health KW - theoretical domains framework KW - thematic analysis KW - remote patient monitoring N2 - Background: During the COVID-19 pandemic, individuals with a positive viral test were enrolled in a study, within 48 hours, to remotely monitor their vital signs to characterize disease progression and recovery. A virtual trial design was adopted to reduce risks to participants and the research community in a study titled Risk Stratification and Early Alerting Regarding COVID-19 Hospitalization (RiskSEARCH). The Food and Drug Administration?cleared Current Health platform with a wearable device is a continuous remote patient monitoring technology that supports hospital-at-home care and is used as a data collection tool. Enrolled participants wore the Current Health wearable device continuously for up to 30 days and took a daily symptom survey via a tablet that was provided. A qualitative substudy was conducted in parallel to better understand virtual trial implementation, including barriers and facilitators for participants. Objective: This study aimed to understand the barriers and facilitators of the user experience of interacting with a virtual care platform and research team, while participating in a fully virtual study using qualitative and quantitative data. Methods: Semistructured interviews were conducted to understand participants? experience of participating in a virtual study during a global pandemic. The schedule included their experience of enrollment and their interactions with equipment and study staff. A total of 3 RiskSEARCH participants were interviewed over telephone, and transcriptions were inductively coded and analyzed using thematic analysis. Themes were mapped onto the Theoretical Domains Framework (TDF) to identify and describe the factors that influenced study adherence. Quantitative metrics, including adherence to wearable and scheduled tasks collected as part of the RiskSEARCH main study, were paired with the interviews to present an overall picture of participation. Results: All participants exceeded our definition of a fully adherent participant and reported that participation was feasible and had a low burden. The symptoms progressively resolved during the trial. Inductive thematic analysis identified 13 main themes from the interview data, which were deductively mapped onto 11 of the 14 TDF domains, highlighting barriers and facilitators for each. Conclusions: Participants in the RiskSEARCH substudy showed high levels of adherence and engagement throughout participation. Although participants experienced some challenges in setting up and maintaining the Current Health kit (eg, charging devices), they reported feeling that the requirements of participation were both reasonable and realistic. We demonstrated that the TDF can be used for inductive thematic analysis. We anticipate expanding this work in future virtual studies and trials to identify barriers and enabling factors for implementation. UR - https://formative.jmir.org/2022/7/e37567 UR - http://dx.doi.org/10.2196/37567 UR - http://www.ncbi.nlm.nih.gov/pubmed/35671408 ID - info:doi/10.2196/37567 ER - TY - JOUR AU - Sargent, H. Rikki AU - Laurie, Shaelyn AU - Weakland, F. Leo AU - Lavery, V. James AU - Salmon, A. Daniel AU - Orenstein, A. Walter AU - Breiman, F. Robert PY - 2022/7/1 TI - Use of Random Domain Intercept Technology to Track COVID-19 Vaccination Rates in Real Time Across the United States: Survey Study JO - J Med Internet Res SP - e37920 VL - 24 IS - 7 KW - COVID-19 KW - vaccination rates KW - Random Domain Intercept Technology KW - health technology KW - vaccination KW - vaccine tracker KW - web-based survey KW - epidemiology KW - health data KW - digital tool KW - online intercept sampling KW - health service N2 - 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. UR - https://www.jmir.org/2022/7/e37920 UR - http://dx.doi.org/10.2196/37920 UR - http://www.ncbi.nlm.nih.gov/pubmed/35709335 ID - info:doi/10.2196/37920 ER - TY - JOUR AU - Yao, Yan AU - Chai, Ruiyu AU - Yang, Jianzhou AU - Zhang, Xiangjun AU - Huang, Xiaojie AU - Yu, Maohe AU - Fu, Geng-feng AU - Lan, Guanghua AU - Qiao, Ying AU - Zhou, Qidi AU - Li, Shuyue AU - Xu, Junjie PY - 2022/6/30 TI - Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis JO - JMIR Public Health Surveill SP - e33995 VL - 8 IS - 6 KW - COVID-19 vaccine KW - vaccine hesitancy KW - PLWHA KW - structural equation modeling N2 - 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. UR - https://publichealth.jmir.org/2022/6/e33995 UR - http://dx.doi.org/10.2196/33995 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486810 ID - info:doi/10.2196/33995 ER - TY - JOUR AU - Hagen, Loni AU - Fox, Ashley AU - O'Leary, Heather AU - Dyson, DeAndre AU - Walker, Kimberly AU - Lengacher, A. Cecile AU - Hernandez, Raquel PY - 2022/6/30 TI - The Role of Influential Actors in Fostering the Polarized COVID-19 Vaccine Discourse on Twitter: Mixed Methods of Machine Learning and Inductive Coding JO - JMIR Infodemiology SP - e34231 VL - 2 IS - 1 KW - COVID-19, vaccine hesitancy, social media, influential actors KW - influencer KW - Twitter N2 - Background: Since COVID-19 vaccines became broadly available to the adult population, sharp divergences in uptake have emerged along partisan lines. Researchers have indicated a polarized social media presence contributing to the spread of mis- or disinformation as being responsible for these growing partisan gaps in uptake. Objective: The major aim of this study was to investigate the role of influential actors in the context of the community structures and discourse related to COVID-19 vaccine conversations on Twitter that emerged prior to the vaccine rollout to the general population and discuss implications for vaccine promotion and policy. Methods: We collected tweets on COVID-19 between July 1, 2020, and July 31, 2020, a time when attitudes toward the vaccines were forming but before the vaccines were widely available to the public. Using network analysis, we identified different naturally emerging Twitter communities based on their internal information sharing. A PageRank algorithm was used to quantitively measure the level of ?influentialness? of Twitter accounts and identifying the ?influencers,? followed by coding them into different actor categories. Inductive coding was conducted to describe discourses shared in each of the 7 communities. Results: Twitter vaccine conversations were highly polarized, with different actors occupying separate ?clusters.? The antivaccine cluster was the most densely connected group. Among the 100 most influential actors, medical experts were outnumbered both by partisan actors and by activist vaccine skeptics or conspiracy theorists. Scientists and medical actors were largely absent from the conservative network, and antivaccine sentiment was especially salient among actors on the political right. Conversations related to COVID-19 vaccines were highly polarized along partisan lines, with ?trust? in vaccines being manipulated to the political advantage of partisan actors. Conclusions: These findings are informative for designing improved vaccine information communication strategies to be delivered on social media especially by incorporating influential actors. Although polarization and echo chamber effect are not new in political conversations in social media, it was concerning to observe these in health conversations on COVID-19 vaccines during the vaccine development process. UR - https://infodemiology.jmir.org/2022/1/e34231 UR - http://dx.doi.org/10.2196/34231 UR - http://www.ncbi.nlm.nih.gov/pubmed/35814809 ID - info:doi/10.2196/34231 ER - TY - JOUR AU - Grygarová, Dominika AU - Adámek, Petr AU - Jurí?ková, Veronika AU - Horá?ek, Ji?í AU - Bak?tein, Eduard AU - Fajnerová, Iveta AU - Kesner, Ladislav PY - 2022/6/28 TI - Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study JO - JMIR Ment Health SP - e36050 VL - 9 IS - 6 KW - mental health KW - COVID-19 KW - lockdown KW - media use KW - anxiety KW - depression KW - nationally representative data KW - survey KW - longitudinal study KW - pandemic KW - social isolation KW - social media KW - psychological trauma KW - mental stress KW - media news N2 - 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. UR - https://mental.jmir.org/2022/6/e36050 UR - http://dx.doi.org/10.2196/36050 UR - http://www.ncbi.nlm.nih.gov/pubmed/35605112 ID - info:doi/10.2196/36050 ER - TY - JOUR AU - Laur, Celia AU - Agarwal, Payal AU - Thai, Kelly AU - Kishimoto, Vanessa AU - Kelly, Shawna AU - Liang, Kyle AU - Bhatia, Sacha R. AU - Bhattacharyya, Onil AU - Martin, Danielle AU - Mukerji, Geetha PY - 2022/6/28 TI - Implementation and Evaluation of COVIDCare@Home, a Family Medicine?Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study JO - JMIR Hum Factors SP - e35091 VL - 9 IS - 2 KW - virtual care KW - COVID-19 pandemic KW - remote monitoring programs KW - social determinants of health KW - digital health KW - COVID-19 KW - pandemic KW - health care KW - remote monitoring KW - clinical outcome KW - patient KW - health care cost KW - patient experience N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35091 UR - http://dx.doi.org/10.2196/35091 UR - http://www.ncbi.nlm.nih.gov/pubmed/35499974 ID - info:doi/10.2196/35091 ER - TY - JOUR AU - Ayala, George AU - Arreola, Sonya AU - Howell, Sean AU - Hoffmann, J. Thomas AU - Santos, Glenn-Milo PY - 2022/6/27 TI - Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Data Sets from Two Global Online Surveys Via File Concatenation With Adjusted Weights JO - JMIR Public Health Surveill SP - e33538 VL - 8 IS - 6 KW - COVID-19 KW - HIV services KW - gay and bisexual men KW - sexual health N2 - Background: Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may be complicating efforts to prevent new HIV infections, reduce AIDS-related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men?s ability to access services is not fully understood. Objective: The aim of this study was to understand access to HIV services at the start of the COVID-19 pandemic. Methods: Our study used data collected from two independent global online surveys conducted with convenience samples of gay and bisexual men. Both data sets had common demographic measurements; however, only the COVID-19 Disparities Survey (n=13,562) collected the outcomes of interest (HIV services access at the height of the first COVID-19 wave) and only the Global Men?s Health and Rights Survey 4 (GMHR-4; n=6188) gathered pre-COVID-19 pandemic exposures/covariates of interest (social/structural enablers of and barriers to HIV services access). We used data fusion methods to combine these data sets utilizing overlapping demographic variables and assessed relationships between exposures and outcomes. We hypothesized that engagement with the gay community and comfort with one?s health care provider would be positively associated with HIV services access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a health care provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. Results: With 19,643 observations after combining data sets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (regression coefficient=0.81, 95% CI 0.75 to 0.86; P<.001), while sexual stigma was negatively associated with access to HIV treatment (coefficient=?1.39, 95% CI ?1.42 to ?1.36; P<.001). Conclusions: HIV services access for gay and bisexual men remained obstructed and perhaps became worse during the first wave of the COVID-19 pandemic. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual men worldwide. UR - https://publichealth.jmir.org/2022/6/e33538 UR - http://dx.doi.org/10.2196/33538 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377321 ID - info:doi/10.2196/33538 ER - TY - JOUR AU - Saini, Vipin AU - Liang, Li-Lin AU - Yang, Yu-Chen AU - Le, Mai Huong AU - Wu, Chun-Ying PY - 2022/6/27 TI - The Association Between Dissemination and Characteristics of Pro-/Anti-COVID-19 Vaccine Messages on Twitter: Application of the Elaboration Likelihood Model JO - JMIR Infodemiology SP - e37077 VL - 2 IS - 1 KW - COVID-19 KW - Twitter KW - provaccine KW - antivaccine KW - elaboration likelihood model KW - infodemiology KW - dissemination KW - content analysis KW - emotional valence KW - social media N2 - Background: Messages on one?s stance toward vaccination on microblogging sites may affect the reader?s decision on whether to receive a vaccine. Understanding the dissemination of provaccine and antivaccine messages relating to COVID-19 on social media is crucial; however, studies on this topic have remained limited. Objective: This study applies the elaboration likelihood model (ELM) to explore the characteristics of vaccine stance messages that may appeal to Twitter users. First, we examined the associations between the characteristics of vaccine stance tweets and the likelihood and number of retweets. Second, we identified the relative importance of the central and peripheral routes in decision-making on sharing a message. Methods: English-language tweets from the United States that contained provaccine and antivaccine hashtags (N=150,338) were analyzed between April 26 and August 26, 2021. Logistic and generalized negative binomial regressions were conducted to predict retweet outcomes. The content-related central-route predictors were measured using the numbers of hashtags and mentions, emotional valence, emotional intensity, and concreteness. The content-unrelated peripheral-route predictors were measured using the numbers of likes and followers and whether the source was a verified user. Results: Content-related characteristics played a prominent role in shaping decisions regarding whether to retweet antivaccine messages. Particularly, positive valence (incidence rate ratio [IRR]=1.32, P=.03) and concreteness (odds ratio [OR]=1.17, P=.01) were associated with higher numbers and likelihood of retweets of antivaccine messages, respectively; emotional intensity (subjectivity) was associated with fewer retweets of antivaccine messages (OR=0.78, P=.03; IRR=0.80, P=.04). However, these factors had either no or only small effects on the sharing of provaccine tweets. Retweets of provaccine messages were primarily determined by content-unrelated characteristics, such as the numbers of likes (OR=2.55, IRR=2.24, P<.001) and followers (OR=1.31, IRR=1.28, P<.001). Conclusions: The dissemination of antivaccine messages is associated with both content-related and content-unrelated characteristics. By contrast, the dissemination of provaccine messages is primarily driven by content-unrelated characteristics. These findings signify the importance of leveraging the peripheral route to promote the dissemination of provaccine messages. Because antivaccine tweets with positive emotions, objective content, and concrete words are more likely to be disseminated, policymakers should pay attention to antivaccine messages with such characteristics. UR - https://infodemiology.jmir.org/2022/1/e37077 UR - http://dx.doi.org/10.2196/37077 UR - http://www.ncbi.nlm.nih.gov/pubmed/35783451 ID - info:doi/10.2196/37077 ER - TY - JOUR AU - Zhao, Xixi AU - Li, Meijia AU - Haihambo, Naem AU - Jin, Jianhua AU - Zeng, Yimeng AU - Qiu, Jinyi AU - Guo, Mingrou AU - Zhu, Yuyao AU - Li, Zhirui AU - Liu, Jiaxin AU - Teng, Jiayi AU - Li, Sixiao AU - Zhao, Ya-nan AU - Cao, Yanxiang AU - Wang, Xuemei AU - Li, Yaqiong AU - Gao, Michel AU - Feng, Xiaoyang AU - Han, Chuanliang PY - 2022/6/23 TI - Changes in Temporal Properties of Notifiable Infectious Disease Epidemics in China During the COVID-19 Pandemic: Population-Based Surveillance Study JO - JMIR Public Health Surveill SP - e35343 VL - 8 IS - 6 KW - class B infectious disease KW - COVID-19 KW - event-related trough KW - infection selectivity KW - oscillation KW - public health interventions KW - pandemic KW - surveillance KW - health policy KW - epidemiology KW - prevention policy KW - public health KW - risk prevention N2 - 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. UR - https://publichealth.jmir.org/2022/6/e35343 UR - http://dx.doi.org/10.2196/35343 UR - http://www.ncbi.nlm.nih.gov/pubmed/35649394 ID - info:doi/10.2196/35343 ER - TY - JOUR AU - Sakur, Fareeya AU - Ward, Kanesha AU - Khatri, Nafees Neha AU - Lau, S. Annie Y. PY - 2022/6/21 TI - Self-care Behaviors and Technology Used During COVID-19: Systematic Review JO - JMIR Hum Factors SP - e35173 VL - 9 IS - 2 KW - self-care KW - self-management KW - chronic conditions KW - COVID-19 KW - pandemic KW - technology KW - digital health KW - telehealth KW - health technology N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35173 UR - http://dx.doi.org/10.2196/35173 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442904 ID - info:doi/10.2196/35173 ER - TY - JOUR AU - Ritschl, Valentin AU - Eibensteiner, Fabian AU - Mosor, Erika AU - Omara, Maisa AU - Sperl, Lisa AU - Nawaz, A. Faisal AU - Siva Sai, Chandragiri AU - Cenanovic, Merisa AU - Devkota, Prasad Hari AU - Hribersek, Mojca AU - De, Ronita AU - Klager, Elisabeth AU - Schaden, Eva AU - Kletecka-Pulker, Maria AU - Völkl-Kernstock, Sabine AU - Willschke, Harald AU - Aufricht, Christoph AU - Atanasov, G. Atanas AU - Stamm, Tanja PY - 2022/6/21 TI - Mandatory Vaccination Against COVID-19: Twitter Poll Analysis on Public Health Opinion JO - JMIR Form Res SP - e35754 VL - 6 IS - 6 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - vaccination KW - Twitter KW - survey KW - mandatory vaccination KW - vaccination hesitancy KW - coronavirus KW - hesitancy KW - social media KW - questionnaire KW - mandatory KW - support KW - poll KW - opinion KW - public health KW - perception N2 - Background: On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective: The purpose of this study was to better understand the public?s perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods: Two Twitter polls were developed (in the English language) to seek the public?s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform?s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results: Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions: Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the ?echo chamber effect,? the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity. UR - https://formative.jmir.org/2022/6/e35754 UR - http://dx.doi.org/10.2196/35754 UR - http://www.ncbi.nlm.nih.gov/pubmed/35617671 ID - info:doi/10.2196/35754 ER - TY - JOUR AU - Zhao, Yuehua AU - Zhu, Sicheng AU - Wan, Qiang AU - Li, Tianyi AU - Zou, Chun AU - Wang, Hao AU - Deng, Sanhong PY - 2022/6/20 TI - Understanding How and by Whom COVID-19 Misinformation is Spread on Social Media: Coding and Network Analyses JO - J Med Internet Res SP - e37623 VL - 24 IS - 6 KW - health misinformation KW - COVID-19 KW - social media KW - misinformation spread KW - infodemiology KW - global health crisis KW - misinformation KW - theoretical model KW - medical information KW - epidemic KW - pandemic N2 - Background: During global health crises such as the COVID-19 pandemic, rapid spread of misinformation on social media has occurred. The misinformation associated with COVID-19 has been analyzed, but little attention has been paid to developing a comprehensive analytical framework to study its spread on social media. Objective: We propose an elaboration likelihood model?based theoretical model to understand the persuasion process of COVID-19?related misinformation on social media. Methods: The proposed model incorporates the central route feature (content feature) and peripheral features (including creator authority, social proof, and emotion). The central-level COVID-19?related misinformation feature includes five topics: medical information, social issues and people?s livelihoods, government response, epidemic spread, and international issues. First, we created a data set of COVID-19 pandemic?related misinformation based on fact-checking sources and a data set of posts that contained this misinformation on real-world social media. Based on the collected posts, we analyzed the dissemination patterns. Results: Our data set included 11,450 misinformation posts, with medical misinformation as the largest category (n=5359, 46.80%). Moreover, the results suggest that both the least (4660/11,301, 41.24%) and most (2320/11,301, 20.53%) active users are prone to sharing misinformation. Further, posts related to international topics that have the greatest chance of producing a profound and lasting impact on social media exhibited the highest distribution depth (maximum depth=14) and width (maximum width=2355). Additionally, 97.00% (2364/2437) of the spread was characterized by radiation dissemination. Conclusions: Our proposed model and findings could help to combat the spread of misinformation by detecting suspicious users and identifying propagation characteristics. UR - https://www.jmir.org/2022/6/e37623 UR - http://dx.doi.org/10.2196/37623 UR - http://www.ncbi.nlm.nih.gov/pubmed/35671411 ID - info:doi/10.2196/37623 ER - TY - JOUR AU - Castilla-Puentes, Ruby AU - Pesa, Jacqueline AU - Brethenoux, Caroline AU - Furey, Patrick AU - Gil Valletta, Liliana AU - Falcone, Tatiana PY - 2022/6/20 TI - Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre- and Mid-COVID-19: Descriptive Analysis JO - JMIR Form Res SP - e33637 VL - 6 IS - 6 KW - depression KW - COVID-19 KW - treatment KW - race/ethnicity KW - digital conversations KW - health belief model KW - artificial intelligence KW - natural language processing N2 - 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. UR - https://formative.jmir.org/2022/6/e33637 UR - http://dx.doi.org/10.2196/33637 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275834 ID - info:doi/10.2196/33637 ER - TY - JOUR AU - Vilendrer, Stacie AU - Lough, E. Mary AU - Garvert, W. Donn AU - Lambert, H. Monique AU - Lu, Hsijing Jonathan AU - Patel, Birju AU - Shah, H. Nigam AU - Williams, Y. Michelle AU - Kling, R. Samantha M. PY - 2022/6/17 TI - Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System JO - J Med Internet Res SP - e36882 VL - 24 IS - 6 KW - telemedicine KW - telehealth KW - informatics KW - real-time locating system KW - COVID-19 KW - pandemic KW - nursing KW - patient safety KW - PPE KW - virtual care KW - nurses KW - patient outcomes KW - pathogen exposure KW - health risk KW - health care staff KW - health care professional N2 - 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. UR - https://www.jmir.org/2022/6/e36882 UR - http://dx.doi.org/10.2196/36882 UR - http://www.ncbi.nlm.nih.gov/pubmed/35635840 ID - info:doi/10.2196/36882 ER - TY - JOUR AU - Li, Jingwei AU - Huang, Wei AU - Sia, Ling Choon AU - Chen, Zhuo AU - Wu, Tailai AU - Wang, Qingnan PY - 2022/6/16 TI - 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 JO - JMIR Public Health Surveill SP - e35266 VL - 8 IS - 6 KW - SARS-CoV-2 KW - COVID 19 KW - epidemic forecasting KW - disease surveillance KW - infectious disease epidemiology KW - social medial KW - online news KW - search query KW - autoregression model N2 - 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. UR - https://publichealth.jmir.org/2022/6/e35266 UR - http://dx.doi.org/10.2196/35266 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507921 ID - info:doi/10.2196/35266 ER - TY - JOUR AU - Herbert, Carly AU - Kheterpal, Vik AU - Suvarna, Thejas AU - Broach, John AU - Marquez, Luis Juan AU - Gerber, Ben AU - Schrader, Summer AU - Nowak, Christopher AU - Harman, Emma AU - Heetderks, William AU - Fahey, Nisha AU - Orvek, Elizabeth AU - Lazar, Peter AU - Ferranto, Julia AU - Noorishirazi, Kamran AU - Valpady, Shivakumar AU - Shi, Qiming AU - Lin, Honghuang AU - Marvel, Kathryn AU - Gibson, Laura AU - Barton, Bruce AU - Lemon, Stephenie AU - Hafer, Nathaniel AU - McManus, David AU - Soni, Apurv PY - 2022/6/16 TI - Design and Preliminary Findings of Adherence to the Self-Testing for Our Protection From COVID-19 (STOP COVID-19) Risk-Based Testing Protocol: Prospective Digital Study JO - JMIR Form Res SP - e38113 VL - 6 IS - 6 KW - COVID-19 KW - rapid antigen tests KW - COVID-19 testing KW - infectious disease KW - disease spread KW - prevention KW - coronavirus KW - adherence KW - reporting KW - mHealth KW - health application KW - mobile health KW - digital health KW - public health KW - surveillance KW - health care KW - smartphone app KW - vaccination KW - digital surveillance N2 - Background: Serial testing for SARS-CoV-2 is recommended to reduce spread of the virus; however, little is known about adherence to recommended testing schedules and reporting practices to health departments. Objective: The Self-Testing for Our Protection from COVID-19 (STOP COVID-19) study aims to examine adherence to a risk-based COVID-19 testing strategy using rapid antigen tests and reporting of test results to health departments. Methods: STOP COVID-19 is a 12-week digital study, facilitated using a smartphone app for testing assistance and reporting. We are recruiting 20,000 participants throughout the United States. Participants are stratified into high- and low-risk groups based on history of COVID-19 infection and vaccination status. High-risk participants are instructed to perform twice-weekly testing for COVID-19 using rapid antigen tests, while low-risk participants test only in the case of symptoms or exposure to COVID-19. All participants complete COVID-19 surveillance surveys, and rapid antigen results are recorded within the smartphone app. Primary outcomes include participant adherence to a risk-based serial testing protocol and percentage of rapid tests reported to health departments. Results: As of February 2022, 3496 participants have enrolled, including 1083 high-risk participants. Out of 13,730 tests completed, participants have reported 13,480 (98.18%, 95% CI 97.9%-98.4%) results to state public health departments with full personal identifying information or anonymously. Among 622 high-risk participants who finished the study period, 35.9% showed high adherence to the study testing protocol. Participants with high adherence reported a higher percentage of test results to the state health department with full identifying information than those in the moderate- or low-adherence groups (high: 71.7%, 95% CI 70.3%-73.1%; moderate: 68.3%, 95% CI 66.0%-70.5%; low: 63.1%, 59.5%-66.6%). Conclusions: Preliminary results from the STOP COVID-19 study provide important insights into rapid antigen test reporting and usage, and can thus inform the use of rapid testing interventions for COVID-19 surveillance. UR - https://formative.jmir.org/2022/6/e38113 UR - http://dx.doi.org/10.2196/38113 UR - http://www.ncbi.nlm.nih.gov/pubmed/35649180 ID - info:doi/10.2196/38113 ER - TY - JOUR AU - Khuntia, Jiban AU - Mejia, J. Frances AU - Ning, Xue AU - Helton, Jeff AU - Stacey, Rulon PY - 2022/6/15 TI - Integration vs Collaborative Redesign Strategies of Health Systems? Supply Chains in the Post-COVID-19 New Normal: Cross-sectional Survey Across the United States JO - JMIR Form Res SP - e35317 VL - 6 IS - 6 KW - COVID-19 KW - post-COVID-19 KW - health systems KW - supply chain integration KW - supply chain collaboration KW - supply chain resilience N2 - Background: Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, questions such as how health systems are shaping strategies to restore the supply chain disruptions are essential to have confidence in health systems? supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. Objective: This study focuses on teasing out the nuance of supply chain integration versus collaborative redesign strategies for health systems in the post-COVID-19 new normal. We focus on 2 research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems? supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. 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 health system CEOs contacted, 135 (21.6%) responded to our survey. We considered supply chain?relevant strategy and outcome variables 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 from the 124 health systems. Next, we used ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. Results: Health systems with higher disruptions would choose integration (positive, P<.001) over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes (P<.01), while collaborations are perceived to lead to greater growth opportunities (P<.05); however, the role of integration in growth is not entirely ruled out (combined model, P<.001). Plausibly, some health systems would choose integration and collaborative redesign models, which have a significant relationship with both services (combined model, P<.01) and growth, establishing the importance of mixed strategies for health systems. Conclusions: The cost of health care continues to rise, and supply-related costs constitute a large portion of a hospital?s expenditure. Understanding supply chain strategic choices are essential for a health system?s success. Although collaboration is an option, focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems. UR - https://formative.jmir.org/2022/6/e35317 UR - http://dx.doi.org/10.2196/35317 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452405 ID - info:doi/10.2196/35317 ER - TY - JOUR AU - Urbanin, Gabriel AU - Meira, Wagner AU - Serpa, Alexandre AU - Costa, Souza Danielle de AU - Baldaçara, Leonardo AU - da Silva, Paula Ana AU - Guatimosim, Rafaela AU - Lacerda, Mendes Anísio AU - Oliveira, Araújo Eduardo AU - Braule, Andre AU - Romano-Silva, Aurélio Marco AU - da Silva, Geraldo Antônio AU - Malloy-Diniz, Leandro AU - Pappa, Gisele AU - Miranda, Marques Débora PY - 2022/6/15 TI - Social Determinants in Self-Protective Behavior Related to COVID-19: Association Rule?Mining Study JO - JMIR Public Health Surveill SP - e34020 VL - 8 IS - 6 KW - social determinants KW - data mining KW - self-protective behavior KW - COVID-19 KW - protection KW - behavior KW - sanitation KW - characteristic KW - Brazil KW - compliance KW - public health KW - policy KW - mask KW - risk N2 - Background: Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks. Objective: Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil. Methods: We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern?mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports. Results: The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic. Conclusions: Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions. Trial Registration: Not applicable. UR - https://publichealth.jmir.org/2022/6/e34020 UR - http://dx.doi.org/10.2196/34020 UR - http://www.ncbi.nlm.nih.gov/pubmed/35704360 ID - info:doi/10.2196/34020 ER - TY - JOUR AU - McCrady, Emma AU - Strychowsky, E. Julie AU - Woolfson, P. Jessica PY - 2022/6/15 TI - Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study JO - JMIR Pediatr Parent SP - e34115 VL - 5 IS - 2 KW - virtual care KW - web-based care KW - COVID-19 KW - pediatrics KW - pandemic KW - physicians KW - digital health KW - pediatricians KW - telehealth N2 - 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. UR - https://pediatrics.jmir.org/2022/2/e34115 UR - http://dx.doi.org/10.2196/34115 UR - http://www.ncbi.nlm.nih.gov/pubmed/35666938 ID - info:doi/10.2196/34115 ER - TY - JOUR AU - Nordtug, Maja AU - Assing Hvidt, Elisabeth AU - Lüchau, Christine Elle AU - Grønning, Anette PY - 2022/6/14 TI - General Practitioners? Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study JO - JMIR Form Res SP - e36289 VL - 6 IS - 6 KW - video consultation technology KW - general practice, COVID-19, doctor-patient communication KW - uncertainties KW - general practitioners KW - video consultation KW - virtual health KW - physician KW - digital health KW - pandemic N2 - 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. UR - https://formative.jmir.org/2022/6/e36289 UR - http://dx.doi.org/10.2196/36289 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653607 ID - info:doi/10.2196/36289 ER - TY - JOUR AU - Downie, Andrew AU - Mashanya, Titus AU - Chipwaza, Beatrice AU - Griffiths, Frances AU - Harris, Bronwyn AU - Kalolo, Albino AU - Ndegese, Sylvester AU - Sturt, Jackie AU - De Valliere, Nicole AU - Pemba, Senga PY - 2022/6/14 TI - Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic JO - JMIR Form Res SP - e32964 VL - 6 IS - 6 KW - remote consultation KW - mobile consulting KW - digital health KW - telehealth KW - mHealth KW - eHealth KW - mobile health KW - health care KW - cascade KW - train the trainer KW - low- and middle-income countries KW - rural areas KW - Tanzania KW - Kirkpatrick KW - consultation KW - training KW - low- and middle-income KW - rural KW - COVID-19 N2 - Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania?s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees? behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. UR - https://formative.jmir.org/2022/6/e32964 UR - http://dx.doi.org/10.2196/32964 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507772 ID - info:doi/10.2196/32964 ER - TY - JOUR AU - Riddell, A. Corinne AU - Neumann, Krista AU - Santaularia, Jeanie N. AU - Farkas, Kriszta AU - Ahern, Jennifer AU - Mason, M. Susan PY - 2022/6/13 TI - Excess Google Searches for Child Abuse and Intimate Partner Violence During the COVID-19 Pandemic: Infoveillance Approach JO - J Med Internet Res SP - e36445 VL - 24 IS - 6 KW - child abuse KW - household violence KW - infoveillance KW - violence KW - domestic violence KW - abuse KW - Google KW - COVID-19 N2 - Background: The COVID-19 pandemic has created environments with increased risk factors for household violence, such as unemployment and financial uncertainty. At the same time, it led to the introduction of policies to mitigate financial uncertainty. Further, it hindered traditional measurements of household violence. Objective: Using an infoveillance approach, our goal was to determine if there were excess Google searches related to exposure to child abuse, intimate partner violence (IPV), and child-witnessed IPV during the COVID-19 pandemic and if any excesses are temporally related to shelter-in-place and economic policies. Methods: Data on relative search volume for each violence measure was extracted using the Google Health Trends application programming interface for each week from 2017 to 2020 for the United States. Using linear regression with restricted cubic splines, we analyzed data from 2017 to 2019 to characterize the seasonal variation shared across prepandemic years. Parameters from prepandemic years were used to predict the expected number of Google searches and 95% prediction intervals (PI) for each week in 2020. Weeks with searches above the upper bound of the PI are in excess of the model?s prediction. Results: Relative search volume for exposure to child abuse was greater than expected in 2020, with 19% (10/52) of the weeks falling above the upper bound of the PI. These excesses in searches began a month after the Pandemic Unemployment Compensation program ended. Relative search volume was also heightened in 2020 for child-witnessed IPV, with 33% (17/52) of the weeks falling above the upper bound of the PI. This increase occurred after the introduction of shelter-in-place policies. Conclusions: Social and financial disruptions, which are common consequences of major disasters such as the COVID-19 pandemic, may increase risks for child abuse and child-witnessed IPV. UR - https://www.jmir.org/2022/6/e36445 UR - http://dx.doi.org/10.2196/36445 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700024 ID - info:doi/10.2196/36445 ER - TY - JOUR AU - Johnson, K. Randi AU - Marker, M. Katie AU - Mayer, David AU - Shortt, Jonathan AU - Kao, David AU - Barnes, C. Kathleen AU - Lowery, T. Jan AU - Gignoux, R. Christopher PY - 2022/6/13 TI - COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study JO - JMIR Public Health Surveill SP - e37327 VL - 8 IS - 6 KW - COVID-19 KW - surveillance KW - pandemic KW - biobank KW - EHR KW - public health KW - integrated data KW - population health KW - health monitoring KW - electronic health record KW - eHealth KW - health record KW - emergency response KW - vaccination status KW - vaccination KW - testing KW - symptom KW - disease impact N2 - 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. UR - https://publichealth.jmir.org/2022/6/e37327 UR - http://dx.doi.org/10.2196/37327 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486493 ID - info:doi/10.2196/37327 ER - TY - JOUR AU - Sousa, Sonia AU - Kalju, Tiina PY - 2022/6/13 TI - Modeling Trust in COVID-19 Contact-Tracing Apps Using the Human-Computer Trust Scale: Online Survey Study JO - JMIR Hum Factors SP - e33951 VL - 9 IS - 2 KW - human-computer interaction KW - COVID-19 KW - human factors KW - trustworthy AI KW - contact-tracing KW - app KW - safety KW - trust KW - artificial intelligence KW - Estonia KW - case study KW - monitoring KW - surveillance KW - perspective KW - awareness KW - design KW - covid KW - mobile app KW - mHealth KW - mobile health N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e33951 UR - http://dx.doi.org/10.2196/33951 UR - http://www.ncbi.nlm.nih.gov/pubmed/35699973 ID - info:doi/10.2196/33951 ER - TY - JOUR AU - Goncalves, Aurelie AU - Bernal, Caroline AU - Korchi, Karim AU - Nogrette, Maxence AU - Deshayes, Maxime AU - Philippe, G. Antony AU - Gisclard, Béatrice AU - Charbonnier, Elodie PY - 2022/6/13 TI - Promoting Physical Activity Among University Students During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e36429 VL - 11 IS - 6 KW - physical activity KW - psychological factors KW - university student KW - COVID-19 N2 - Background: Since the beginning of the COVID-19 pandemic, sanitary context and e-learning have greatly modified student lifestyles and led to deteriorations in their mental health. An increase in anxiety and depressive symptoms and sedentary behaviors, reduction in physical activity, and a stronger tendency to move toward unhealthy diet have been demonstrated. This finding highlights the need for innovative interventions to promote healthy lifestyle among students. Objective: This research protocol aims to evaluate the effects of an intervention program on the lifestyle and psychological state of students. Methods: Students from University of Nîmes were recruited and randomly assigned to 1 of 2 following conditions: an intervention group and a control group. Participants in the intervention group were engaged in an 8-week physical activity program. Prior to the start of the program, design-based innovative workshops were conducted with participants to ensure that the program was co-constructed by the users and met their specific needs. Students in the control group did not receive any intervention. For each group, measures of physical activity, sedentary time, anthropometric data, sleep, physical condition, and psychological variables (eg, anxiety, depression, motivation, body appreciation, perceived control, well-being) were conducted at baseline and 9 weeks later. Results: A total of 110 participants were initially included. Reporting of the results is projected for the spring of 2022. Conclusions: It is anticipated that this innovative intervention co-constructed by pairs will promote a healthier lifestyle and psychological health in students. There is every reason to believe that a mobilized co-construction approach is a promising strategy to limit unhealthy habits and promote physical activity while increasing motivation. The development and evaluation of interventions to address the specific needs of university students is essential and could be transferred to other vulnerable populations such as people with chronic diseases or older people. Trial Registration: ClinicalTrials.gov NCT05019482; https://clinicaltrials.gov/ct2/show/NCT05019482 International Registered Report Identifier (IRRID): DERR1-10.2196/36429 UR - https://www.researchprotocols.org/2022/6/e36429 UR - http://dx.doi.org/10.2196/36429 UR - http://www.ncbi.nlm.nih.gov/pubmed/35700019 ID - info:doi/10.2196/36429 ER - TY - JOUR AU - Ullah, Shahid AU - Ullah, Farhan AU - Rahman, Wajeeha AU - Karras, A. Dimitrios AU - Ullah, Anees AU - Ahmad, Gulzar AU - Ijaz, Muhammad AU - Gao, Tianshun PY - 2022/6/10 TI - The Cancer Research Database (CRDB): Integrated Platform to Gain Statistical Insight Into the Correlation Between Cancer and COVID-19 JO - JMIR Cancer SP - e35020 VL - 8 IS - 2 KW - cancer database KW - COVID-19 KW - CRDB KW - genomics KW - PHP KW - cancer and COVID-19 KW - cancer statistics KW - cancer research KW - health database KW - research platform N2 - Background: The advancement of cancer research has been facilitated through freely available cancer literature, databases, and tools. The age of genomics and big data has given rise to the need for cooperation and data sharing in order to make efficient use of this new information in the COVID-19 pandemic. Although there are many databases for cancer research, their access is not easy owing to different ways of processing and managing the data. There is an absence of a unified platform to manage all of them in a transparent and more comprehensible way. Objective: In this study, an improved integrated cancer research database and platform is provided to facilitate a deeper statistical insight into the correlation between cancer and the COVID-19 pandemic, unifying the collection of almost all previous published cancer databases and defining a model web database for cancer research, and scoring databases on the basis of the variety types of cancer, sample size, completeness of omics results, and user interface. Methods: Databases examined and integrated include the Data Portal database, Genomic database, Proteomic database, Expression database, Gene database, and Mutation database; and it is expected that this launch will sort, save, advance the understanding and encourage the use of these resources in the cancer research environment. Results: To make it easy to search valuable information, 85 cancer databases are provided in the form of a table, and a database of databases named the Cancer Research Database (CRDB) has been built and presented herein. Furthermore, the CRDB has been herein equipped with unique navigation tools in order to be explored by three methods; that is, any single database can be browsed by typing the name in the given search bar, while all categories can be browsed by clicking on the name of the category or image expression icon, thus serving as a facility that could provide all the category databases on a single click. Conclusions: The computational platform (PHP, HTML, CSS, and MySQL) used to build CRDB for the cancer scientific community can be freely investigated and browsed on the internet and is planned to be updated in a timely manner. In addition, based on the proposed platform, the status and diagnoses statistics of cancer during the COVID-19 pandemic have been thoroughly investigated herein using CRDB, thus providing an easy-to-manage, understandable framework that mines knowledge for future researchers. UR - https://cancer.jmir.org/2022/2/e35020 UR - http://dx.doi.org/10.2196/35020 UR - http://www.ncbi.nlm.nih.gov/pubmed/35430561 ID - info:doi/10.2196/35020 ER - TY - JOUR AU - Chen, Ying-Hsien AU - Wu, Hui-Wen AU - Huang, Ching-Chang AU - Lee, Jen-Kuang AU - Yang, Li-Tan AU - Hsu, Tse-Pin AU - Hung, Chi-Sheng AU - Ho, Yi-Lwun PY - 2022/6/10 TI - The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study JO - Interact J Med Res SP - e37880 VL - 11 IS - 1 KW - COVID-19 KW - telemedicine KW - video-based virtual clinic N2 - Background: The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. Objective: To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center. Methods: We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. Results: There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern. Conclusions: Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks. UR - https://www.i-jmr.org/2022/1/e37880 UR - http://dx.doi.org/10.2196/37880 UR - http://www.ncbi.nlm.nih.gov/pubmed/35687404 ID - info:doi/10.2196/37880 ER - TY - JOUR AU - Briggs, Mariah Shanelle AU - Lipoff, Benjamin Jules AU - Collier, Marie Sigrid PY - 2022/6/9 TI - Using Implementation Science to Understand Teledermatology Implementation Early in the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Dermatol SP - e33833 VL - 5 IS - 2 KW - teledermatology KW - telemedicine KW - telehealth KW - COVID-19 KW - remote care KW - implementation science KW - store and forward KW - Organizational Readiness to Change Assessment KW - acceptability KW - feasibility KW - digital health KW - dermatology KW - dermatologist KW - health technology N2 - Background: Implementation science has been recognized for its potential to improve the integration of evidence-based practices into routine dermatologic care. The COVID-19 pandemic has resulted in rapid teledermatology implementation worldwide. Although several studies have highlighted patient and care provider satisfaction with teledermatology during the COVID-19 pandemic, less is known about the implementation process. Objective: Our goal was to use validated tools from implementation science to develop a deeper understanding of the implementation of teledermatology during the COVID-19 pandemic. Our primary aims were to describe (1) the acceptability and feasibility of the implementation of teledermatology and (2) organizational readiness for the implementation of teledermatology during the COVID-19 pandemic. We also sought to offer an example of how implementation science can be used in dermatologic research. Methods: An anonymous, web-based survey was distributed to Association of Professors of Dermatology members. It focused on (1) the acceptability, feasibility, and appropriateness of teledermatology and (2) organizational readiness for implementing teledermatology. It incorporated subscales from the Organizational Readiness to Change Assessment?a validated measure of organizational characteristics that predict implementation success. Results: Of the 518 dermatologists emailed, 35 (7%) responded, and all implemented or scaled up teledermatology during the pandemic. Of the 11 care providers with the highest level of organizational readiness, 11 (100%) said that they plan to continue using teledermatology after the pandemic. Most respondents agreed or strongly agreed that they had sufficient training (24/35, 69%), financial resources (20/35, 57%), and facilities (20/35, 57%). However, of the 35 respondents, only 15 (43%) agreed or strongly agreed that they had adequate staffing support. Most respondents considered the most acceptable teledermatology modality to be synchronous audio and video visits with supplemental stored digital photos (23/35, 66%) and considered the least acceptable modality to be telephone visits without stored digital photos (6/35, 17%). Overall, most respondents thought that the implementation of synchronous audio and video with stored digital photos (31/35, 89%) and telephone visits with stored digital photos (31/35, 89%) were the most feasible. When asked about types of visits that were acceptable for synchronous video/audio visits (with stored digital photos), 18 of the 31 respondents (58%) said ?new patients,? 27 (87%) said ?existing patients,? 19 (61%) said ?medication monitoring,? 3 (10%) said ?total body skin exams,? and 22 (71%) said ?lesions of concern.? Conclusions: This study serves as an introduction to how implementation science research methods can be used to understand the implementation of novel technologies in dermatology. Our work builds upon prior studies by further characterizing the acceptability and feasibility of different teledermatology modalities. Our study may suggest initial insights on how dermatology practices and health care systems can support dermatologists in successfully incorporating teledermatology after the pandemic. UR - https://derma.jmir.org/2022/2/e33833 UR - http://dx.doi.org/10.2196/33833 UR - http://www.ncbi.nlm.nih.gov/pubmed/35720247 ID - info:doi/10.2196/33833 ER - TY - JOUR AU - Patel, Pragna AU - Kerzner, Michael AU - Reed, B. Jason AU - Sullivan, Sean Patrick AU - El-Sadr, M. Wafaa PY - 2022/6/7 TI - Public Health Implications of Adapting HIV Pre-exposure Prophylaxis Programs for Virtual Service Delivery in the Context of the COVID-19 Pandemic: Systematic Review JO - JMIR Public Health Surveill SP - e37479 VL - 8 IS - 6 KW - HIV KW - pre-exposure prophylaxis KW - COVID-19 KW - virtual service delivery KW - HIV prevention KW - public health KW - systematic review KW - virtual service KW - health intervention KW - digital intervention KW - health technology KW - social media platform KW - telehealth KW - public health message N2 - 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. UR - https://publichealth.jmir.org/2022/6/e37479 UR - http://dx.doi.org/10.2196/37479 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486813 ID - info:doi/10.2196/37479 ER - TY - JOUR AU - Yu, Hanzhi AU - Du, Runming AU - Wang, Minmin AU - Yu, Fengyun AU - Yang, Juntao AU - Jiao, Lirui AU - Wang, Zhuoran AU - Liu, Haitao AU - Wu, Peixin AU - Bärnighausen, Till AU - Xue, Lan AU - Wang, Chen AU - McMahon, Shannon AU - Geldsetzer, Pascal AU - Chen, Simiao PY - 2022/6/7 TI - Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China JO - JMIR Public Health Surveill SP - e33484 VL - 8 IS - 6 KW - COVID-19 vaccines KW - China KW - global allocation KW - public attitudes KW - cross-sectional KW - survey KW - vaccines KW - COVID-19 KW - pandemic KW - public health KW - health policy KW - epidemiology N2 - 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. UR - https://publichealth.jmir.org/2022/6/e33484 UR - http://dx.doi.org/10.2196/33484 UR - http://www.ncbi.nlm.nih.gov/pubmed/35483084 ID - info:doi/10.2196/33484 ER - TY - JOUR AU - Savage, D. Rachel AU - Di Nicolo, Sophia AU - Wu, Wei AU - Li, Joyce AU - Lawson, Andrea AU - Grieve, Jim AU - Goel, Vivek AU - Rochon, A. Paula PY - 2022/6/6 TI - 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 JO - JMIR Aging SP - e34793 VL - 5 IS - 2 KW - digital technology KW - loneliness KW - older adults KW - COVID-19 KW - elderly KW - lonely KW - mental health KW - factor KW - usage KW - social media KW - video KW - communication KW - connection KW - connect KW - family KW - friend KW - age KW - support N2 - 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. UR - https://aging.jmir.org/2022/2/e34793 UR - http://dx.doi.org/10.2196/34793 UR - http://www.ncbi.nlm.nih.gov/pubmed/35344502 ID - info:doi/10.2196/34793 ER - TY - JOUR AU - Lundberg, L. Alexander AU - Lorenzo-Redondo, Ramon AU - Hultquist, F. Judd AU - Hawkins, A. Claudia AU - Ozer, A. Egon AU - Welch, B. Sarah AU - Prasad, Vara P. V. AU - Achenbach, J. Chad AU - White, I. Janine AU - Oehmke, F. James AU - Murphy, L. Robert AU - Havey, J. Robert AU - Post, A. Lori PY - 2022/6/3 TI - Overlapping Delta and Omicron Outbreaks During the COVID-19 Pandemic: Dynamic Panel Data Estimates JO - JMIR Public Health Surveill SP - e37377 VL - 8 IS - 6 KW - Omicron variant of concern KW - Delta KW - COVID-19 KW - SARS-CoV-2 KW - B.1.1.529 KW - outbreak KW - Arellano-Bond estimator KW - dynamic panel data KW - stringency index KW - surveillance KW - disease transmission metrics N2 - 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. UR - https://publichealth.jmir.org/2022/6/e37377 UR - http://dx.doi.org/10.2196/37377 UR - http://www.ncbi.nlm.nih.gov/pubmed/35500140 ID - info:doi/10.2196/37377 ER - TY - JOUR AU - Couture, Alexia AU - Iuliano, Danielle A. AU - Chang, H. Howard AU - Patel, N. Neha AU - Gilmer, Matthew AU - Steele, Molly AU - Havers, P. Fiona AU - Whitaker, Michael AU - Reed, Carrie PY - 2022/6/2 TI - Estimating COVID-19 Hospitalizations in the United States With Surveillance Data Using a Bayesian Hierarchical Model: Modeling Study JO - JMIR Public Health Surveill SP - e34296 VL - 8 IS - 6 KW - COVID-19 KW - SARS-CoV-2 KW - hospitalization KW - Bayesian KW - COVID-NET KW - extrapolation KW - hospital KW - estimation KW - prediction KW - United States KW - surveillance KW - data KW - model KW - modeling KW - hierarchical KW - rate KW - novel KW - framework KW - monitoring N2 - 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. UR - https://publichealth.jmir.org/2022/6/e34296 UR - http://dx.doi.org/10.2196/34296 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452402 ID - info:doi/10.2196/34296 ER - TY - JOUR AU - Silva, Vieira Cícera Renata Diniz AU - Lopes, Horácio Rayssa AU - de Goes Bay Jr, Osvaldo AU - Martiniano, Santos Claudia AU - Fuentealba-Torres, Miguel AU - Arcêncio, Alexandre Ricardo AU - Lapão, Velez Luís AU - Dias, Sonia AU - Uchoa, Costa Severina Alice da PY - 2022/5/31 TI - Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review JO - JMIR Hum Factors SP - e35380 VL - 9 IS - 2 KW - digital health KW - telehealth KW - telemedicine KW - primary health care KW - quality of care KW - COVID-19 KW - pandemic KW - science database KW - gray literature N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35380 UR - http://dx.doi.org/10.2196/35380 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319466 ID - info:doi/10.2196/35380 ER - TY - JOUR AU - Silenou, C. Bernard AU - Verset, Carolin AU - Kaburi, B. Basil AU - Leuci, Olivier AU - Ghozzi, Stéphane AU - Duboudin, Cédric AU - Krause, Gérard PY - 2022/5/31 TI - A Novel Tool for Real-time Estimation of Epidemiological Parameters of Communicable Diseases Using Contact-Tracing Data: Development and Deployment JO - JMIR Public Health Surveill SP - e34438 VL - 8 IS - 5 KW - COVID-19 KW - disease outbreak KW - contact tracing KW - serial interval KW - basic reproduction number KW - infectious disease incubation period KW - superspreading events KW - telemedicine KW - public health KW - epidemiology KW - surveillance tool KW - outbreak response KW - pandemic KW - digital health application KW - response strategy N2 - 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. UR - https://publichealth.jmir.org/2022/5/e34438 UR - http://dx.doi.org/10.2196/34438 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486812 ID - info:doi/10.2196/34438 ER - TY - JOUR AU - Adeyinka, A. Daniel AU - Neudorf, Cory AU - Camillo, A. Cheryl AU - Marks, N. Wendie AU - Muhajarine, Nazeem PY - 2022/5/31 TI - COVID-19 Vaccination and Public Health Countermeasures on Variants of Concern in Canada: Evidence From a Spatial Hierarchical Cluster Analysis JO - JMIR Public Health Surveill SP - e31968 VL - 8 IS - 5 KW - COVID-19 KW - variants of concern KW - stringency index KW - mobility index KW - vaccination coverage KW - machine learning KW - Canada N2 - Background: There is mounting evidence that the third wave of COVID-19 incidence is declining, yet variants of concern (VOCs) continue to present public health challenges in Canada. The emergence of VOCs has sparked debate on how to effectively control their impacts on the Canadian population. Objective: Provincial and territorial governments have implemented a wide range of policy measures to protect residents against community transmission of COVID-19, but research examining the specific impact of policy countermeasures on the VOCs in Canada is needed. Our study objective was to identify provinces with disproportionate prevalence of VOCs relative to COVID-19 mitigation efforts in provinces and territories in Canada. Methods: We analyzed publicly available provincial- and territorial-level data on the prevalence of VOCs in relation to mitigating factors, summarized in 3 measures: (1) strength of public health countermeasures (stringency index), (2) the extent to which people moved about outside their homes (mobility index), and (3) the proportion of the provincial or territorial population that was fully vaccinated (vaccine uptake). Using spatial agglomerative hierarchical cluster analysis (unsupervised machine learning), provinces and territories were grouped into clusters by stringency index, mobility index, and full vaccine uptake. The Kruskal-Wallis test was used to compare the prevalence of VOCs (Alpha, or B.1.1.7; Beta, or B.1.351; Gamma, or P.1; and Delta, or B.1.617.2 variants) across the clusters. Results: We identified 3 clusters of vaccine uptake and countermeasures. Cluster 1 consisted of the 3 Canadian territories and was characterized by a higher degree of vaccine deployment and fewer countermeasures. Cluster 2 (located in Central Canada and the Atlantic region) was typified by lower levels of vaccine deployment and moderate countermeasures. The third cluster, which consisted of provinces in the Pacific region, Central Canada, and the Prairies, exhibited moderate vaccine deployment but stronger countermeasures. The overall and variant-specific prevalences were significantly different across the clusters. Conclusions: This ?up to the point? analysis found that implementation of COVID-19 public health measures, including the mass vaccination of populations, is key to controlling VOC prevalence rates in Canada. As of June 15, 2021, the third wave of COVID-19 in Canada is declining, and those provinces and territories that had implemented more comprehensive public health measures showed lower VOC prevalence. Public health authorities and governments need to continue to communicate the importance of sociobehavioural preventive measures, even as populations in Canada continue to receive their primary and booster doses of vaccines. UR - https://publichealth.jmir.org/2022/5/e31968 UR - http://dx.doi.org/10.2196/31968 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486447 ID - info:doi/10.2196/31968 ER - TY - JOUR AU - Petrova, Mariya AU - Miller-Perusse, Michael AU - Hirshfield, Sabina AU - Carrico, Adam AU - Horvath, Keith PY - 2022/5/31 TI - Effect of the COVID-19 Pandemic on Stimulant Use and Antiretroviral Therapy Adherence Among Men Who Have Sex With Men Living With HIV: Qualitative Focus Group Study JO - JMIR Form Res SP - e30897 VL - 6 IS - 5 KW - stimulants KW - HIV KW - ART KW - antiretroviral therapy KW - MSM KW - men who have sex with men KW - COVID-19 KW - pandemic KW - therapy KW - drug use KW - virtual focus groups KW - virtual health KW - medication adherence N2 - Background: Evidence suggests that economic, social, and psychological circumstances brought about by the COVID-19 pandemic may have a serious impact on behavioral health. Men who have sex with men (MSM) are disproportionally impacted by HIV and stimulant use, the co-occurrence of which heightens HIV transmission risk and undermines nationwide treatment strategies as prevention efforts for ending the HIV epidemic. There is a paucity of information regarding the potential impact of the COVID-19 pandemic on the substance use and HIV medication adherence in this key vulnerable population?MSM who use stimulants and are living with HIV. Objective: The aim of this qualitative study was to identify ways in which the COVID-19 pandemic has affected stimulant use and antiretroviral therapy (ART) adherence among a sample of MSM living with HIV. Methods: Two focus groups were conducted in August 2020 via videoconferencing technology compliant with the Health Insurance Portability and Accountability Act. Potential participants from an established research participant registry at State University of New York Downstate Health Sciences University were invited and screened for study participation on the basis of inclusion criteria. A semistructured interview guide was followed. A general inductive approach was used to analyze the data. Findings in two general areas of interest, the impact of the COVID-19 pandemic on stimulant use and ART adherence, emerged directly from the raw data. Results: A total of 12 ethnically diverse participants over the age of 25 years took part in the study. Results were heterogeneous in terms of the effects of the pandemic on both stimulant use and ART adherence among MSM living with HIV. Some men indicated increased or sustained stimulant use and ART adherence, and others reported decreased stimulant use and ART adherence. Reasons for these behavioral changes ranged from concerns about their own health and that of their loved ones to challenges brought about by the lack of daily structure during the lockdown phase of the pandemic and emotion regulation difficulties. Conclusions: The COVID-19 pandemic has had a differential impact on stimulant use and ART medication adherence among MSM living with HIV. The reasons for behavioral change identified in this study may be salient intervention targets to support ART medication adherence and lower stimulant use among MSM in the aftermath of the of the COVID-19 pandemic, as well as beyond. UR - https://formative.jmir.org/2022/5/e30897 UR - http://dx.doi.org/10.2196/30897 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275839 ID - info:doi/10.2196/30897 ER - TY - JOUR AU - Clark, D. Kristen AU - Lunn, R. Mitchell AU - Sherman, F. Athena D. AU - Bosley, G. Hannah AU - Lubensky, E. Micah AU - Obedin-Maliver, Juno AU - Dastur, Zubin AU - Flentje, Annesa PY - 2022/5/30 TI - COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study JO - JMIR Public Health Surveill SP - e34710 VL - 8 IS - 5 KW - PTSD KW - posttraumatic stress disorder KW - anxiety KW - minority populations KW - vicarious trauma KW - tertiary trauma KW - COVID-19 KW - pandemic KW - public health KW - sexual orientation KW - gender identity KW - mental health N2 - 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. UR - https://publichealth.jmir.org/2022/5/e34710 UR - http://dx.doi.org/10.2196/34710 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486805 ID - info:doi/10.2196/34710 ER - TY - JOUR AU - Zhu, Patricia AU - Tatar, Ovidiu AU - Griffin-Mathieu, Gabrielle AU - Perez, Samara AU - Haward, Ben AU - Zimet, Gregory AU - Tunis, Matthew AU - Dubé, Ève AU - Rosberger, Zeev PY - 2022/5/30 TI - 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 JO - JMIR Public Health Surveill SP - e37328 VL - 8 IS - 5 KW - COVID-19 KW - vaccination KW - altruism KW - prosocial motives KW - video intervention KW - randomized controlled trial KW - younger adults KW - vaccine hesitancy KW - public health KW - youth KW - digital intervention KW - health intervention KW - health promotion KW - web survey KW - digital health KW - online health KW - health information N2 - 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 (?21=20.55, P<.001). The between-group difference in postintervention intentions (?23=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 UR - https://publichealth.jmir.org/2022/5/e37328 UR - http://dx.doi.org/10.2196/37328 UR - http://www.ncbi.nlm.nih.gov/pubmed/35544437 ID - info:doi/10.2196/37328 ER - TY - JOUR AU - Math, K. Renukaradhya AU - Mudennavar, Nayana AU - Javaregowda, Kanive Palaksha AU - Savanur, Ambuja PY - 2022/5/30 TI - In Silico Comparative Analysis of the Functional, Structural, and Evolutionary Properties of SARS-CoV-2 Variant Spike Proteins JO - JMIR Bioinform Biotech SP - e37391 VL - 3 IS - 1 KW - spike protein variants KW - NCBI KW - bioinformatics tools KW - pI KW - isoelectric point KW - 2D map KW - phylogenetic tree KW - COVID-19 KW - COVID therapy KW - SARS-CoV-2 treatment KW - therapeutic KW - spike protein KW - protein KW - prophylactic KW - sequence analysis KW - genomic KW - bioinformatics KW - viral protein N2 - 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. UR - https://bioinform.jmir.org/2022/1/e37391 UR - http://dx.doi.org/10.2196/37391 UR - http://www.ncbi.nlm.nih.gov/pubmed/35669291 ID - info:doi/10.2196/37391 ER - TY - JOUR AU - Liu, Xiaohui AU - Kar, Bandana AU - Montiel Ishino, Alejandro Francisco AU - Onega, Tracy AU - Williams, Faustine PY - 2022/5/30 TI - The Associations Between Racially/Ethnically Stratified COVID-19 Tweets and COVID-19 Cases and Deaths: Cross-sectional Study JO - JMIR Form Res SP - e30371 VL - 6 IS - 5 KW - racial/ethnic stratification KW - geo-tagged COVID-19 tweets KW - racial/ethnic disparity KW - surveillance N2 - 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. UR - https://formative.jmir.org/2022/5/e30371 UR - http://dx.doi.org/10.2196/30371 UR - http://www.ncbi.nlm.nih.gov/pubmed/35537056 ID - info:doi/10.2196/30371 ER - TY - JOUR AU - Powell, Leigh AU - Nour, Radwa AU - Zidoun, Youness AU - Kaladhara, Sreelekshmi AU - Al Suwaidi, Hanan AU - Zary, Nabil PY - 2022/5/30 TI - A Web-Based Public Health Intervention for Addressing Vaccine Misinformation: Protocol for Analyzing Learner Engagement and Impacts on the Hesitancy to Vaccinate JO - JMIR Res Protoc SP - e38034 VL - 11 IS - 5 KW - public health KW - population health KW - education KW - gamification KW - COVID-19 KW - vaccination KW - misinformation KW - infodemic KW - vaccine hesitancy KW - web-based health KW - web-based intervention KW - learning design KW - dissemination N2 - 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 UR - https://www.researchprotocols.org/2022/5/e38034 UR - http://dx.doi.org/10.2196/38034 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451967 ID - info:doi/10.2196/38034 ER - TY - JOUR AU - Hussain, Zain AU - Sheikh, Zakariya AU - Tahir, Ahsen AU - Dashtipour, Kia AU - Gogate, Mandar AU - Sheikh, Aziz AU - Hussain, Amir PY - 2022/5/27 TI - Artificial Intelligence?Enabled Social Media Analysis for Pharmacovigilance of COVID-19 Vaccinations in the United Kingdom: Observational Study JO - JMIR Public Health Surveill SP - e32543 VL - 8 IS - 5 KW - COVID-19 KW - artificial intelligence KW - deep learning KW - Facebook KW - health informatics KW - natural language processing KW - public health KW - sentiment analysis KW - social media KW - Twitter KW - infodemiology KW - vaccination N2 - 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. UR - https://publichealth.jmir.org/2022/5/e32543 UR - http://dx.doi.org/10.2196/32543 UR - http://www.ncbi.nlm.nih.gov/pubmed/35144240 ID - info:doi/10.2196/32543 ER - TY - JOUR AU - Froese, Henri AU - A Prempeh, G. Angel PY - 2022/5/27 TI - Mask Use to Curtail Influenza in a Post?COVID-19 World: Modeling Study JO - JMIRx Med SP - e31955 VL - 3 IS - 2 KW - mask KW - protection KW - COVID-19 KW - influenza KW - transmission KW - intervention KW - infectious disease KW - respiratory KW - simulation KW - model KW - prevalence KW - efficacy N2 - 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. UR - https://med.jmirx.org/2022/2/e31955 UR - http://dx.doi.org/10.2196/31955 UR - http://www.ncbi.nlm.nih.gov/pubmed/35666696 ID - info:doi/10.2196/31955 ER - TY - JOUR AU - Xu, Yue AU - Wu, Qingqing AU - Xu, Shuiyang AU - Zhao, Yusui AU - Zhang, Xuehai PY - 2022/5/26 TI - Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study JO - JMIR Public Health Surveill SP - e32278 VL - 8 IS - 5 KW - COVID-19 KW - internet-based KW - disease prevention KW - mask KW - knowledge KW - behavior N2 - 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. UR - https://publichealth.jmir.org/2022/5/e32278 UR - http://dx.doi.org/10.2196/32278 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486491 ID - info:doi/10.2196/32278 ER - TY - JOUR AU - Zhang, Chun Ke AU - Fang, Yuan AU - Cao, He AU - Chen, Hongbiao AU - Hu, Tian AU - Chen, Qi Ya AU - Zhou, Xiaofeng AU - Wang, Zixin PY - 2022/5/25 TI - The Impacts of the COVID-19 Pandemic on HIV Testing Utilization Among Men Who Have Sex With Men in China: Cross-sectional Online Survey JO - JMIR Public Health Surveill SP - e30070 VL - 8 IS - 5 KW - COVID-19 KW - HIV testing KW - sexual risk behaviors KW - structural barriers KW - perception KW - men who have sex with men KW - China KW - MSM KW - HIV KW - testing KW - impact KW - utilization KW - cross-sectional KW - online survey KW - barrier KW - access N2 - 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. UR - https://publichealth.jmir.org/2022/5/e30070 UR - http://dx.doi.org/10.2196/30070 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486811 ID - info:doi/10.2196/30070 ER - TY - JOUR AU - Kellerman, K. John AU - Hamilton, L. Jessica AU - Selby, A. Edward AU - Kleiman, M. Evan PY - 2022/5/25 TI - The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e36966 VL - 9 IS - 5 KW - news consumption KW - worry KW - hopelessness KW - ecological momentary assessment KW - news media KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - stress KW - psychological distress KW - mediation model KW - digital health N2 - Background: Consumption of distressing news media, which substantially increased during the COVID-19 pandemic, has demonstrable negative effects on mental health. Objective: This study examines the proximal impact of daily exposure to news about COVID-19 on mental health in the first year of the pandemic. Methods: A sample of 546 college students completed daily ecological momentary assessments (EMAs) for 8 weeks, measuring exposure to news about COVID-19, worry and optimism specifically related to COVID-19, hopelessness, and general worry. Results: Participants completed >80,000 surveys. Multilevel mediation models indicated that greater daily exposure to news about COVID-19 is associated with higher same-day and next-day worry about the pandemic. Elevations in worry specifically about COVID-19 were in turn associated with greater next-day hopelessness and general worry. Optimism about COVID-19 mediated the relationship between daily exposure to COVID-19 news and next-day general worry but was not related to hopelessness. Conclusions: This study demonstrates the mental health impact of daily exposure to COVID-19 news and highlights how worry about the pandemic contributes over time to hopelessness and general worry. UR - https://mental.jmir.org/2022/5/e36966 UR - http://dx.doi.org/10.2196/36966 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377320 ID - info:doi/10.2196/36966 ER - TY - JOUR AU - Liu, Cong AU - Lee, Junghwan AU - Ta, Casey AU - Soroush, Ali AU - Rogers, R. James AU - Kim, Hyun Jae AU - Natarajan, Karthik AU - Zucker, Jason AU - Perl, Yehoshua AU - Weng, Chunhua PY - 2022/5/24 TI - Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis JO - JMIR Public Health Surveill SP - e35311 VL - 8 IS - 5 KW - COVID-19 KW - medical informatics KW - real-word evidence KW - vaccination KW - electronic health records N2 - 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. UR - https://publichealth.jmir.org/2022/5/e35311 UR - http://dx.doi.org/10.2196/35311 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486806 ID - info:doi/10.2196/35311 ER - TY - JOUR AU - Laird, Breanne AU - Puzia, Megan AU - Larkey, Linda AU - Ehlers, Diane AU - Huberty, Jennifer PY - 2022/5/24 TI - A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e30294 VL - 6 IS - 5 KW - stress KW - meditation KW - mHealth KW - COVID-19 KW - mobile app KW - mental health KW - mindfulness KW - digital intervention KW - psychological outcomes N2 - Background: Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app?based studies have reported a low proportion of or even no male participants. Objective: This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. Methods: This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ?15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. Results: Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. Conclusions: A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. Trial Registration: ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138 UR - https://formative.jmir.org/2022/5/e30294 UR - http://dx.doi.org/10.2196/30294 UR - http://www.ncbi.nlm.nih.gov/pubmed/34989677 ID - info:doi/10.2196/30294 ER - TY - JOUR AU - Cho, Jungyun AU - Kang, Wook AU - Lee, Julak PY - 2022/5/23 TI - 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 JO - JMIR Public Health Surveill SP - e35958 VL - 8 IS - 5 KW - COVID-19 KW - government departments? networks KW - network structure KW - contagious disease response KW - social network analysis N2 - 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. UR - https://publichealth.jmir.org/2022/5/e35958 UR - http://dx.doi.org/10.2196/35958 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486100 ID - info:doi/10.2196/35958 ER - TY - JOUR AU - Olusanya, A. Olufunto AU - White, Brianna AU - Melton, A. Chad AU - Shaban-Nejad, Arash PY - 2022/5/17 TI - Examining the Implementation of Digital Health to Strengthen the COVID-19 Pandemic Response and Recovery and Scale up Equitable Vaccine Access in African Countries JO - JMIR Form Res SP - e34363 VL - 6 IS - 5 KW - COVID-19 KW - SARS-CoV-2 KW - Africa KW - preparedness KW - response KW - recovery KW - digital health KW - artificial intelligence KW - vaccine equity UR - https://formative.jmir.org/2022/5/e34363 UR - http://dx.doi.org/10.2196/34363 UR - http://www.ncbi.nlm.nih.gov/pubmed/35512271 ID - info:doi/10.2196/34363 ER - TY - JOUR AU - Rajamani, Sripriya AU - Austin, Robin AU - Geiger-Simpson, Elena AU - Jantraporn, Ratchada AU - Park, Suhyun AU - Monsen, A. Karen PY - 2022/5/16 TI - Understanding Whole-Person Health and Resilience During the COVID-19 Pandemic and Beyond: A Cross-sectional and Descriptive Correlation Study JO - JMIR Nursing SP - e38063 VL - 5 IS - 1 KW - Omaha System KW - whole-person health KW - strengths KW - resilience KW - assessment KW - app KW - health information technology KW - health informatics KW - nursing KW - health care KW - mobile health KW - health application KW - mHealth KW - health data KW - health community KW - digital health N2 - Background: The COVID-19 pandemic has prompted an interest in whole-person health and emotional well-being. Informatics solutions through user-friendly tools such as mobile health apps offer immense value. Prior research developed a consumer-facing app MyStrengths + MyHealth using Simplified Omaha System Terms (SOST) to assess whole-person health. The MyStrengths + MyHealth app assesses strengths, challenges, and needs (SCN) for 42 concepts across four domains (My Living, My Mind and Networks, My Body, My Self-care; eg, Income, Emotions, Pain, and Nutrition, respectively). Given that emotional well-being was a predominant concern during the COVID-19 pandemic, we sought to understand whole-person health for participants with/without Emotions challenges. Objective: This study aims to use visualization techniques and data from attendees at a Midwest state fair to examine SCN overall and by groups with/without Emotions challenges, and to explore the resilience of participants. Methods: This cross-sectional and descriptive correlational study surveyed adult attendees at a 2021 Midwest state fair. Data were visualized using Excel and analyzed using descriptive and inferential statistics using SPSS. Results: The study participants (N=182) were primarily female (n=123, 67.6%), aged ?45 years (n=112, 61.5%), White (n=154, 84.6%), and non-Hispanic (n=177, 97.3%). Compared to those without Emotions challenges, those with Emotions challenges were aged 18-44 (P<.001) years, more often female (P=.02), and not married (P=.01). Overall, participants had more strengths (mean 28.6, SD 10.5) than challenges (mean 12, SD 7.5) and needs (mean 4.2, SD 7.5). The most frequent needs were in Emotions, Nutrition, Income, Sleeping, and Exercising. Compared to those without Emotions challenges, those with Emotions challenges had fewer strengths (P<.001), more challenges (P<.001), and more needs (P<.001), along with fewer strengths for Emotions (P<.001) and for the cluster of health-related behaviors domain concepts, Sleeping (P=.002), Nutrition (P<.001), and Exercising (P<.001). Resilience was operationalized as correlations among strengths for SOST concepts and visualized for participants with/without an Emotions challenge. Those without Emotions challenges had more positive strengths correlations across multiple concepts/domains. Conclusions: This survey study explored a large community-generated data set to understand whole-person health and showed between-group differences in SCN and resilience for participants with/without Emotions challenges. It contributes to the literature regarding an app-aided and data-driven approach to whole-person health and resilience. This research demonstrates the power of health informatics and provides researchers with a data-driven methodology for additional studies to build evidence on whole-person health and resilience. UR - https://nursing.jmir.org/2022/1/e38063 UR - http://dx.doi.org/10.2196/38063 UR - http://www.ncbi.nlm.nih.gov/pubmed/35576563 ID - info:doi/10.2196/38063 ER - TY - JOUR AU - Stahl, Melissa AU - Cheung, James AU - Post, Kevin AU - Valin, P. James AU - Jacobs, Ira PY - 2022/5/16 TI - Accelerating Virtual Health Implementation Following the COVID-19 Pandemic: Questionnaire Study JO - JMIR Form Res SP - e32819 VL - 6 IS - 5 KW - virtual health KW - eHealth KW - mHealth KW - telemedicine KW - telehealth KW - COVID-19 KW - health system KW - care delivery KW - strategy KW - business model N2 - Background: The COVID-19 pandemic accelerated drivers for virtual health adoption and triggered the US federal government to implement regulatory changes to reduce barriers to virtual health implementation. Consequently, virtual health solutions have been increasingly adopted, and health systems in the United States have been reorganizing their care delivery process with unprecedented speed. Objective: This study aimed to assess and make recommendations on the strategy, business model, implementation, and future considerations for scaling and sustaining virtual health solutions based on the views of executives from the largest health systems in the United States. Methods: In September 2020 and October 2020, the Health Management Academy conducted 29 quantitative surveys and 23 qualitative interviews involving 58 executives from 41 of the largest health systems in the United States. Participating health systems were approximately equally distributed across size categories (small, medium, and large, defined as annual total operating revenue US $2-3 billion, $3-6 billion, and >$6 billion, respectively) and US Census Bureau regions (Northeast, Midwest, South, and West). Results: Based on the Health Management Academy?s assessment of approaches to governance, financing, data infrastructure, and clinical integration of virtual health, most participating health systems (13/24, 54%) had a mid-stage level of maturity in virtual health implementation. Executives reported the pandemic is forcing health systems to re-examine strategic priorities; the most commonly raised key impacts were increased access (15/21, 71%) and flexibility (10/21, 48%) as well as lower costs of care delivery (9/21, 43%). Most executives (16/28, 57%) reported their organization had a defined budget for virtual health, and many noted that virtual health is best supported through value-based payment models. Irrespective of health system maturity, reimbursement was consistently rated as a key challenge to virtual health scaling, along with patient access to and understanding of virtual health technology. The success of virtual health implementation was most commonly measured by patient satisfaction, health care provider engagement, and proportion of health care providers using virtual health solutions (reported by 7/8, 88%; 6/8, 75%; and 7/8, 75% of information technology executives, respectively). Almost all health systems (27/29, 93%) expect to continue growing their virtual health offerings for the foreseeable future, with user-friendliness and ease of integration into the electronic medical record as key factors in making go-forward decisions on virtual health solutions (each selected by 9/10, 90% executives). Conclusions: The increased demand for virtual health solutions during the COVID-19 pandemic is expected to continue postpandemic. Consequently, health systems are re-evaluating their current platforms, processes, and strategy to develop a sustainable, long-term approach to virtual health. To ensure future success, health system leaders need to proactively build on their virtual health solutions; advocate for payment, site flexibility, and reimbursement parity for virtual health; and demonstrate continued engagement and boldness to evolve care beyond established models. UR - https://formative.jmir.org/2022/5/e32819 UR - http://dx.doi.org/10.2196/32819 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323115 ID - info:doi/10.2196/32819 ER - TY - JOUR AU - Portelli, Beatrice AU - Scaboro, Simone AU - Tonino, Roberto AU - Chersoni, Emmanuele AU - Santus, Enrico AU - Serra, Giuseppe PY - 2022/5/13 TI - Monitoring User Opinions and Side Effects on COVID-19 Vaccines in the Twittersphere: Infodemiology Study of Tweets JO - J Med Internet Res SP - e35115 VL - 24 IS - 5 KW - adverse drug events KW - COVID-19 KW - digital pharmacovigilance KW - opinion mining KW - vaccines KW - social media KW - machine learning KW - deep learning KW - learning models KW - sentiment analysis KW - Twitter analysis KW - Twitter KW - web portal KW - public health N2 - Background: In the current phase of the COVID-19 pandemic, we are witnessing the most massive vaccine rollout in human history. Like any other drug, vaccines may cause unexpected side effects, which need to be investigated in a timely manner to minimize harm in the population. If not properly dealt with, side effects may also impact public trust in the vaccination campaigns carried out by national governments. Objective: Monitoring social media for the early identification of side effects, and understanding the public opinion on the vaccines are of paramount importance to ensure a successful and harmless rollout. The objective of this study was to create a web portal to monitor the opinion of social media users on COVID-19 vaccines, which can offer a tool for journalists, scientists, and users alike to visualize how the general public is reacting to the vaccination campaign. Methods: We developed a tool to analyze the public opinion on COVID-19 vaccines from Twitter, exploiting, among other techniques, a state-of-the-art system for the identification of adverse drug events on social media; natural language processing models for sentiment analysis; statistical tools; and open-source databases to visualize the trending hashtags, news articles, and their factuality. All modules of the system are displayed through an open web portal. Results: A set of 650,000 tweets was collected and analyzed in an ongoing process that was initiated in December 2020. The results of the analysis are made public on a web portal (updated daily), together with the processing tools and data. The data provide insights on public opinion about the vaccines and its change over time. For example, users show a high tendency to only share news from reliable sources when discussing COVID-19 vaccines (98% of the shared URLs). The general sentiment of Twitter users toward the vaccines is negative/neutral; however, the system is able to record fluctuations in the attitude toward specific vaccines in correspondence with specific events (eg, news about new outbreaks). The data also show how news coverage had a high impact on the set of discussed topics. To further investigate this point, we performed a more in-depth analysis of the data regarding the AstraZeneca vaccine. We observed how media coverage of blood clot?related side effects suddenly shifted the topic of public discussions regarding both the AstraZeneca and other vaccines. This became particularly evident when visualizing the most frequently discussed symptoms for the vaccines and comparing them month by month. Conclusions: We present a tool connected with a web portal to monitor and display some key aspects of the public?s reaction to COVID-19 vaccines. The system also provides an overview of the opinions of the Twittersphere through graphic representations, offering a tool for the extraction of suspected adverse events from tweets with a deep learning model. UR - https://www.jmir.org/2022/5/e35115 UR - http://dx.doi.org/10.2196/35115 UR - http://www.ncbi.nlm.nih.gov/pubmed/35446781 ID - info:doi/10.2196/35115 ER - TY - JOUR AU - Wang, Qiang AU - Xiu, Shixin AU - Yang, Liuqing AU - Han, Ying AU - Cui, Tingting AU - Shi, Naiyang AU - Liu, Minqi AU - Yi, Youqin AU - Liu, Chang AU - Wang, Xuwen AU - Yang, Guoping AU - Ji, Lili AU - Zhou, Weijie AU - Jin, Hui AU - Zhen, Shiqi AU - Lin, Leesa PY - 2022/5/13 TI - Changes in Parental Attitudes Toward COVID-19 Vaccination and Routine Childhood Vaccination During the COVID-19 Pandemic: Repeated Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e33235 VL - 8 IS - 5 KW - childhood vaccination KW - COVID-19 vaccine KW - vaccine hesitancy KW - repeated cross-section survey N2 - 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. UR - https://publichealth.jmir.org/2022/5/e33235 UR - http://dx.doi.org/10.2196/33235 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486516 ID - info:doi/10.2196/33235 ER - TY - JOUR AU - Wang, Haofen AU - Du, Huifang AU - Qi, Guilin AU - Chen, Huajun AU - Hu, Wei AU - Chen, Zhuo PY - 2022/5/13 TI - Construction of a Linked Data Set of COVID-19 Knowledge Graphs: Development and Applications JO - JMIR Med Inform SP - e37215 VL - 10 IS - 5 KW - knowledge graph KW - linked data KW - COVID-19 KW - knowledge extraction KW - knowledge fusion KW - natural language processing KW - artificial intelligence KW - data set KW - schema modeling KW - semantic search N2 - Background: With the continuous spread of COVID-19, information about the worldwide pandemic is exploding. Therefore, it is necessary and significant to organize such a large amount of information. As the key branch of artificial intelligence, a knowledge graph (KG) is helpful to structure, reason, and understand data. Objective: To improve the utilization value of the information and effectively aid researchers to combat COVID-19, we have constructed and successively released a unified linked data set named OpenKG-COVID19, which is one of the largest existing KGs related to COVID-19. OpenKG-COVID19 includes 10 interlinked COVID-19 subgraphs covering the topics of encyclopedia, concept, medical, research, event, health, epidemiology, goods, prevention, and character. Methods: In this paper, we introduce the key techniques exploited in building COVID-19 KGs in a top-down manner. First, the schema of the modeling process for each KG in OpenKG-COVID19 is described. Second, we propose different methods for extracting knowledge from open government sites, professional texts, public domain?specific sources, and public encyclopedia sites. The curated 10 COVID-19 KGs are further linked together at both the schema and data levels. In addition, we present the naming convention for OpenKG-COVID19. Results: OpenKG-COVID19 has more than 2572 concepts, 329,600 entities, 513 properties, and 2,687,329 facts, and the data set will be updated continuously. Each COVID-19 KG was evaluated, and the average precision was found to be above 93%. We have developed search and browse interfaces and a SPARQL endpoint to improve user access. Possible intelligent applications based on OpenKG-COVID19 for further development are also described. Conclusions: A KG is useful for intelligent question-answering, semantic searches, recommendation systems, visualization analysis, and decision-making support. Research related to COVID-19, biomedicine, and many other communities can benefit from OpenKG-COVID19. Furthermore, the 10 KGs will be continuously updated to ensure that the public will have access to sufficient and up-to-date knowledge. UR - https://medinform.jmir.org/2022/5/e37215 UR - http://dx.doi.org/10.2196/37215 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476822 ID - info:doi/10.2196/37215 ER - TY - JOUR AU - Constant, Aymery AU - Conserve, Donaldson AU - Gallopel-Morvan, Karine AU - Raude, Jocelyn PY - 2022/5/13 TI - Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study JO - JMIRx Med SP - e32859 VL - 3 IS - 2 KW - Extended Parallel Process Model KW - COVID-19 KW - lockdown KW - public acceptance KW - nonpharmaceutical measures KW - Likert scale KW - France N2 - 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. UR - https://med.jmirx.org/2022/2/e32859 UR - http://dx.doi.org/10.2196/32859 UR - http://www.ncbi.nlm.nih.gov/pubmed/35648730 ID - info:doi/10.2196/32859 ER - TY - JOUR AU - Chen, Uan-I AU - Xu, Hua AU - Krause, Millard Trudy AU - Greenberg, Raymond AU - Dong, Xiao AU - Jiang, Xiaoqian PY - 2022/5/12 TI - Factors Associated With COVID-19 Death in the United States: Cohort Study JO - JMIR Public Health Surveill SP - e29343 VL - 8 IS - 5 KW - COVID-19 KW - risk factors KW - survival analysis KW - cohort studies KW - EHR data N2 - 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. UR - https://publichealth.jmir.org/2022/5/e29343 UR - http://dx.doi.org/10.2196/29343 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377319 ID - info:doi/10.2196/29343 ER - TY - JOUR AU - Shah, S. Harita AU - Dolwick Grieb, Suzanne AU - Flores-Miller, Alejandra AU - Phillips, H. Katherine AU - Page, R. Kathleen AU - Cervantes, Ana AU - Yang, Cui PY - 2022/5/12 TI - A Crowdsourcing Open Contest to Design a Latino-Specific COVID-19 Campaign: Mixed Methods Analysis JO - JMIR Form Res SP - e35764 VL - 6 IS - 5 KW - crowdsourcing KW - Latino KW - open contest KW - community engagement KW - social marketing KW - COVID-19 KW - mixed method KW - implementation KW - thematic analysis N2 - Background: Latino communities are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. Objective: The aims of this study are to (1) implement and evaluate a crowdsourcing open contest to solicit a name for a COVID-19 social marketing campaign for Latino populations in Maryland and (2) conduct a thematic analysis of submitted entries to guide campaign messaging. Methods: To assess the level of community engagement in this crowdsourcing open contest, we used descriptive statistics to analyze data on entries, votes, and demographic characteristics of participants. The submitted text was analyzed through inductive thematic analysis. Results: We received 74 entries within a 2-week period. The top 10 entries were chosen by community judges and the winner was decided by popular vote. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We used these themes to directly inform our social marketing intervention and found that advertisements based on these themes became the highest performing. Conclusions: Crowdsourcing open contests are an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by health care disparities, such as Latino communities. The thematic analysis of contest entries can be a valuable strategy to inform the development of social marketing campaign materials. UR - https://formative.jmir.org/2022/5/e35764 UR - http://dx.doi.org/10.2196/35764 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357317 ID - info:doi/10.2196/35764 ER - TY - JOUR AU - Gangireddy, Rakshith AU - Chakraborty, Stuti AU - Pakenham-Walsh, Neil AU - Nagarajan, Branavan AU - Krishan, Prerna AU - McGuire, Richard AU - Vaghela, Gladson AU - Sriharan, Abi PY - 2022/5/11 TI - Themes Surrounding COVID-19 and Its Infodemic: Qualitative Analysis of the COVID-19 Discussion on the Multidisciplinary Healthcare Information for All Health Forum JO - JMIR Infodemiology SP - e30167 VL - 2 IS - 1 KW - infodemic KW - infodemiology KW - COVID-19 KW - pandemic KW - misinformation KW - health information KW - theme KW - public health KW - qualitative study KW - global health N2 - Background: Healthcare Information for All (HIFA) is a multidisciplinary global campaign consisting of more than 20,000 members worldwide committed to improving the availability and use of health care information in low- and middle-income countries (LMICs). During the COVID-19 pandemic, online HIFA forums saw a tremendous amount of discussion regarding the lack of information about COVID-19, the spread of misinformation, and the pandemic?s impact on different communities. Objective: This study aims to analyze the themes and perspectives shared in the COVID-19 discussion on English HIFA forums. Methods: Over a period of 8 months, a qualitative thematic content analysis of the COVID-19 discussion on English HIFA forums was conducted. In total, 865 posts between January 24 and October 31, 2020, from 246 unique study participants were included and analyzed. Results: In total, 6 major themes were identified: infodemic, health system, digital health literacy, economic consequences, marginalized peoples, and mental health. The geographical distribution of study participants involved in the discussion spanned across 46 different countries in every continent except Antarctica. Study participants? professions included public health workers, health care providers, and researchers, among others. Study participants? affiliation included nongovernment organizations (NGOs), commercial organizations, academic institutions, the United Nations (UN), the World Health Organization (WHO), and others. Conclusions: The themes that emerged from this analysis highlight personal recounts, reflections, suggestions, and evidence around addressing COVID-19 related misinformation and might also help to understand the timeline of information evolution, focus, and needs surrounding the COVID-19 pandemic. UR - https://infodemiology.jmir.org/2022/1/e30167 UR - http://dx.doi.org/10.2196/30167 UR - http://www.ncbi.nlm.nih.gov/pubmed/35586197 ID - info:doi/10.2196/30167 ER - TY - JOUR AU - Niu, Qian AU - Liu, Junyu AU - Kato, Masaya AU - Shinohara, Yuki AU - Matsumura, Natsuki AU - Aoyama, Tomoki AU - Nagai-Tanima, Momoko PY - 2022/5/9 TI - Public Opinion and Sentiment Before and at the Beginning of COVID-19 Vaccinations in Japan: Twitter Analysis JO - JMIR Infodemiology SP - e32335 VL - 2 IS - 1 KW - COVID-19 KW - Japan KW - vaccine KW - Twitter KW - sentiment KW - latent dirichlet allocation KW - natural language processing N2 - Background: COVID-19 vaccines are considered one of the most effective ways for containing the COVID-19 pandemic, but Japan lagged behind other countries in vaccination in the early stages. A deeper understanding of the slow progress of vaccination in Japan can be instructive for COVID-19 booster vaccination and vaccinations during future pandemics. Objective: This retrospective study aims to analyze the slow progress of early-stage vaccination in Japan by exploring opinions and sentiment toward the COVID-19 vaccine in Japanese tweets before and at the beginning of vaccination. Methods: We collected 144,101 Japanese tweets containing COVID-19 vaccine-related keywords between August 1, 2020, and June 30, 2021. We visualized the trend of the tweets and sentiments and identified the critical events that may have triggered the surges. Correlations between sentiments and the daily infection, death, and vaccination cases were calculated. The latent dirichlet allocation model was applied to identify topics of negative tweets from the beginning of vaccination. We also conducted an analysis of vaccine brands (Pfizer, Moderna, AstraZeneca) approved in Japan. Results: The daily number of tweets continued with accelerating growth after the start of large-scale vaccinations in Japan. The sentiments of around 85% of the tweets were neutral, and negative sentiment overwhelmed the positive sentiment in the other tweets. We identified 6 public-concerned topics related to the negative sentiment at the beginning of the vaccination process. Among the vaccines from the 3 manufacturers, the attitude toward Moderna was the most positive, and the attitude toward AstraZeneca was the most negative. Conclusions: Negative sentiment toward vaccines dominated positive sentiment in Japan, and the concerns about side effects might have outweighed fears of infection at the beginning of the vaccination process. Topic modeling on negative tweets indicated that the government and policy makers should take prompt actions in building a safe and convenient vaccine reservation and rollout system, which requires both flexibility of the medical care system and the acceleration of digitalization in Japan. The public showed different attitudes toward vaccine brands. Policy makers should provide more evidence about the effectiveness and safety of vaccines and rebut fake news to build vaccine confidence. UR - https://infodemiology.jmir.org/2022/1/e32335 UR - http://dx.doi.org/10.2196/32335 UR - http://www.ncbi.nlm.nih.gov/pubmed/35578643 ID - info:doi/10.2196/32335 ER - TY - JOUR AU - Huang, Ming AU - Khurana, Aditya AU - Mastorakos, George AU - Wen, Andrew AU - He, Huan AU - Wang, Liwei AU - Liu, Sijia AU - Wang, Yanshan AU - Zong, Nansu AU - Prigge, Julie AU - Costello, Brian AU - Shah, Nilay AU - Ting, Henry AU - Fan, Jungwei AU - Patten, Christi AU - Liu, Hongfang PY - 2022/5/5 TI - Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Hum Factors SP - e35187 VL - 9 IS - 2 KW - patient portal KW - patient portal message KW - asynchronous communication KW - COVID-19 KW - utilization KW - digital health KW - healthcare KW - health care KW - remote healthcare KW - virtual care KW - pandemic N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e35187 UR - http://dx.doi.org/10.2196/35187 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171108 ID - info:doi/10.2196/35187 ER - TY - JOUR AU - Hunter, Alex AU - Leckie, Todd AU - Coe, Oliver AU - Hardy, Benjamin AU - Fitzpatrick, Daniel AU - Gonçalves, Ana-Carolina AU - Standing, Mary-Kate AU - Koulouglioti, Christina AU - Richardson, Alan AU - Hodgson, Luke PY - 2022/5/2 TI - Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study JO - JMIR Rehabil Assist Technol SP - e25494 VL - 9 IS - 2 KW - COVID-19 KW - telemedicine KW - rehabilitation KW - critical illness KW - smartphone KW - digital health KW - mobile health KW - remote therapy KW - device usability N2 - Background: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site?the MDT site (n=19)?had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results: Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup?s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post?critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID): RR2-10.12968/ijtr.2020.0102 UR - https://rehab.jmir.org/2022/2/e25494 UR - http://dx.doi.org/10.2196/25494 UR - http://www.ncbi.nlm.nih.gov/pubmed/35417402 ID - info:doi/10.2196/25494 ER - TY - JOUR AU - Adly, Sedky Aya AU - Adly, Sedky Mahmoud AU - Adly, Sedky Afnan PY - 2022/5/2 TI - 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? JO - J Med Internet Res SP - e37413 VL - 24 IS - 5 KW - telemedicine KW - oxygen therapy KW - noninvasive positive airway pressure KW - BiPAP KW - osteopathic medicine KW - physical therapy KW - SARS-CoV-2 KW - COVID-19 KW - teletherapy KW - telemanagement UR - https://www.jmir.org/2022/5/e37413 UR - http://dx.doi.org/10.2196/37413 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476751 ID - info:doi/10.2196/37413 ER - TY - JOUR AU - Chen, Chih-Wei AU - Wei, Cheng-Chung James PY - 2022/5/2 TI - 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? JO - J Med Internet Res SP - e34437 VL - 24 IS - 5 KW - telemedicine KW - oxygen therapy KW - noninvasive positive airway pressure KW - BiPAP KW - osteopathic medicine KW - physical therapy KW - SARS-CoV-2 KW - COVID-19 KW - teletherapy KW - telemanagement UR - https://www.jmir.org/2022/5/e34437 UR - http://dx.doi.org/10.2196/34437 UR - http://www.ncbi.nlm.nih.gov/pubmed/35476637 ID - info:doi/10.2196/34437 ER - TY - JOUR AU - Kyabaggu, Ramona AU - Marshall, Deneice AU - Ebuwei, Patience AU - Ikenyei, Uche PY - 2022/4/28 TI - Health Literacy, Equity, and Communication in the COVID-19 Era of Misinformation: Emergence of Health Information Professionals in Infodemic Management JO - JMIR Infodemiology SP - e35014 VL - 2 IS - 1 KW - COVID-19 KW - social media KW - infodemiology KW - infoveillance KW - equity KW - health literacy KW - digital literacy KW - health information management KW - pandemic KW - health information KW - public policy KW - infodemic UR - https://infodemiology.jmir.org/2022/1/e35014 UR - http://dx.doi.org/10.2196/35014 UR - http://www.ncbi.nlm.nih.gov/pubmed/35529308 ID - info:doi/10.2196/35014 ER - TY - JOUR AU - Jalilian, Laleh AU - Wu, Irene AU - Ing, Jakun AU - Dong, Xuezhi AU - Sadik, Joshua AU - Pan, George AU - Hitson, Heather AU - Thomas, Erin AU - Grogan, Tristan AU - Simkovic, Michael AU - Kamdar, Nirav PY - 2022/4/27 TI - Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study JO - JMIR Perioper Med SP - e33926 VL - 5 IS - 1 KW - COVID-19 KW - pain management KW - telemedicine KW - cost savings KW - patient satisfaction N2 - Background: An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, health care providers have used telemedicine for pain management of both interventional patients and those with chronic pain. Objective: In this study, we aimed to describe the implementation of a telemedicine program for pain management in an academic pain division in a large metropolitan area. We also aimed to estimate patient cost savings from telemedicine, before and after the California COVID-19 ?Safer at Home? directive, and to estimate patient satisfaction with telemedicine for pain management care. Methods: This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1398 patients and conducted 2948 video visits for remote pain management care. We used the publicly available Internal Revenue Service?s Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimated median travel time and travel distance with Google Maps? Distance Matrix application programming interface, direct cost of travel with median value for regular fuel cost in California, and time-based opportunity savings from estimated hourly earnings and round-trip time. We reported patient satisfaction scores derived from a postvisit satisfaction survey containing questions with responses on a 5-point Likert scale. Results: Patients who attended telemedicine visits avoided an estimated median round-trip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within the sample, their median hourly earnings were US $28 (IQR US $21-$39) per hour. Patients saved a median of US $22 on gas and parking and a median total of US $52 (IQR US $36-$75) per telemedicine visit based on estimated hourly earnings and travel time. Patients who were evaluated serially with telemedicine for medication management saved a median of US $156 over a median of 3 visits. A total of 91.4% (286/313) of patients surveyed were satisfied with their telemedicine experience. Conclusions: Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for patients with pain. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings. UR - https://periop.jmir.org/2022/1/e33926 UR - http://dx.doi.org/10.2196/33926 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023841 ID - info:doi/10.2196/33926 ER - TY - JOUR AU - Tahamtan, Iman AU - Potnis, Devendra AU - Mohammadi, Ehsan AU - Singh, Vandana AU - Miller, E. Laura PY - 2022/4/26 TI - The Mutual Influence of the World Health Organization (WHO) and Twitter Users During COVID-19: Network Agenda-Setting Analysis JO - J Med Internet Res SP - e34321 VL - 24 IS - 4 KW - COVID-19 KW - agenda setting KW - network agenda setting KW - Twitter KW - social media KW - public opinion KW - content analysis KW - public health KW - WHO N2 - 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. UR - https://www.jmir.org/2022/4/e34321 UR - http://dx.doi.org/10.2196/34321 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275836 ID - info:doi/10.2196/34321 ER - TY - JOUR AU - Chen, Yen-Pin AU - Chen, Yi-Ying AU - Yang, Kai-Chou AU - Lai, Feipei AU - Huang, Chien-Hua AU - Chen, Yun-Nung AU - Tu, Yi-Chin PY - 2022/4/26 TI - The Prevalence and Impact of Fake News on COVID-19 Vaccination in Taiwan: Retrospective Study of Digital Media JO - J Med Internet Res SP - e36830 VL - 24 IS - 4 KW - misinformation KW - vaccine hesitancy KW - vaccination KW - infodemic KW - infodemiology KW - COVID-19 KW - public immunity KW - social media KW - fake news N2 - 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 (?=0.98, P=.002) of vaccine availability on the following week's vaccination doses, and a negative adjusted coefficient (?=?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. UR - https://www.jmir.org/2022/4/e36830 UR - http://dx.doi.org/10.2196/36830 UR - http://www.ncbi.nlm.nih.gov/pubmed/35380546 ID - info:doi/10.2196/36830 ER - TY - JOUR AU - Lee, An Hsiu AU - Wu, Wei-Chen AU - Kung, Hsin-Hua AU - Udayasankaran, Ganesh Jai AU - Wei, Yu-Chih AU - Kijsanayotin, Boonchai AU - Marcelo, B. Alvin AU - Hsu, Chien-Yeh PY - 2022/4/26 TI - Design of a Vaccine Passport Validation System Using Blockchain-based Architecture: Development Study JO - JMIR Public Health Surveill SP - e32411 VL - 8 IS - 4 KW - COVID-19 KW - vaccine passport KW - global border control KW - health policy KW - international infectious disease strategy KW - vaccine KW - policy KW - strategy KW - blockchain KW - privacy KW - security KW - testing KW - verification KW - certification KW - Fast Healthcare Interoperability Resource N2 - 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. UR - https://publichealth.jmir.org/2022/4/e32411 UR - http://dx.doi.org/10.2196/32411 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377316 ID - info:doi/10.2196/32411 ER - TY - JOUR AU - Gupta, Ekta AU - Mishra, Kumar Rupesh AU - Kumar Niraj, Ranjan Ravi PY - 2022/4/26 TI - Identification of Potential Vaccine Candidates Against SARS-CoV-2 to Fight COVID-19: Reverse Vaccinology Approach JO - JMIR Bioinform Biotech SP - e32401 VL - 3 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - reverse vaccinology KW - molecular docking KW - molecular dynamics simulation KW - vaccine candidates KW - vaccine KW - simulation KW - virus KW - peptide KW - antigen KW - immunology KW - biochemistry KW - genetics N2 - 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. UR - https://bioinform.jmir.org/2022/1/e32401 UR - http://dx.doi.org/10.2196/32401 UR - http://www.ncbi.nlm.nih.gov/pubmed/35506029 ID - info:doi/10.2196/32401 ER - TY - JOUR AU - Grigsby-Toussaint, Diana AU - Champagne, Ashley AU - Uhr, Justin AU - Silva, Elizabeth AU - Noh, Madeline AU - Bradley, Adam AU - Rashleigh, Patrick PY - 2022/4/20 TI - US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study JO - JMIR Infodemiology SP - e30885 VL - 2 IS - 1 KW - Black maternal health KW - disparity KW - COVID-19 KW - Twitter KW - topic modeling KW - digital humanities KW - infoveillance KW - maternal health KW - minority KW - women KW - advocacy KW - social media KW - model KW - trend KW - feasibility N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e30885 UR - http://dx.doi.org/10.2196/30885 UR - http://www.ncbi.nlm.nih.gov/pubmed/35578642 ID - info:doi/10.2196/30885 ER - TY - JOUR AU - Rovetta, Alessandro PY - 2022/4/19 TI - Google Trends as a Predictive Tool for COVID-19 Vaccinations in Italy: Retrospective Infodemiological Analysis JO - JMIRx Med SP - e35356 VL - 3 IS - 2 KW - COVID-19 KW - epidemiology KW - Google Trends KW - infodemiology KW - infoveillance KW - Italy KW - public health KW - SARS-CoV-2 KW - vaccinations KW - vaccines KW - social media analysis KW - social media N2 - Background: Google Trends is an infoveillance tool widely used by the scientific community to investigate different user behaviors related to COVID-19. However, several limitations regarding its adoption are reported in the literature. Objective: This paper aims to provide an effective and efficient approach to investigating vaccine adherence against COVID-19 via Google Trends. Methods: Through the cross-correlational analysis of well-targeted hypotheses, we investigate the predictive capacity of web searches related to COVID-19 toward vaccinations in Italy from November 2020 to November 2021. The keyword ?vaccine reservation? query (VRQ) was chosen as it reflects a real intention of being vaccinated (V). Furthermore, the impact of the second most read Italian newspaper (vaccine-related headlines [VRH]) on vaccine-related web searches was investigated to evaluate the role of the mass media as a confounding factor. Fisher r-to-z transformation (z) and percentage difference (?) were used to compare Spearman coefficients. A regression model V=f(VRH, VRQ) was built to validate the results found. The Holm-Bonferroni correction was adopted (P*). SEs are reported. Results: Simple and generic keywords are more likely to identify the actual web interest in COVID-19 vaccines than specific and elaborated keywords. Cross-correlations between VRQ and V were very strong and significant (min r²=0.460, P*<.001, lag 0 weeks; max r²=0.903, P*<.001, lag 6 weeks). The remaining cross-correlations have been markedly lower (?>55.8%; z>5.8; P*<.001). The regression model confirmed the greater significance of VRQ versus VRH (P*<.001 vs P=.03, P*=.29). Conclusions: This research provides preliminary evidence in favor of using Google Trends as a surveillance and prediction tool for vaccine adherence against COVID-19 in Italy. Further research is needed to establish the appropriate use and limits of Google Trends for vaccination tracking. However, these findings prove that the search for suitable keywords is a fundamental step to reduce confounding factors. Additionally, targeting hypotheses helps diminish the likelihood of spurious correlations. It is recommended that Google Trends be leveraged as a complementary infoveillance tool by government agencies to monitor and predict vaccine adherence in this and future crises by following the methods proposed in this paper. UR - https://med.jmirx.org/2022/2/e35356 UR - http://dx.doi.org/10.2196/35356 UR - http://www.ncbi.nlm.nih.gov/pubmed/35481982 ID - info:doi/10.2196/35356 ER - TY - JOUR AU - Röbbelen, Alice AU - Schmieding, L. Malte AU - Kopka, Marvin AU - Balzer, Felix AU - Feufel, A. Markus PY - 2022/4/15 TI - Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e33733 VL - 8 IS - 4 KW - clinical decision support KW - usability KW - COVID-19 KW - consumer health KW - medical informatic KW - symptom checker KW - decision support KW - symptom KW - support KW - decision making KW - algorithm KW - flowchart KW - agent N2 - 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) UR - https://publichealth.jmir.org/2022/4/e33733 UR - http://dx.doi.org/10.2196/33733 UR - http://www.ncbi.nlm.nih.gov/pubmed/34882571 ID - info:doi/10.2196/33733 ER - TY - JOUR AU - Davidson, Brittany AU - Ferrer Portillo, Mara Katiuska AU - Wac, Marceli AU - McWilliams, Chris AU - Bourdeaux, Christopher AU - Craddock, Ian PY - 2022/4/13 TI - Requirements for a Bespoke Intensive Care Unit Dashboard in Response to the COVID-19 Pandemic: Semistructured Interview Study JO - JMIR Hum Factors SP - e30523 VL - 9 IS - 2 KW - intensive care KW - critical care KW - COVID-19 KW - human-centered design KW - dashboard KW - eHealth KW - disease monitoring KW - monitoring KW - ICU KW - design KW - development KW - interview N2 - 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. UR - https://humanfactors.jmir.org/2022/2/e30523 UR - http://dx.doi.org/10.2196/30523 UR - http://www.ncbi.nlm.nih.gov/pubmed/35038301 ID - info:doi/10.2196/30523 ER - TY - JOUR AU - Mohammadi, Ehsan AU - Tahamtan, Iman AU - Mansourian, Yazdan AU - Overton, Holly PY - 2022/4/13 TI - Identifying Frames of the COVID-19 Infodemic: Thematic Analysis of Misinformation Stories Across Media JO - JMIR Infodemiology SP - e33827 VL - 2 IS - 1 KW - COVID-19 KW - pandemic KW - misinformation KW - fake news KW - framing theory KW - social media KW - infodemic KW - thematic analysis KW - theme KW - pattern KW - prevalence N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e33827 UR - http://dx.doi.org/10.2196/33827 UR - http://www.ncbi.nlm.nih.gov/pubmed/37113806 ID - info:doi/10.2196/33827 ER - TY - JOUR AU - Ho, Vanda AU - Merchant, A. Reshma PY - 2022/4/13 TI - The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study JO - JMIR Aging SP - e33165 VL - 5 IS - 2 KW - senior KW - telehealth KW - digital exercise KW - acceptability KW - telemedicine KW - elderly KW - older adults KW - outcome KW - isolation KW - decline KW - function KW - adoption KW - perception KW - exercise KW - physical activity KW - questionnaire KW - COVID-19 N2 - Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ?60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14% (n=6), 12% (n=5), and 24% (n=10) of participants, respectively. Of the participants, 29% (n=12) had possible sarcopenia and 14% (n=6) were prefrail. Around 24% (n=10) were at risk of social isolation. Most of the participants (n=38, 91%) agreed that technology is good, and 79% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79%) agreed that they have the necessary knowledge, and 91% (n=38) had technological assistance available. However, 57% (n=24) were still apprehensive about using technology. Despite 71% (n=30) of older adults owning their devices, 36% (n=15) felt finances were limiting. Through digital HAPPY, 45% (n=19) of participants reported feeling stronger, 48% (n=20) had improved spirits, and 40% (n=17) and 38% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. UR - https://aging.jmir.org/2022/2/e33165 UR - http://dx.doi.org/10.2196/33165 UR - http://www.ncbi.nlm.nih.gov/pubmed/35294921 ID - info:doi/10.2196/33165 ER - TY - JOUR AU - Sidani, E. Jaime AU - Hoffman, Beth AU - Colditz, B. Jason AU - Wolynn, Riley AU - Hsiao, Lily AU - Chu, Kar-Hai AU - Rose, J. Jason AU - Shensa, Ariel AU - Davis, Esa AU - Primack, Brian PY - 2022/4/13 TI - Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content JO - JMIR Form Res SP - e26335 VL - 6 IS - 4 KW - COVID-19 KW - coronavirus KW - e-cigarette KW - electronic nicotine delivery systems KW - Twitter KW - social media KW - misinformation KW - discussion KW - public health KW - communication KW - concern KW - severity KW - conspiracy N2 - 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. UR - https://formative.jmir.org/2022/4/e26335 UR - http://dx.doi.org/10.2196/26335 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311684 ID - info:doi/10.2196/26335 ER - TY - JOUR AU - Mullarkey, Michael AU - Dobias, Mallory AU - Sung, Jenna AU - Ahuvia, Isaac AU - Shumake, Jason AU - Beevers, Christopher AU - Schleider, Jessica PY - 2022/4/12 TI - Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial JO - JMIR Ment Health SP - e33473 VL - 9 IS - 4 KW - anxiety KW - COVID-19 KW - single-session intervention KW - SSI KW - perceived control KW - intervention KW - mental health KW - control KW - online intervention KW - telemedicine KW - telehealth KW - scalable N2 - Background: Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental health care. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. Objective: Our registered report evaluated a no-therapist, single-session, online intervention targeting perceived control over anxiety in the COVID-19 context against a placebo intervention encouraging handwashing. We tested whether the intervention could (1) decrease generalized anxiety and increase perceived control over anxiety and (2) achieve this without decreasing social-distancing intentions. Methods: We tested these questions using a between-subjects design in a weighted-probability sample of US adults recruited via a closed online platform (ie, Prolific). All outcomes were indexed via online self-report questionnaires. Results: Of 522 randomized individuals, 500 (95.8%) completed the baseline survey and intervention. Intent-to-treat analyses using all randomized participants (N=522) found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d=?0.06 (95% CI ?0.27 to 0.15; P=.48), effects on perceived control were d=0.04 (95% CI ?0.08 to 0.16; P=.48), and effects on social-distancing intentions were d=?0.02 (95% CI ?0.23 to 0.19; P=.83). Conclusions: Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions, including the challenge of targeting perceived control over anxiety, are discussed. Trial Registration: ClinicalTrials.gov NCT04459455; https://clinicaltrials.gov/show/NCT04459455 UR - https://mental.jmir.org/2022/4/e33473 UR - http://dx.doi.org/10.2196/33473 UR - http://www.ncbi.nlm.nih.gov/pubmed/35230962 ID - info:doi/10.2196/33473 ER - TY - JOUR AU - John, Jari PY - 2022/4/12 TI - Modeling Years of Life Lost Due to COVID-19, Socioeconomic Status, and Nonpharmaceutical Interventions: Development of a Prediction Model JO - JMIRx Med SP - e30144 VL - 3 IS - 2 KW - COVID-19 KW - pandemic KW - socioeconomic status KW - mortality KW - nonpharmaceutical interventions KW - prediction model KW - low-income status KW - life expectancy KW - public health KW - income groups N2 - 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. UR - https://med.jmirx.org/2022/2/e30144 UR - http://dx.doi.org/10.2196/30144 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438949 ID - info:doi/10.2196/30144 ER - TY - JOUR AU - Ozluk, Pelin AU - Cobb, Rebecca AU - Hoots, Alyson AU - Sylwestrzak, Malgorzata PY - 2022/4/11 TI - Association Between Mobile App Use and Caregivers? Support System, Time Spent on Caregiving, and Perceived Well-being: Survey Study From a Large Employer JO - J Med Internet Res SP - e28504 VL - 24 IS - 4 KW - caregiving KW - mobile app KW - mobile phone N2 - Background: Mobile technology to address caregiver needs has been on the rise. There is limited evidence of effectiveness of such technologies on caregiver experiences. Objective: This study evaluates the effectiveness of ianacare, a mobile app, among employees of a large employer. ianacare mobilizes personal social circles to help with everyday tasks. Through the use of ianacare, we evaluate the associations between coordinating caregiving tasks among a caregiver?s personal support network and outcomes related to the caregiver?s support system, time use, perceived productivity, and perceived health and well-being. Caregiver tasks include tasks such as meal preparation, respite care, pet care, and transportation. Time use is the measure of a caregiver?s time spent on caregiving tasks and how much time they had to take off from work to attend planned or unplanned caregiving tasks. Methods: We conducted 2 surveys to assess within-participant changes in outcomes for the unpaid, employed, caregivers after 6 weeks of using the mobile app (n=176) between March 30, 2020, and May 11, 2020. The surveys contained questions in three domains: the caregiver?s support system, time use and perceived productivity, and perceived health and well-being. The results of the linear probability models are presented below. Results: App use was significantly associated with decreasing the probability of doing most caregiving tasks alone by 9.1% points (SE 0.04; P=.01) and increasing the probability of at least one person helping the primary caregiver by 8.0% points (SE 0.035; P=.02). App use was also associated with improving the time use of the primary caregiver who took significantly less time off work to attend to caregiving duties by 12.5% points (SE 0.04; P=.003) and decreased the probability of spending more than 30 hours weekly on caregiving by 9.1% points (SE 0.04; P=.02). Additional findings on the positive impact of the app included a decrease in the probability of reporting feeling overwhelmed by caregiving tasks by 12.5% points (SE 0.04; P=.003) and a decrease in the probability of reporting negative health effects by 6.8% points (SE 0.04; P=.07) because of caregiving. Although subjects reported that COVID-19 increased their stress attributed to caregiving and prevented them from requesting help for some caregiving tasks, using the app was still associated with improvements in receiving help and lessening of the negative effects of caregiving on the caregivers. Conclusions: App use was associated with improvements in 7 of 11 caregiver outcomes across three main categories: their support system, time spent on caregiving, and perceived health and well-being. These findings provide encouraging evidence that the mobile app can significantly reduce caregiver burden by leveraging a caregiver?s support network despite the additional challenges brought by COVID-19 on caregivers. UR - https://www.jmir.org/2022/4/e28504 UR - http://dx.doi.org/10.2196/28504 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404266 ID - info:doi/10.2196/28504 ER - TY - JOUR AU - Langnickel, Lisa AU - Podorskaja, Daria AU - Fluck, Juliane PY - 2022/4/8 TI - Pre2Pub?Tracking the Path From Preprint to Journal Article: Algorithm Development and Validation JO - J Med Internet Res SP - e34072 VL - 24 IS - 4 KW - preprints KW - information retrieval KW - COVID-19 KW - metadata KW - BERT KW - Bidirectional Encoder Representations from Transformers N2 - Background: The current COVID-19 crisis underscores the importance of preprints, as they allow for rapid communication of research results without delay in review. To fully integrate this type of publication into library information systems, we developed preview: a publicly available, central search engine for COVID-19?related preprints, which clearly distinguishes this source from peer-reviewed publications. The relationship between the preprint version and its corresponding journal version should be stored as metadata in both versions so that duplicates can be easily identified and information overload for researchers is reduced. Objective: In this work, we investigated the extent to which the relationship information between preprint and corresponding journal publication is present in the published metadata, how it can be further completed, and how it can be used in preVIEW to identify already republished preprints and filter those duplicates in search results. Methods: We first analyzed the information content available at the preprint servers themselves and the information that can be retrieved via Crossref. Moreover, we developed the algorithm Pre2Pub to find the corresponding reviewed article for each preprint. We integrated the results of those different resources into our search engine preVIEW, presented the information in the result set overview, and added filter options accordingly. Results: Preprints have found their place in publication workflows; however, the link from a preprint to its corresponding journal publication is not completely covered in the metadata of the preprint servers or in Crossref. Our algorithm Pre2Pub is able to find approximately 16% more related journal articles with a precision of 99.27%. We also integrate this information in a transparent way within preVIEW so that researchers can use it in their search. Conclusions: Relationships between the preprint version and its journal version is valuable information that can help researchers finding only previously unknown information in preprints. As long as there is no transparent and complete way to store this relationship in metadata, the Pre2Pub algorithm is a suitable extension to retrieve this information. UR - https://www.jmir.org/2022/4/e34072 UR - http://dx.doi.org/10.2196/34072 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285808 ID - info:doi/10.2196/34072 ER - TY - JOUR AU - Tiersma, Keenae AU - Reichman, Mira AU - Popok, J. Paula AU - Nelson, Zoe AU - Barry, Maura AU - Elwy, Rani A. AU - Flores, J. Efrén AU - Irwin, E. Kelly AU - Vranceanu, Ana-Maria PY - 2022/4/8 TI - The Strategies for Quantitative and Qualitative Remote Data Collection: Lessons From the COVID-19 Pandemic JO - JMIR Form Res SP - e30055 VL - 6 IS - 4 KW - web-based research KW - remote research KW - remote data collection KW - blended design KW - electronic data collection KW - mobile phone UR - https://formative.jmir.org/2022/4/e30055 UR - http://dx.doi.org/10.2196/30055 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394441 ID - info:doi/10.2196/30055 ER - TY - JOUR AU - Rovetta, Alessandro AU - Bhagavathula, Srikanth Akshaya PY - 2022/4/7 TI - The Impact of COVID-19 on Mortality in Italy: Retrospective Analysis of Epidemiological Trends JO - JMIR Public Health Surveill SP - e36022 VL - 8 IS - 4 KW - COVID-19 KW - deniers KW - excess deaths KW - epidemiology KW - infodemic KW - infodemiology KW - Italy KW - longitudinal analysis KW - mortality KW - time series KW - pandemic KW - public health N2 - 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. UR - https://publichealth.jmir.org/2022/4/e36022 UR - http://dx.doi.org/10.2196/36022 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238784 ID - info:doi/10.2196/36022 ER - TY - JOUR AU - Hajek, André AU - König, Hans-Helmut PY - 2022/4/7 TI - Frequency and Correlates of Online Consultations With Doctors or Therapists in Middle-Aged and Older Adults: Nationally Representative Cross-sectional Study JO - J Med Internet Res SP - e29781 VL - 24 IS - 4 KW - online consultations KW - doctor KW - therapists KW - telehealth KW - COVID-19 KW - SARS-CoV-2 KW - digital health N2 - 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. UR - https://www.jmir.org/2022/4/e29781 UR - http://dx.doi.org/10.2196/29781 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389360 ID - info:doi/10.2196/29781 ER - TY - JOUR AU - Stennett, Jack AU - Hou, Renyou AU - Traverson, Lola AU - Ridde, Valéry AU - Zinszer, Kate AU - Chabrol, Fanny PY - 2022/4/6 TI - Lessons Learned From the Resilience of Chinese Hospitals to the COVID-19 Pandemic: Scoping Review JO - JMIRx Med SP - e31272 VL - 3 IS - 2 KW - COVID-19 KW - pandemic KW - SARS-CoV-2 KW - health care KW - hospitals KW - health care strategy KW - hospital resilience KW - interventions KW - crisis response KW - crisis preparedness KW - public health N2 - 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. UR - https://med.jmirx.org/2022/2/e31272 UR - http://dx.doi.org/10.2196/31272 UR - http://www.ncbi.nlm.nih.gov/pubmed/35435649 ID - info:doi/10.2196/31272 ER - TY - JOUR AU - Gray, Kathleen AU - Chapman, Wendy AU - Khan, R. Urooj AU - Borda, Ann AU - Budge, Marc AU - Dutch, Martin AU - Hart, K. Graeme AU - Gilbert, Cecily AU - Wani, Ahmad Tafheem PY - 2022/4/6 TI - The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services JO - JMIR Form Res SP - e32619 VL - 6 IS - 4 KW - COVID-19 KW - health system innovation KW - rapid development and deployment methods KW - remote patient monitoring KW - software development N2 - 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. UR - https://formative.jmir.org/2022/4/e32619 UR - http://dx.doi.org/10.2196/32619 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297765 ID - info:doi/10.2196/32619 ER - TY - JOUR AU - Traxler, D. Brett AU - Rucker, M. Brayden AU - Greenough, C. Mary AU - Sajjadi, B. Nicholas AU - Hartwell, Micah PY - 2022/4/5 TI - Influence of the COVID-19 Pandemic on Clinical Trial Discontinuation in Anesthesiology: Cross-sectional Analysis JO - JMIR Perioper Med SP - e34936 VL - 5 IS - 1 KW - clinical trials KW - anesthesia KW - anesthesiology KW - COVID-19 KW - pandemic KW - perioperative care KW - lockdown N2 - 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. UR - https://periop.jmir.org/2022/1/e34936 UR - http://dx.doi.org/10.2196/34936 UR - http://www.ncbi.nlm.nih.gov/pubmed/35358057 ID - info:doi/10.2196/34936 ER - TY - JOUR AU - Jaworski, K. Beth AU - Taylor, Katherine AU - Ramsey, M. Kelly AU - Heinz, J. Adrienne AU - Steinmetz, Sarah AU - Owen, E. Jason AU - Tsai, Jack AU - Pietrzak, H. Robert PY - 2022/4/5 TI - Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel JO - JMIR Ment Health SP - e36217 VL - 9 IS - 4 KW - COVID-19 KW - coronavirus KW - mobile app KW - mHealth KW - digital health KW - mental health KW - public mental health KW - stress KW - coping KW - older adults KW - veterans N2 - Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective: The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results: We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions: The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan. UR - https://mental.jmir.org/2022/4/e36217 UR - http://dx.doi.org/10.2196/36217 UR - http://www.ncbi.nlm.nih.gov/pubmed/35245204 ID - info:doi/10.2196/36217 ER - TY - JOUR AU - De Kock, H. Johannes AU - Latham, Ann Helen AU - Cowden, G. Richard AU - Cullen, Breda AU - Narzisi, Katia AU - Jerdan, Shaun AU - Munoz, Sarah-Anne AU - Leslie, J. Stephen AU - Stamatis, Andreas AU - Eze, Jude PY - 2022/4/4 TI - Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e34002 VL - 9 IS - 4 KW - eHealth KW - public health KW - depression KW - anxiety KW - well-being KW - mobile health KW - intervention studies KW - staff KW - occupational health KW - NHS KW - intervention KW - support KW - COVID-19 KW - randomized controlled trial N2 - Background: Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. Objective: This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. Methods: NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). Results: Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI ?0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI ?0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI ?0.11 to 0.46), and mental well-being (vs MPS: Cohen d=?0.04, 95% CI ?0.62 to ?0.08; vs NHSWBP: Cohen d=?0.15, 95% CI ?0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. Conclusions: Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. Trial Registration: ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122 UR - https://mental.jmir.org/2022/4/e34002 UR - http://dx.doi.org/10.2196/34002 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044927 ID - info:doi/10.2196/34002 ER - TY - JOUR AU - Nowicka, Anna AU - Jaszczak, Jakub AU - Szymanek Pasternak, Anna AU - Simon, Krzysztof PY - 2022/4/4 TI - Application of a Web-based Self-assessment Triage Tool During the COVID-19 Pandemic: Descriptive Study JO - JMIR Hum Factors SP - e34134 VL - 9 IS - 2 KW - COVID-19 KW - symptom checker KW - preclinical triage KW - self-assessment tool KW - online applications KW - COVID-19 remote triage KW - COVID-19 self-assessment N2 - 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 Wroc?aw. 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. UR - https://humanfactors.jmir.org/2022/2/e34134 UR - http://dx.doi.org/10.2196/34134 UR - http://www.ncbi.nlm.nih.gov/pubmed/35168192 ID - info:doi/10.2196/34134 ER - TY - JOUR AU - Zhang, Wei AU - Velez, Dominick PY - 2022/4/4 TI - 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 JO - JMIR Form Res SP - e32387 VL - 6 IS - 4 KW - physical activity KW - COVID-19 KW - mental health KW - depression KW - anxiety KW - United States KW - survey KW - cross-sectional KW - distress KW - risk N2 - 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. UR - https://formative.jmir.org/2022/4/e32387 UR - http://dx.doi.org/10.2196/32387 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302509 ID - info:doi/10.2196/32387 ER - TY - JOUR AU - Marshall, Christopher AU - Lanyi, Kate AU - Green, Rhiannon AU - Wilkins, C. Georgina AU - Pearson, Fiona AU - Craig, Dawn PY - 2022/3/31 TI - Using Natural Language Processing to Explore Mental Health Insights From UK Tweets During the COVID-19 Pandemic: Infodemiology Study JO - JMIR Infodemiology SP - e32449 VL - 2 IS - 1 KW - Twitter KW - mental health KW - COVID-19 KW - sentiment KW - lockdown KW - soft intelligence KW - artificial intelligence KW - machine learning KW - natural language processing N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e32449 UR - http://dx.doi.org/10.2196/32449 UR - http://www.ncbi.nlm.nih.gov/pubmed/36406146 ID - info:doi/10.2196/32449 ER - TY - JOUR AU - Bacsu, Juanita-Dawne AU - Fraser, Sarah AU - Chasteen, L. Alison AU - Cammer, Allison AU - Grewal, S. Karl AU - Bechard, E. Lauren AU - Bethell, Jennifer AU - Green, Shoshana AU - McGilton, S. Katherine AU - Morgan, Debra AU - O?Rourke, M. Hannah AU - Poole, Lisa AU - Spiteri, J. Raymond AU - O'Connell, E. Megan PY - 2022/3/31 TI - Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study JO - JMIR Aging SP - e35677 VL - 5 IS - 1 KW - coronavirus 2019 KW - social media KW - stigma KW - dementia KW - ageism KW - COVID-19 KW - Twitter KW - bias KW - infodemiology KW - attention KW - risk KW - impact KW - misinformation KW - belief KW - cognition KW - cognitive impairment N2 - Background: During the pandemic, there has been significant social media attention focused on the increased COVID-19 risks and impacts for people with dementia and their care partners. However, these messages can perpetuate misconceptions, false information, and stigma. Objective: This study used Twitter data to understand stigma against people with dementia propagated during the COVID-19 pandemic. Methods: We collected 1743 stigma-related tweets using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: Based on our analysis, 4 main themes were identified: (1) ageism and devaluing the lives of people with dementia, (2) misinformation and false beliefs about dementia and COVID-19, (3) dementia used as an insult for political ridicule, and (4) challenging stigma against dementia. Social media has been used to spread stigma, but it can also be used to challenge negative beliefs, stereotypes, and false information. Conclusions: Dementia education and awareness campaigns are urgently needed on social media to address COVID-19-related stigma. When stigmatizing discourse on dementia is widely shared and consumed amongst the public, it has public health implications. How we talk about dementia shapes how policymakers, clinicians, and the public value the lives of people with dementia. Stigma perpetuates misinformation, pejorative language, and patronizing attitudes that can lead to discriminatory actions, such as the limited provision of lifesaving supports and health services for people with dementia during the pandemic. COVID-19 policies and public health messages should focus on precautions and preventive measures rather than labeling specific population groups. UR - https://aging.jmir.org/2022/1/e35677 UR - http://dx.doi.org/10.2196/35677 UR - http://www.ncbi.nlm.nih.gov/pubmed/35290197 ID - info:doi/10.2196/35677 ER - TY - JOUR AU - Nozari, Ala AU - Mukerji, Shivali AU - Lok, Ling-Ling AU - Gu, Qingrou AU - Buhl, Lauren AU - Jain, Sanjay AU - Ortega, Rafael PY - 2022/3/31 TI - Perception of Web-Based Didactic Activities During the COVID-19 Pandemic Among Anesthesia Residents: Pilot Questionnaire Study JO - JMIR Med Educ SP - e31080 VL - 8 IS - 1 KW - resident education KW - COVID-19 KW - barriers to education KW - didactic KW - medical education KW - online education KW - web-based education KW - virtual training KW - anesthesiology residents KW - medical residents KW - pandemic KW - virtual didactics N2 - Background: Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. Objective: In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineate the perceived barriers to the successful implementation of web-based medical education. Methods: A 19-item survey was compiled and distributed electronically using Qualtrics. This anonymous survey included information on the training level of each resident, their participation in formal didactics before and during the pandemic, and their perception of the ease and limitations of virtual didactics. The resident?s opinions on specific educational resources were assessed, and the effectiveness of new delivery methods on resident engagement and learning was examined. Results: Thirty anesthesiology residents were surveyed, 19 of whom agreed to participate in the pilot study. One participant with incomplete responses was excluded, yielding a final cohort of 18 respondents. Most residents (56%, 10/18) reported that the COVID-19 pandemic negatively affected their residency training. The time spent on didactic training and independent studies was, nevertheless, not affected by the pandemic for 90% (16/18) of respondents. Nonetheless, 72% (13/18) of residents were less engaged during virtual lectures in comparison to in-person didactics. Important limitations included distraction from the physical environment (67%, 12/18), internet instability (67%, 12/18), less obligation to participate (44%, 8/18), technical difficulty and unmuted microphones (33%, 6/18, each), and people speaking over each other (28%, 5/18). Despite these limitations, most residents stated that they would like to keep a combination of virtual didactics including live Zoom lectures (56%, 10/18), prerecorded web didactics (56%, 10/18), and virtual ground rounds via Zoom (50%, 9/18) as the ?new normal.? Conclusions: Despite important limitations listed in this report, anesthesia residents would like to keep a combination of virtual lectures and presentations as the new normal after the COVID-19 pandemic. UR - https://mededu.jmir.org/2022/1/e31080 UR - http://dx.doi.org/10.2196/31080 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275840 ID - info:doi/10.2196/31080 ER - TY - JOUR AU - Fidel Kinori, Guila Sara AU - Carot-Sans, Gerard AU - Cuartero, Andrés AU - Valero-Bover, Damià AU - Roma Monfa, Rosa AU - Garcia, Elisabet AU - Pérez Sust, Pol AU - Blanch, Jordi AU - Piera-Jiménez, Jordi AU - Ramos-Quiroga, Antoni Josep PY - 2022/3/31 TI - 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 JO - JMIR Form Res SP - e27402 VL - 6 IS - 3 KW - web-based app KW - emotional management KW - lockdown KW - COVID-19 KW - posttraumatic stress disorder KW - anxiety KW - quarantine KW - PTSD KW - app KW - emotion KW - development KW - platform KW - retrospective KW - usage KW - utilization N2 - 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. UR - https://formative.jmir.org/2022/3/e27402 UR - http://dx.doi.org/10.2196/27402 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142638 ID - info:doi/10.2196/27402 ER - TY - JOUR AU - Zhou, Lexin AU - Romero-García, Nekane AU - Martínez-Miranda, Juan AU - Conejero, Alberto J. AU - García-Gómez, M. Juan AU - Sáez, Carlos PY - 2022/3/30 TI - Subphenotyping of Mexican Patients With COVID-19 at Preadmission To Anticipate Severity Stratification: Age-Sex Unbiased Meta-Clustering Technique JO - JMIR Public Health Surveill SP - e30032 VL - 8 IS - 3 KW - COVID-19 KW - subphenotypes KW - clustering KW - characterization KW - observational KW - epidemiology KW - Mexico N2 - 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. UR - https://publichealth.jmir.org/2022/3/e30032 UR - http://dx.doi.org/10.2196/30032 UR - http://www.ncbi.nlm.nih.gov/pubmed/35144239 ID - info:doi/10.2196/30032 ER - TY - JOUR AU - Farrell, Ruth AU - Collart, Christina AU - Craighead, Caitlin AU - Pierce, Madelyn AU - Chien, Edward AU - Frankel, Richard AU - Tucker Edmonds, Brownsyne AU - Perni, Uma AU - Coleridge, Marissa AU - Ranzini, C. Angela AU - Rose, Susannah PY - 2022/3/30 TI - The Successes and Challenges of Implementing Telehealth for Diverse Patient Populations Requiring Prenatal Care During COVID-19: Qualitative Study JO - JMIR Form Res SP - e32791 VL - 6 IS - 3 KW - prenatal health care delivery KW - telehealth KW - COVID-19 KW - patient experience KW - challenge KW - telemedicine KW - pregnancy KW - women KW - diversity KW - prenatal KW - obstetric KW - reception KW - experience KW - development N2 - Background: Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients? receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. Objective: In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: This study involved qualitative methods to explore pregnant patients? experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. Results: Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. Conclusions: Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients. UR - https://formative.jmir.org/2022/3/e32791 UR - http://dx.doi.org/10.2196/32791 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275833 ID - info:doi/10.2196/32791 ER - TY - JOUR AU - Vilendrer, Stacie AU - Sackeyfio, Sarah AU - Akinbami, Eliel AU - Ghosh, Roy AU - Luu, Ha Jacklyn AU - Pathak, Divya AU - Shimada, Masahiro AU - Williamson, Elise Emmanuelle AU - Shieh, Lisa PY - 2022/3/30 TI - Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment JO - JMIR Form Res SP - e32933 VL - 6 IS - 3 KW - telemedicine KW - inpatient KW - patient experience KW - COVID-19 KW - infection control KW - quality of health care KW - communication KW - hospital KW - perspective KW - qualitative N2 - 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. UR - https://formative.jmir.org/2022/3/e32933 UR - http://dx.doi.org/10.2196/32933 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147510 ID - info:doi/10.2196/32933 ER - TY - JOUR AU - Cimini, Rodrigues Christiane Correa AU - Maia, Xavier Junia AU - Pires, Carvalho Magda AU - Ribeiro, Bonisson Leonardo AU - Pinto, Almeida Vânia Soares de Oliveira e. AU - Batchelor, James AU - Ribeiro, Pinho Antonio Luiz AU - Marcolino, Soriano Milena PY - 2022/3/29 TI - 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 JO - JMIR Med Inform SP - e35216 VL - 10 IS - 3 KW - hypertension KW - diabetes mellitus KW - COVID-19 KW - pandemic KW - primary health care KW - telemedicine KW - clinical decision support systems KW - patient care management N2 - 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. UR - https://medinform.jmir.org/2022/3/e35216 UR - http://dx.doi.org/10.2196/35216 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191842 ID - info:doi/10.2196/35216 ER - TY - JOUR AU - Jang, Hyeju AU - Rempel, Emily AU - Roe, Ian AU - Adu, Prince AU - Carenini, Giuseppe AU - Janjua, Zafar Naveed PY - 2022/3/29 TI - Tracking Public Attitudes Toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-Based Sentiment Analysis JO - J Med Internet Res SP - e35016 VL - 24 IS - 3 KW - COVID-19 KW - vaccination KW - Twitter KW - aspect-based sentiment analysis KW - Canada KW - social media KW - pandemic KW - content analysis KW - vaccine rollout KW - sentiment analysis KW - public sentiment KW - public health KW - health promotion KW - vaccination promotion N2 - 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. UR - https://www.jmir.org/2022/3/e35016 UR - http://dx.doi.org/10.2196/35016 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275835 ID - info:doi/10.2196/35016 ER - TY - JOUR AU - Timmermans, Lotte AU - Huybrechts, Ine AU - Decat, Peter AU - Foulon, Veerle AU - Van Hecke, Ann AU - Vermandere, Mieke AU - Schoenmakers, Birgitte PY - 2022/3/25 TI - Recommendations for Researchers on Synchronous, Online, Nominal Group Sessions in Times of COVID-19: Fishbone Analysis JO - JMIR Form Res SP - e34539 VL - 6 IS - 3 KW - COVID-19 KW - fishbone diagram KW - nominal group technique KW - video conferencing KW - primary health care KW - qualitative research N2 - 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. UR - https://formative.jmir.org/2022/3/e34539 UR - http://dx.doi.org/10.2196/34539 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225814 ID - info:doi/10.2196/34539 ER - TY - JOUR AU - Elgersma, Hess Ingeborg AU - Fretheim, Atle AU - Indseth, Thor AU - Munch, Thorolvsen Anita AU - Johannessen, Bøe Live AU - Hansen, Engh Christine PY - 2022/3/24 TI - The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial JO - J Med Internet Res SP - e34544 VL - 24 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - social media KW - campaign KW - cluster randomized trial KW - nonpharmaceutical interventions KW - migrant KW - intervention KW - testing KW - strategy KW - public health KW - Facebook KW - communication N2 - 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 UR - https://www.jmir.org/2022/3/e34544 UR - http://dx.doi.org/10.2196/34544 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285811 ID - info:doi/10.2196/34544 ER - TY - JOUR AU - Khuntia, Jiban AU - Ning, Xue AU - Stacey, Rulon PY - 2022/3/24 TI - Competition and Integration of US Health Systems in the Post-COVID-19 New Normal: Cross-sectional Survey JO - JMIR Form Res SP - e32477 VL - 6 IS - 3 KW - post-COVID-19 KW - health system KW - competition KW - vertical integration KW - horizontal integration KW - COVID-19 KW - integration KW - cross-sectional KW - survey KW - United States KW - characteristic KW - perception KW - decision N2 - 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. UR - https://formative.jmir.org/2022/3/e32477 UR - http://dx.doi.org/10.2196/32477 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133973 ID - info:doi/10.2196/32477 ER - TY - JOUR AU - Leong, Man Cheng AU - Lee, Ting-I AU - Chien, Yu-Mei AU - Kuo, Li-Na AU - Kuo, Yu-Feng AU - Chen, Hsiang-Yin PY - 2022/3/23 TI - 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 JO - J Med Internet Res SP - e31449 VL - 24 IS - 3 KW - diabetes KW - COVID-19 KW - education KW - video KW - social media KW - health literacy KW - self-care activity KW - type 2 diabetes KW - attitude KW - mHealth N2 - 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 UR - https://www.jmir.org/2022/3/e31449 UR - http://dx.doi.org/10.2196/31449 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319478 ID - info:doi/10.2196/31449 ER - TY - JOUR AU - Paralkar, Anmol Tapasvini AU - Lay, Phoebe AU - Stubbs, Sawyer AU - Ahmed, Hadi Syed AU - Ghani, Minha AU - Osier, Nico PY - 2022/3/23 TI - Occurrence Patterns of Traumatic Brain Injury Within the Emergency Department and Internal Screening Process Efficacy During the COVID-19 Pandemic: Retrospective Analysis JO - Interact J Med Res SP - e29513 VL - 11 IS - 1 KW - COVID-19 KW - coronavirus KW - pandemic KW - clinical recruitment KW - traumatic brain injury KW - children KW - participant-focused KW - recruitment KW - enrollment KW - digital screening KW - brain KW - EHR KW - electronic health record KW - database N2 - Background: Traumatic brain injury (TBI) is one of the leading causes of death in pediatric patients. Continued recruitment of pediatric TBI participants into a biobank amidst the COVID-19 pandemic not only necessitates adaptive changes to traditional recruitment methods but also requires an evaluation of emergency department (ED) utilization by TBI-presenting patients. Objective: The primary objective of this exploratory retrospective study was to evaluate pediatric TBI-related ED utilization during the pandemic. The secondary objective was to appraise the efficacy of the research team?s internal screening processes. Methods: Potential participants (ie, individuals who met all inclusion criteria and would be approached by a consenter) were screened from an ED?s electronic health record system. Data regarding their visit were recorded in a Health Insurance Portability and Accountability Act?compliant manner, which were cleaned through Google Sheets. Cleaned data were then coded as either a screening variable or a hospital utilization variable to examine the effects of the pandemic on internal operations and hospital utilization patterns. The variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the R programming language via the two-sample Student t test and the Mann-Whitney-Wilcoxon rank-sum test. Results: The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants (P<.001) were identified in 2020 (222/633, 35.1%) than in 2019 (195/908, 21.4%). A significantly greater proportion of potential participants (P<.001) had a visit reason indicative of a TBI in 2020 (181/222, 81.5%) than in 2019 (103/195, 52.8%). A significantly greater proportion of these injuries (P=.02) occurred inside (39/181, 21.5%) in 2020 than in 2019 (11/103, 10.7%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older (P=.006) in 2019 (mean 8.93 years) than in 2020 (mean 7.31 years). Screeners spent significantly longer (P=.03) to identify potential participants in March 2020 (55 minutes) than in March 2019 (32 minutes), but spent significantly less time (P=.01) to do so in July 2020 (22 minutes) than in July 2019 (42 minutes). Screening coverage was significantly lower (P<.001) in March 2020 (241.8 hours) than in March 2019 (346.5 hours). Screening coverage was significantly greater (P<.001) in April 2020 (611.5 hours) and July 2020 (513.5 hours) than in April 2019 (470.5 hours) and July 2019 (404.3 hours), respectively. Conclusions: There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research. UR - https://www.i-jmr.org/2022/1/e29513 UR - http://dx.doi.org/10.2196/29513 UR - http://www.ncbi.nlm.nih.gov/pubmed/35225820 ID - info:doi/10.2196/29513 ER - TY - JOUR AU - Aronson, David Ian AU - Bennett, S. Alex AU - Ardouin-Guerrier, Mary-Andrée AU - Rivera-Castellar, German AU - Gibson, Brent AU - Santoscoy, Samantha AU - Vargas-Estrella, Brittney PY - 2022/3/23 TI - How Vaccine Ambivalence Can Lead People Who Inject Drugs to Decline COVID-19 Vaccination and Ways This Can Be Addressed: Qualitative Study JO - JMIR Form Res SP - e35066 VL - 6 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - people who inject drugs KW - vaccine KW - vaccine hesitancy KW - barrier KW - vaccination KW - drugs KW - hesitancy KW - qualitative KW - impact KW - interview KW - United States KW - communication KW - danger KW - community N2 - 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. UR - https://formative.jmir.org/2022/3/e35066 UR - http://dx.doi.org/10.2196/35066 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191841 ID - info:doi/10.2196/35066 ER - TY - JOUR AU - Ye, Siqin AU - Anstey, Edmund D. AU - Grauer, Anne AU - Metser, Gil AU - Moise, Nathalie AU - Schwartz, Joseph AU - Kronish, Ian AU - Abdalla, Marwah PY - 2022/3/23 TI - The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study JO - JMIR Form Res SP - e32403 VL - 6 IS - 3 KW - telemedicine KW - hypertension KW - blood pressure KW - quality of care KW - impact KW - COVID-19 KW - cohort KW - cardiology KW - telehealth KW - retrospective N2 - 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. UR - https://formative.jmir.org/2022/3/e32403 UR - http://dx.doi.org/10.2196/32403 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138254 ID - info:doi/10.2196/32403 ER - TY - JOUR AU - Chen, Xi AU - Lin, Fen AU - Cheng, W. Edmund PY - 2022/3/22 TI - Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions JO - J Med Internet Res SP - e31088 VL - 24 IS - 3 KW - infodemic KW - information overload KW - psychological distress KW - protective behavior KW - cross-national survey KW - Asia KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2022/3/e31088 UR - http://dx.doi.org/10.2196/31088 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103601 ID - info:doi/10.2196/31088 ER - TY - JOUR AU - Yu, Ellie AU - Hagens, Simon PY - 2022/3/22 TI - Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Aging SP - e35221 VL - 5 IS - 1 KW - virtual care KW - virtual visit KW - COVID-19 KW - survey KW - virtual care demand KW - virtual care use KW - older adults KW - elderly care KW - aging KW - digital health KW - pandemic N2 - Background: The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective: The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods: A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger?s Léger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using ?2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results: A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions: This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies. UR - https://aging.jmir.org/2022/1/e35221 UR - http://dx.doi.org/10.2196/35221 UR - http://www.ncbi.nlm.nih.gov/pubmed/35134746 ID - info:doi/10.2196/35221 ER - TY - JOUR AU - Sato, Christa AU - Adumattah, Anita AU - Abulencia, Krisel Maria AU - Garcellano, Dennis Peter AU - Li, Tai-Wai Alan AU - Fung, Kenneth AU - Poon, Kwong-Lai Maurice AU - Vahabi, Mandana AU - Wong, Pui-Hing Josephine PY - 2022/3/22 TI - COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study JO - JMIR Form Res SP - e35280 VL - 6 IS - 3 KW - COVID-19 KW - COVID-19 in Canada KW - health care providers KW - pandemic stressors KW - health impact KW - caregiving roles KW - situational identities KW - emotional labor KW - hero discourse KW - social ecological framework N2 - 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. UR - https://formative.jmir.org/2022/3/e35280 UR - http://dx.doi.org/10.2196/35280 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138256 ID - info:doi/10.2196/35280 ER - TY - JOUR AU - Seródio Figueiredo, Maurício Carlos AU - de Melo, Tiago AU - Goes, Raphaela PY - 2022/3/21 TI - Evaluating Voice Assistants' Responses to COVID-19 Vaccination in Portuguese: Quality Assessment JO - JMIR Hum Factors SP - e34674 VL - 9 IS - 1 KW - voice assistant KW - natural user interface KW - Portuguese language KW - health information KW - COVID-19 KW - vaccine KW - immunization KW - health device KW - digital health N2 - 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 of?cial 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. UR - https://humanfactors.jmir.org/2022/1/e34674 UR - http://dx.doi.org/10.2196/34674 UR - http://www.ncbi.nlm.nih.gov/pubmed/35041617 ID - info:doi/10.2196/34674 ER - TY - JOUR AU - Bradwell, Hannah AU - Baines, Rebecca AU - Edwards, J. Katie AU - Stevens, Sebastian AU - Atkinson, Kate AU - Wilkinson, Ellen AU - Chatterjee, Arunangsu AU - Jones, B. Ray PY - 2022/3/21 TI - 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 JO - JMIR Form Res SP - e30486 VL - 6 IS - 3 KW - COVID-19 KW - video consultations KW - remote consultation KW - Attend Anywhere KW - patient feedback KW - patient experience KW - staff feedback KW - outpatients KW - pandemic N2 - 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. UR - https://formative.jmir.org/2022/3/e30486 UR - http://dx.doi.org/10.2196/30486 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311688 ID - info:doi/10.2196/30486 ER - TY - JOUR AU - Haucke, Matthias AU - Heinz, Andreas AU - Liu, Shuyan AU - Heinzel, Stephan PY - 2022/3/17 TI - The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis JO - J Med Internet Res SP - e32598 VL - 24 IS - 3 KW - COVID-19 KW - mental health KW - outbreak KW - epidemic KW - pandemic KW - psychological response KW - emotional well-being KW - ecological momentary assessment KW - risk KW - protective factors KW - lockdown measures KW - loneliness KW - mood inertia KW - stressors KW - mobile apps KW - mHealth KW - digital health KW - EMA KW - smartphone apps KW - network model KW - cognition KW - stress KW - temporal dynamic network KW - permutation testing KW - network comparison KW - network characteristics KW - multilevel vector autoregressive model KW - mlVAR N2 - Background: The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood. Objective: We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets. Methods: We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a ?no-lockdown? and a ?lockdown? stage. COVID-19?related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices. Results: We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage. Conclusions: The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions. UR - https://www.jmir.org/2022/3/e32598 UR - http://dx.doi.org/10.2196/32598 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191843 ID - info:doi/10.2196/32598 ER - TY - JOUR AU - Akpan, Ubong Godwin AU - Bello, Mohammed Isah AU - Touray, Kebba AU - Ngofa, Reuben AU - Oyaole, Rasheed Daniel AU - Maleghemi, Sylvester AU - Babona, Marie AU - Chikwanda, Chanda AU - Poy, Alain AU - Mboussou, Franck AU - Ogundiran, Opeayo AU - Impouma, Benido AU - Mihigo, Richard AU - Yao, Michel Nda Konan AU - Ticha, Muluh Johnson AU - Tuma, Jude AU - A Mohamed, Farouk Hani AU - Kanmodi, Kehinde AU - Ejiofor, Ephraim Nonso AU - Kipterer, Kapoi John AU - Manengu, Casimir AU - Kasolo, Francis AU - Seaman, Vincent AU - Mkanda, Pascal PY - 2022/3/17 TI - Leveraging Polio Geographic Information System Platforms in the African Region for Mitigating COVID-19 Contact Tracing and Surveillance Challenges: Viewpoint JO - JMIR Mhealth Uhealth SP - e22544 VL - 10 IS - 3 KW - contact tracing KW - GIS KW - COVID-19 KW - surveillance N2 - Background: The ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic. Objective: This paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization via the WHO?s polio program in the African region. Methods: We repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to enable actionable insights. Results: The contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility?based surveillance app has been used more extensively, as it has been used in 27 countries in the region. Conclusions: In light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field. From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries? efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19. UR - https://mhealth.jmir.org/2022/3/e22544 UR - http://dx.doi.org/10.2196/22544 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854813 ID - info:doi/10.2196/22544 ER - TY - JOUR AU - Limingoja, Leevi AU - Antila, Kari AU - Jormanainen, Vesa AU - Röntynen, Joel AU - Jägerroos, Vilma AU - Soininen, Leena AU - Nordlund, Hanna AU - Vepsäläinen, Kristian AU - Kaikkonen, Risto AU - Lallukka, Tea PY - 2022/3/17 TI - Impact of a Conformité Européenne (CE) Certification?Marked Medical Software Sensor on COVID-19 Pandemic Progression Prediction: Register-Based Study Using Machine Learning Methods JO - JMIR Form Res SP - e35181 VL - 6 IS - 3 KW - health care KW - health technology assessment KW - machine learning KW - COVID-19 KW - COVID-19 forecasting KW - pandemic KW - health technology KW - digital health KW - online symptom checker KW - health data KW - admission data KW - viral spread N2 - 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. UR - https://formative.jmir.org/2022/3/e35181 UR - http://dx.doi.org/10.2196/35181 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179497 ID - info:doi/10.2196/35181 ER - TY - JOUR AU - Deiner, S. Michael AU - Seitzman, D. Gerami AU - Kaur, Gurbani AU - McLeod, D. Stephen AU - Chodosh, James AU - Lietman, M. Thomas AU - Porco, C. Travis PY - 2022/3/16 TI - Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study JO - JMIR Infodemiology SP - e31732 VL - 2 IS - 1 KW - COVID-19 KW - pandemic KW - communicable disease KW - social distancing KW - infodemiology KW - Google Trends KW - influenza KW - conjunctivitis KW - ocular symptoms KW - seasonality KW - trend KW - online health information KW - information-seeking N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e31732 UR - http://dx.doi.org/10.2196/31732 UR - http://www.ncbi.nlm.nih.gov/pubmed/35320981 ID - info:doi/10.2196/31732 ER - TY - JOUR AU - Calac, J. Alec AU - Haupt, R. Michael AU - Li, Zhuoran AU - Mackey, Tim PY - 2022/3/16 TI - Spread of COVID-19 Vaccine Misinformation in the Ninth Inning: Retrospective Observational Infodemic Study JO - JMIR Infodemiology SP - e33587 VL - 2 IS - 1 KW - infoveillance KW - infodemiology KW - COVID-19 KW - vaccine KW - Twitter KW - social listening KW - social media KW - misinformation KW - spread KW - observational KW - hesitancy KW - communication KW - discourse N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e33587 UR - http://dx.doi.org/10.2196/33587 UR - http://www.ncbi.nlm.nih.gov/pubmed/35320982 ID - info:doi/10.2196/33587 ER - TY - JOUR AU - Lami, Faris AU - Elfadul, Maisa AU - Rashak, Hiba AU - Al Nsour, Mohannad AU - Akhtar, Hashaam AU - Khader, Yousef AU - Hussein, M. Ahmed AU - Naciri, Mariam AU - Samy, Sahar AU - Ghaleb, Yasser AU - Taha, Hana AU - Hussein, Alaa AU - Ali, A. Nameer AU - Hussein, Raheem AU - Ikram, Aamer AU - Rahman, ur Fazal AU - Khan, Mujeeb Mohammad AU - Adam, Reema AU - Ahmed, Yusuf Abdulrazaq AU - Afifi, Salma PY - 2022/3/15 TI - Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study JO - JMIR Public Health Surveill SP - e32831 VL - 8 IS - 3 KW - critical outcomes KW - COVID-19 KW - severity KW - mortality KW - outcome KW - risk factor KW - retrospective KW - implementation KW - demographic KW - pattern KW - trend KW - risk N2 - 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. UR - https://publichealth.jmir.org/2022/3/e32831 UR - http://dx.doi.org/10.2196/32831 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736222 ID - info:doi/10.2196/32831 ER - TY - JOUR AU - Yeung, Kan Andy Wai AU - Wochele-Thoma, Thomas AU - Eibensteiner, Fabian AU - Klager, Elisabeth AU - Hribersek, Mojca AU - Parvanov, D. Emil AU - Hrg, Dalibor AU - Völkl-Kernstock, Sabine AU - Kletecka-Pulker, Maria AU - Schaden, Eva AU - Willschke, Harald AU - Atanasov, G. Atanas PY - 2022/3/15 TI - Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis JO - JMIR Public Health Surveill SP - e34003 VL - 8 IS - 3 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - vaccine KW - readability KW - content quality KW - online health information KW - side effect KW - public health KW - medicine KW - quality KW - perception N2 - 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. UR - https://publichealth.jmir.org/2022/3/e34003 UR - http://dx.doi.org/10.2196/34003 UR - http://www.ncbi.nlm.nih.gov/pubmed/35073276 ID - info:doi/10.2196/34003 ER - TY - JOUR AU - Turek, R. Janice AU - Bansal, Vikas AU - Tekin, Aysun AU - Singh, Shuchita AU - Deo, Neha AU - Sharma, Mayank AU - Bogojevic, Marija AU - Qamar, Shahraz AU - Singh, Romil AU - Kumar, Vishakha AU - Kashyap, Rahul PY - 2022/3/15 TI - Lessons From a Rapid Project Management Exercise in the Time of Pandemic: Methodology for a Global COVID-19 VIRUS Registry Database JO - JMIR Res Protoc SP - e27921 VL - 11 IS - 3 KW - COVID-19 KW - critical care KW - global KW - program management KW - registry N2 - Background: The rapid emergence of the COVID-19 pandemic globally collapsed health care organizations worldwide. Incomplete knowledge of best practices, progression of disease, and its impact could result in fallible care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission have not been captured or communicated well between international organizations experiencing the same impact from the virus. This led to the expedited need for establishing international communication and data collection on the critical care patients admitted with COVID-19. Objective: Developing a global registry to collect patient data in the critical care setting was imperative with the goal of analyzing and ameliorating outcomes. Methods: A prospective, observational global registry database was put together to record extensive deidentified clinical information for patients hospitalized with COVID-19. Results: Project management was crucial for prompt implementation of the registry for synchronization, improving efficiency, increasing innovation, and fostering global collaboration for valuable data collection. The Society of Critical Care Medicine Discovery VIRUS (Viral Infection and Respiratory Illness Universal Study): COVID-19 Registry would compile data for crucial longitudinal outcomes for disease, treatment, and research. The agile project management approach expedited establishing the registry in 15 days and submission of institutional review board agreement for 250 participating sites. There has been enrollment of sites every month with a total of 306 sites from 28 countries and 64,114 patients enrolled (as of June 7, 2021). Conclusions: This protocol addresses project management lessons in a time of crises which can be a precept for rapid project management for a large-scale health care data registry. We aim to discuss the approach and methodology for establishing the registry, the challenges faced, and the factors contributing to successful outcomes. Trial Registration: ClinicalTrials.gov NCT04323787; https://clinicaltrials.gov/ct2/show/NCT04323787 UR - https://www.researchprotocols.org/2022/3/e27921 UR - http://dx.doi.org/10.2196/27921 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762062 ID - info:doi/10.2196/27921 ER - TY - JOUR AU - Gliske, Kate AU - Welsh, W. Justine AU - Braughton, E. Jacqueline AU - Waller, A. Lance AU - Ngo, M. Quyen PY - 2022/3/14 TI - Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices JO - JMIR Ment Health SP - e36263 VL - 9 IS - 3 KW - telehealth KW - substance use disorder KW - COVID-19 KW - substance use treatment KW - feasibility study KW - routine outcome monitoring data KW - mental health KW - addiction KW - digital health KW - telemedicine KW - outpatient program KW - virtual health KW - addiction treatment KW - virtual care KW - patient outcomes N2 - Background: The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. Objective: This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. Methods: The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). Results: No significant differences were detected by delivery format in continuous abstinence (?22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one?s ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). Conclusions: Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care. UR - https://mental.jmir.org/2022/3/e36263 UR - http://dx.doi.org/10.2196/36263 UR - http://www.ncbi.nlm.nih.gov/pubmed/35285807 ID - info:doi/10.2196/36263 ER - TY - JOUR AU - Quinn, K. Emma AU - Fenton, Shelby AU - Ford-Sahibzada, A. Chelsea AU - Harper, Andrew AU - Marcon, R. Alessandro AU - Caulfield, Timothy AU - Fazel, S. Sajjad AU - Peters, E. Cheryl PY - 2022/3/14 TI - COVID-19 and Vitamin D Misinformation on YouTube: Content Analysis JO - JMIR Infodemiology SP - e32452 VL - 2 IS - 1 KW - COVID-19 KW - vitamin D KW - misinformation KW - YouTube KW - content analysis KW - social media KW - video KW - infodemic KW - risk KW - prevention KW - health information KW - immunity KW - immune system KW - supplements KW - natural medicine N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e32452 UR - http://dx.doi.org/10.2196/32452 UR - http://www.ncbi.nlm.nih.gov/pubmed/35310014 ID - info:doi/10.2196/32452 ER - TY - JOUR AU - Rueca, Martina AU - Giombini, Emanuela AU - Messina, Francesco AU - Bartolini, Barbara AU - Di Caro, Antonino AU - Capobianchi, Rosaria Maria AU - Gruber, EM Cesare PY - 2022/3/14 TI - The Easy-to-Use SARS-CoV-2 Assembler for Genome Sequencing: Development Study JO - JMIR Bioinform Biotech SP - e31536 VL - 3 IS - 1 KW - SARS-CoV-2 genome KW - bioinformatics tool KW - NGS data analysis KW - COVID-19 KW - genome KW - health informatics KW - bioinformatic KW - digital tools KW - algorithms N2 - 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. UR - https://bioinform.jmir.org/2022/1/e31536 UR - http://dx.doi.org/10.2196/31536 UR - http://www.ncbi.nlm.nih.gov/pubmed/35309411 ID - info:doi/10.2196/31536 ER - TY - JOUR AU - Tsvyatkova, Damyanka AU - Buckley, Jim AU - Beecham, Sarah AU - Chochlov, Muslim AU - O?Keeffe, R. Ian AU - Razzaq, Abdul AU - Rekanar, Kaavya AU - Richardson, Ita AU - Welsh, Thomas AU - Storni, Cristiano AU - PY - 2022/3/11 TI - Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework JO - JMIR Mhealth Uhealth SP - e30691 VL - 10 IS - 3 KW - COVID-19 KW - mHealth KW - digital contact tracing apps KW - framework KW - evaluation KW - mobile health KW - health apps KW - digital health KW - contact tracing N2 - 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. UR - https://mhealth.jmir.org/2022/3/e30691 UR - http://dx.doi.org/10.2196/30691 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084338 ID - info:doi/10.2196/30691 ER - TY - JOUR AU - Balaji, Aanika AU - Clever, Lou Sarah PY - 2022/3/11 TI - Authors? Reply to: Techniques to Teach Students Effectively Using Telemedicine. Comment on ?Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial? JO - JMIR Med Educ SP - e37401 VL - 8 IS - 1 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 KW - teaching KW - telemedicine KW - clerkships UR - https://mededu.jmir.org/2022/1/e37401 UR - http://dx.doi.org/10.2196/37401 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191840 ID - info:doi/10.2196/37401 ER - TY - JOUR AU - Kandola, Hardeep AU - Minhas, Sonica PY - 2022/3/11 TI - Techniques to Teach Students Effectively Using Telemedicine. Comment on ?Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial? JO - JMIR Med Educ SP - e30703 VL - 8 IS - 1 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 KW - teaching KW - telemedicine KW - clerkships UR - https://mededu.jmir.org/2022/1/e30703 UR - http://dx.doi.org/10.2196/30703 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191846 ID - info:doi/10.2196/30703 ER - TY - JOUR AU - Røislien, Jo AU - O'Hara, K. Jane AU - Smeets, Ionica AU - Brønnick, Kolbjørn AU - Berg, Hilde Siv AU - Shortt, Therese Marie AU - Lungu, Adrian Daniel AU - Thune, Henriette AU - Wiig, Siri PY - 2022/3/11 TI - Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study JO - JMIR Res Protoc SP - e34275 VL - 11 IS - 3 KW - pandemics KW - risk KW - public health KW - science communication KW - mixed methods KW - evidence-based medicine KW - COVID-19 N2 - 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 UR - https://www.researchprotocols.org/2022/3/e34275 UR - http://dx.doi.org/10.2196/34275 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147500 ID - info:doi/10.2196/34275 ER - TY - JOUR AU - Imamura, Kotaro AU - Sasaki, Natsu AU - Sekiya, Yuki AU - Watanabe, Kazuhiro AU - Sakuraya, Asuka AU - Matsuyama, Yutaka AU - Nishi, Daisuke AU - Kawakami, Norito PY - 2022/3/10 TI - The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial JO - JMIR Form Res SP - e33883 VL - 6 IS - 3 KW - COVID-19 KW - education KW - internet-based intervention KW - occupational groups KW - psychological distress KW - mental health KW - digital health KW - health intervention KW - psychoeducation N2 - 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 UR - https://formative.jmir.org/2022/3/e33883 UR - http://dx.doi.org/10.2196/33883 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133972 ID - info:doi/10.2196/33883 ER - TY - JOUR AU - Sharma, E. Anjana AU - Khoong, C. Elaine AU - Sierra, Maribel AU - Rivadeneira, A. Natalie AU - Nijagal, A. Malini AU - Su, George AU - Lyles, R. Courtney AU - DeFries, Triveni AU - Tuot, S. Delphine AU - Sarkar, Urmimala PY - 2022/3/10 TI - System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic JO - JMIR Form Res SP - e34088 VL - 6 IS - 3 KW - telemedicine KW - safety-net hospitals KW - health care delivery KW - ambulatory care KW - vulnerable populations KW - COVID-19 KW - survey KW - vulnerable KW - telehealth KW - hospital KW - safety KW - delivery KW - video KW - implementation KW - health system N2 - 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. UR - https://formative.jmir.org/2022/3/e34088 UR - http://dx.doi.org/10.2196/34088 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148271 ID - info:doi/10.2196/34088 ER - TY - JOUR AU - El Gindi, Hany AU - Shalaby, Reham AU - Gusnowski, April AU - Vuong, Wesley AU - Surood, Shireen AU - Hrabok, Marianne AU - Greenshaw, J. Andrew AU - Agyapong, Vincent PY - 2022/3/9 TI - The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey JO - JMIR Form Res SP - e27469 VL - 6 IS - 3 KW - COVID-19 KW - health care worker KW - mobile technology KW - Text4Hope KW - anxiety KW - depression KW - stress KW - pandemic KW - e-mental health KW - mental health KW - impact KW - physician KW - nurse KW - Canada N2 - 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. UR - https://formative.jmir.org/2022/3/e27469 UR - http://dx.doi.org/10.2196/27469 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995203 ID - info:doi/10.2196/27469 ER - TY - JOUR AU - Håkansson, Anders AU - Sundvall, Andreas AU - Lyckberg, Axel PY - 2022/3/9 TI - Effects of a National Preventive Intervention Against Potential COVID-19?Related Gambling Problems in Online Gamblers: Self-Report Survey Study JO - JMIR Form Res SP - e33066 VL - 6 IS - 3 KW - gambling disorder KW - problem gambling KW - COVID-19 KW - harm reduction KW - behavioral addiction N2 - Background: The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments introduced COVID-19?specific interventions early with the aim to prevent gambling problems, but their effects have not been evaluated. Objective: This study aimed to evaluate a Swedish COVID-19?related temporary legislation imposing an automated weekly deposit limit for online casino gambling. Methods: The study was an anonymous survey sent by a state-owned gambling operator to online gamblers (N=619), among whom 54.0% (n=334) were moderate-risk/problem gamblers who reached the weekly limit on online gambling during the summer of 2020. Results: Overall, 60.1% (372/619) were aware of having been limited by the COVID-19?related deposit limit, and a minority (145/619, 23.4%) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 38.7% (144/372) believed the intervention decreased their overall gambling, whereas 7.8% (29/372) believed it rather increased it. However, 82.5% (307/372) reported having gambled at more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42% among moderate-risk/problem gamblers and 19% among others; P<.001). An increase in gambling following the intervention was associated with being a moderate-risk/problem gambler and having negative attitudes toward the intervention. Conclusions: The weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting gambling at other operators and the lower effect in clients with gambling problems. UR - https://formative.jmir.org/2022/3/e33066 UR - http://dx.doi.org/10.2196/33066 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678751 ID - info:doi/10.2196/33066 ER - TY - JOUR AU - Caskey, John AU - McConnell, L. Iain AU - Oguss, Madeline AU - Dligach, Dmitriy AU - Kulikoff, Rachel AU - Grogan, Brittany AU - Gibson, Crystal AU - Wimmer, Elizabeth AU - DeSalvo, E. Traci AU - Nyakoe-Nyasani, E. Edwin AU - Churpek, M. Matthew AU - Afshar, Majid PY - 2022/3/8 TI - Identifying COVID-19 Outbreaks From Contact-Tracing Interview Forms for Public Health Departments: Development of a Natural Language Processing Pipeline JO - JMIR Public Health Surveill SP - e36119 VL - 8 IS - 3 KW - natural language processing KW - public health informatics KW - named entity recognition KW - contact tracing KW - COVID-19 KW - outbreaks KW - neural language model KW - disease surveillance KW - digital health KW - electronic surveillance KW - public health KW - digital surveillance tool N2 - 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. UR - https://publichealth.jmir.org/2022/3/e36119 UR - http://dx.doi.org/10.2196/36119 UR - http://www.ncbi.nlm.nih.gov/pubmed/35144241 ID - info:doi/10.2196/36119 ER - TY - JOUR AU - Sugaya, Nagisa AU - Yamamoto, Tetsuya AU - Suzuki, Naho AU - Uchiumi, Chigusa PY - 2022/3/8 TI - The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study JO - JMIR Public Health Surveill SP - e32694 VL - 8 IS - 3 KW - coronavirus disease 2019 KW - mild lockdown KW - social isolation KW - longitudinal survey KW - public health KW - surveillance KW - epidemiology KW - COVID-19 KW - pandemic KW - lockdown KW - psychological behavior KW - social factors KW - mental health N2 - 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. UR - https://publichealth.jmir.org/2022/3/e32694 UR - http://dx.doi.org/10.2196/32694 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107428 ID - info:doi/10.2196/32694 ER - TY - JOUR AU - Kim, Sunyoung AU - Yao, Willow AU - Du, Xiaotong PY - 2022/3/8 TI - Exploring Older Adults? Adoption and Use of a Tablet Computer During COVID-19: Longitudinal Qualitative Study JO - JMIR Aging SP - e32957 VL - 5 IS - 1 KW - older adults KW - tablet computer KW - technology acceptance KW - mental model KW - longitudinal study KW - COVID-19 N2 - Background: As mobile computing technology evolves, such as smartphones and tablet computers, it increasingly offers features that may be particularly beneficial to older adults. However, the digital divide exists, and many older adults have been shown to have difficulty using these devices. The COVID-19 pandemic has magnified how much older adults need but are excluded from having access to technologies to meet essential daily needs and overcome physical distancing restrictions. Objective: This study sought to understand how older adults who had never used a tablet computer learn to use it, what they want to use it for, and what barriers they experience as they continue to use it during social isolation caused by the COVID-19 pandemic. Methods: We conducted a series of semistructured interviews with eight people aged 65 years and older for 16 weeks, investigating older novice users? adoption and use of a tablet computer during the nationwide lockdown due to COVID-19. Results: Participants were gradually yet successfully accustomed to using a tablet computer to serve various daily needs, including entertainment, social connectedness, and information-seeking. However, this success was not achieved through developing sufficient digital skills but rather by applying the methods they were already familiar with in its operation, such as taking and referring to instruction notes. Conclusions: Our findings imply that older adults without digital literacy can still benefit from a digital device for quality of later life if proper traditional methods they are already familiar with are offered in its use. UR - https://aging.jmir.org/2022/1/e32957 UR - http://dx.doi.org/10.2196/32957 UR - http://www.ncbi.nlm.nih.gov/pubmed/35134747 ID - info:doi/10.2196/32957 ER - TY - JOUR AU - Sui, Wuyou AU - Rush, Jonathan AU - Rhodes, E. Ryan PY - 2022/3/8 TI - Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study JO - JMIR Form Res SP - e25055 VL - 6 IS - 3 KW - eHealth KW - physical activity KW - adults KW - adherence KW - COVID-19 KW - fitness KW - video KW - YouTube KW - Instagram KW - social media KW - longitudinal N2 - 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. UR - https://formative.jmir.org/2022/3/e25055 UR - http://dx.doi.org/10.2196/25055 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258459 ID - info:doi/10.2196/25055 ER - TY - JOUR AU - Blane, T. Janice AU - Bellutta, Daniele AU - Carley, M. Kathleen PY - 2022/3/7 TI - Social-Cyber Maneuvers During the COVID-19 Vaccine Initial Rollout: Content Analysis of Tweets JO - J Med Internet Res SP - e34040 VL - 24 IS - 3 KW - social cybersecurity KW - social-cyber maneuvers KW - social network analysis KW - disinformation KW - BEND maneuvers KW - COVID-19 KW - coronavirus KW - social media KW - vaccine KW - anti-vaccine KW - pro-vaccine KW - ORA-PRO KW - cybersecurity KW - security KW - Twitter KW - community KW - communication KW - health information KW - manipulation KW - belief N2 - 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. UR - https://www.jmir.org/2022/3/e34040 UR - http://dx.doi.org/10.2196/34040 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044302 ID - info:doi/10.2196/34040 ER - TY - JOUR AU - Basch, E. Charles AU - Basch, H. Corey PY - 2022/3/7 TI - Epidemiology, Secondary School Curricula, and Preparing the Next Generation for Global Citizenship JO - JMIR Public Health Surveill SP - e36006 VL - 8 IS - 3 KW - COVID-19 KW - epidemiology KW - secondary school KW - global citizenship KW - emerging infectious disease KW - public health KW - teaching KW - student KW - high school education KW - population health UR - https://publichealth.jmir.org/2022/3/e36006 UR - http://dx.doi.org/10.2196/36006 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254281 ID - info:doi/10.2196/36006 ER - TY - JOUR AU - Ozkara, Berksu Burak AU - Karabacak, Mert AU - Alpaydin, Demet Duygu PY - 2022/3/7 TI - Student-Run Online Journal Club Initiative During a Time of Crisis: Survey Study JO - JMIR Med Educ SP - e33612 VL - 8 IS - 1 KW - online journal club KW - medical student KW - distance learning KW - COVID-19 KW - undergraduate education KW - student journal club KW - online education KW - establishment KW - initiative KW - literature KW - research KW - publishing KW - education N2 - Background: Since the closure of university campuses due to COVID-19 in spring 2020 necessitated a quick transition to online courses, medical students were isolated from hospitals and universities, negatively impacting their education. During this time, medical students had no opportunity to participate in academic discussions and were also socially isolated. Furthermore, medical doctors and professors of medical schools were given additional responsibilities during the pandemic because they were the frontliners in the fight against COVID-19. As a result, they did not have enough time to contribute effectively to medical student education. Objective: This paper describes the establishment of the Cerrahpasa Neuroscience Society Journal Clubs, a group of entirely student-run online journal clubs at Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa. Methods: The website, mass emailing, and social media accounts were used to announce the online journal clubs. Only medical students were eligible to apply. Journal clubs included psychiatry, neuroradiology, neurosurgery, neurology, and neuroscience. Following the last journal club meeting, a questionnaire created by the society?s board was distributed to the participants. SPSS Statistics (version 26) was used for statistical analysis. Results: Since March 15, 2021, synchronous online journal club meetings have been held every 2 weeks on a weekday using Google Meet, Microsoft Teams, or Zoom. Meetings of each journal club lasted approximately 1 hour on average. Interstudent interaction across multiple institutions was achieved since a total of 45 students from 11 different universities attended the meetings on a regular basis. Students on the society?s board served as academic mentors for the clubs. The clubs received excellent feedback from participants, with an overall contentment score of 4.32 out of 5. Conclusions: By establishing these clubs, we have created a venue for academic discussions, which helps to reduce the negative impact of the pandemic on education. In addition, we believe it greatly aided students in staying in touch with their peers, thereby reducing the sense of isolation. We realize that traditional journal clubs are run by faculty; however, we believe that this experience demonstrated that medical students could run a journal club on their own since the feedback from participants was excellent. Additionally, as a medical student, being a journal club academic mentor is a challenging responsibility; however, having this responsibility significantly improved our academic mentors? leadership abilities. UR - https://mededu.jmir.org/2022/1/e33612 UR - http://dx.doi.org/10.2196/33612 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148270 ID - info:doi/10.2196/33612 ER - TY - JOUR AU - Geneviève, Darryl Lester AU - Martani, Andrea AU - Wangmo, Tenzin AU - Elger, Simone Bernice PY - 2022/3/4 TI - Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response JO - JMIR Public Health Surveill SP - e33277 VL - 8 IS - 3 KW - precision public health KW - structural racism KW - COVID-19 KW - pandemic KW - social justice KW - health equity KW - SARS-CoV-2 KW - stigma KW - discrimination KW - disparity KW - inequality KW - precision health KW - public health KW - racism KW - equity KW - mortality KW - morbidity UR - https://publichealth.jmir.org/2022/3/e33277 UR - http://dx.doi.org/10.2196/33277 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089868 ID - info:doi/10.2196/33277 ER - TY - JOUR AU - Huang, Zhilian AU - Tay, Evonne AU - Wee, Dillon AU - Guo, Huiling AU - Lim, Yee-Fen Hannah AU - Chow, Angela PY - 2022/3/4 TI - Public Perception of the Use of Digital Contact-Tracing Tools After the COVID-19 Lockdown: Sentiment Analysis and Opinion Mining JO - JMIR Form Res SP - e33314 VL - 6 IS - 3 KW - infectious disease KW - sentiment analysis KW - opinion mining KW - COVID-19 KW - contact tracing KW - public health KW - opinion KW - data mining KW - survey KW - cross-sectional N2 - 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. UR - https://formative.jmir.org/2022/3/e33314 UR - http://dx.doi.org/10.2196/33314 UR - http://www.ncbi.nlm.nih.gov/pubmed/35120017 ID - info:doi/10.2196/33314 ER - TY - JOUR AU - Schriger, H. Simone AU - Klein, R. Melanie AU - Last, S. Briana AU - Fernandez-Marcote, Sara AU - Dallard, Natalie AU - Jones, Bryanna AU - Beidas, S. Rinad PY - 2022/3/3 TI - Community Mental Health Clinicians? Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Pediatr Parent SP - e29250 VL - 5 IS - 1 KW - telehealth KW - COVID-19 KW - evidence-based practice KW - community mental health KW - trauma-focused cognitive behavioral therapy KW - implementation science KW - youth mental health N2 - Background: In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians? experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective: We examined community mental health clinicians? perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods: We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists? responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results: Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions: First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services. UR - https://pediatrics.jmir.org/2022/1/e29250 UR - http://dx.doi.org/10.2196/29250 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023839 ID - info:doi/10.2196/29250 ER - TY - JOUR AU - Young, D. Sean AU - Zhang, Qingpeng AU - Zeng, Dajun Daniel AU - Zhan, Yongcheng AU - Cumberland, William PY - 2022/3/3 TI - Social Media Images as an Emerging Tool to Monitor Adherence to COVID-19 Public Health Guidelines: Content Analysis JO - J Med Internet Res SP - e24787 VL - 24 IS - 3 KW - internet KW - social media KW - health informatics KW - tool KW - monitor KW - adherence KW - COVID-19 KW - public health KW - guidelines KW - content analysis KW - policy N2 - 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. UR - https://www.jmir.org/2022/3/e24787 UR - http://dx.doi.org/10.2196/24787 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995205 ID - info:doi/10.2196/24787 ER - TY - JOUR AU - Cai, Owen AU - Sousa-Pinto, Bernardo PY - 2022/3/3 TI - United States Influenza Search Patterns Since the Emergence of COVID-19: Infodemiology Study JO - JMIR Public Health Surveill SP - e32364 VL - 8 IS - 3 KW - COVID-19 KW - influenza KW - surveillance KW - media coverage KW - Google Trends KW - infodemiology KW - monitoring KW - trend KW - United States KW - information-seeking KW - online health information N2 - 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 (?= ?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: ?=0.643; 2019-2020: ?=0.902), while the correlation between Google Trends influenza data and influenza media coverage volume remained stable (2020-2021: ?=0.746; 2019-2020: ?=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. UR - https://publichealth.jmir.org/2022/3/e32364 UR - http://dx.doi.org/10.2196/32364 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878996 ID - info:doi/10.2196/32364 ER - TY - JOUR AU - Jalali, Niloofar AU - Tran, Ken N. AU - Sen, Anindya AU - Morita, Pelegrini Plinio PY - 2022/3/3 TI - Identifying the Socioeconomic, Demographic, and Political Determinants of Social Mobility and Their Effects on COVID-19 Cases and Deaths: Evidence From US Counties JO - JMIR Infodemiology SP - e31813 VL - 2 IS - 1 KW - COVID-19 KW - cases KW - deaths KW - mobility KW - Google mobility data KW - clustering N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e31813 UR - http://dx.doi.org/10.2196/31813 UR - http://www.ncbi.nlm.nih.gov/pubmed/35287305 ID - info:doi/10.2196/31813 ER - TY - JOUR AU - Ruiz-Roman, Rebeca AU - Martinez-Perez, Clara AU - Gil Prados, Inés AU - Cristóbal, Ignacio AU - Sánchez-Tena, Ángel Miguel PY - 2022/3/3 TI - COVID-19 and Pregnancy: Citation Network Analysis and Evidence Synthesis JO - JMIR Pediatr Parent SP - e29189 VL - 5 IS - 1 KW - pandemic KW - COVID-19 KW - SARS-CoV-2 KW - pregnancy KW - perinatal KW - citation KW - bibliometric KW - network analysis KW - women KW - maternal health KW - fetal health KW - research KW - literature KW - transmission KW - delivery KW - impact N2 - 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. UR - https://pediatrics.jmir.org/2022/1/e29189 UR - http://dx.doi.org/10.2196/29189 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044301 ID - info:doi/10.2196/29189 ER - TY - JOUR AU - Arshonsky, Josh AU - Krawczyk, Noa AU - Bunting, M. Amanda AU - Frank, David AU - Friedman, R. Samuel AU - Bragg, A. Marie PY - 2022/3/3 TI - Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums JO - JMIR Form Res SP - e32871 VL - 6 IS - 3 KW - opioid use KW - Reddit KW - coping strategies KW - COVID-19 KW - opioid KW - drug KW - coping KW - social media KW - strategy KW - content analysis KW - abstain KW - addiction KW - data mining KW - support N2 - 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. UR - https://formative.jmir.org/2022/3/e32871 UR - http://dx.doi.org/10.2196/32871 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084345 ID - info:doi/10.2196/32871 ER - TY - JOUR AU - Moon, Hana AU - Lee, Ho Geon AU - Cho, Jeong Yoon PY - 2022/3/3 TI - Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study JO - JMIR Form Res SP - e30085 VL - 6 IS - 3 KW - COVID-19 KW - health literacy KW - readability KW - public health KW - health equity KW - consumer health information KW - information dissemination KW - health education KW - eHealth KW - online KW - social media KW - pandemic KW - infodemic N2 - 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. UR - https://formative.jmir.org/2022/3/e30085 UR - http://dx.doi.org/10.2196/30085 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072633 ID - info:doi/10.2196/30085 ER - TY - JOUR AU - Choi, H. Edmond P. AU - Duan, Wenjie AU - Fong, T. Daniel Y. AU - Lok, W. Kris Y. AU - Ho, Mandy AU - Wong, H. Janet Y. AU - Lin, Chia-Chin PY - 2022/3/2 TI - Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study JO - JMIR Form Res SP - e31992 VL - 6 IS - 3 KW - Chinese KW - COVID-19 KW - fear KW - psychometric KW - validation KW - scale KW - mental health KW - information KW - cross-sectional KW - validity KW - reliability KW - support N2 - 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 ? 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. UR - https://formative.jmir.org/2022/3/e31992 UR - http://dx.doi.org/10.2196/31992 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072632 ID - info:doi/10.2196/31992 ER - TY - JOUR AU - Hasan, Abul AU - Levene, Mark AU - Weston, David AU - Fromson, Renate AU - Koslover, Nicolas AU - Levene, Tamara PY - 2022/2/28 TI - Monitoring COVID-19 on Social Media: Development of an End-to-End Natural Language Processing Pipeline Using a Novel Triage and Diagnosis Approach JO - J Med Internet Res SP - e30397 VL - 24 IS - 2 KW - COVID-19 KW - conditional random fields KW - disease detection and surveillance KW - medical social media KW - natural language processing KW - severity and prevalence KW - support vector machines KW - triage and diagnosis N2 - 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. UR - https://www.jmir.org/2022/2/e30397 UR - http://dx.doi.org/10.2196/30397 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142636 ID - info:doi/10.2196/30397 ER - TY - JOUR AU - Nitiema, Pascal PY - 2022/2/25 TI - Telehealth Before and During the COVID-19 Pandemic: Analysis of Health Care Workers' Opinions JO - J Med Internet Res SP - e29519 VL - 24 IS - 2 KW - telehealth KW - telemedicine KW - COVID-19 KW - pandemic KW - physical examination KW - sentiment score KW - structural topic modeling KW - opinion KW - health care worker KW - social media KW - discussion N2 - 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. UR - https://www.jmir.org/2022/2/e29519 UR - http://dx.doi.org/10.2196/29519 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978532 ID - info:doi/10.2196/29519 ER - TY - JOUR AU - Wong, Chun Frankie Ho AU - Leung, Yi Dara Kiu AU - Wong, Yan Edwin Lok AU - Liu, Tianyin AU - Lu, Shiyu AU - Chan, Fung On AU - Wong, Yan Gloria Hoi AU - Lum, Sang Terry Yat PY - 2022/2/25 TI - The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey JO - JMIR Infodemiology SP - e33029 VL - 2 IS - 1 KW - COVID-19 KW - mental health KW - information technology KW - media trust KW - social media KW - Hong Kong N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e33029 UR - http://dx.doi.org/10.2196/33029 UR - http://www.ncbi.nlm.nih.gov/pubmed/35257090 ID - info:doi/10.2196/33029 ER - TY - JOUR AU - Yoo, Yejong Paul AU - Movahed, Mehrnoosh AU - Rue, Ishana AU - Santos, Dos Carlos Denner AU - Majnemer, Annette AU - Shikako, Keiko PY - 2022/2/25 TI - Changes in Use of a Leisure Activity Mobile App for Children With Disabilities During the COVID-19 Pandemic: Retrospective Study JO - JMIR Pediatr Parent SP - e32274 VL - 5 IS - 1 KW - COVID-19 KW - participation KW - childhood disability KW - online leisure KW - app engagement KW - mHealth KW - children KW - parents KW - mobile apps KW - mobile health KW - digital health KW - pandemic KW - online leisure activities KW - user engagement KW - app usability N2 - Background: Participation in leisure activities is essential for child development and a human right as per the United Nations Convention on the Rights of the Child. Children with disabilities face several restrictions when participating in leisure activities as compared to same age peers without disabilities. Access to information about accessible, inclusive leisure activities is one of the barriers limiting participation, and one potential health promotion strategy is to provide access to information to increase participation. The Jooay App is a mobile app listing such activities in Canada and Australia. With the COVID-19 global pandemic and subsequent public health measures, most community-based facilities providing the activities listed on Jooay were closed. The app therefore started listing online activities offered with the expectation of continuing to provide information for families and understanding the extent to which users relied on the mobile app as a tool to identify new safe leisure opportunities. Objective: This study aims to describe the engagement of the Jooay app before and during COVID-19, and to estimate the extent to which the listing of online activities was related to the engagement of the Jooay app. Methods: We conducted a retrospective study comparing Jooay app use between March 2020 and February 2021 to the engagement between March 2019 and February 2020 by Jooay users. Spearman rank correlations were carried out to identify associations between the activities listed and the users? engagement from May 2020 to February 2021. Results: Active engagement with the Jooay app from March 2020 to February 2021 dropped by an average of 135 engagements (64.2%) compared to engagements in 2019-2020. The largest monthly drop in engagement was observed in May 2020 by 239 engagements (88.8%). There was a strong positive correlation between the number of active users and the number of online activities listed on the app (rs=0.900). Conclusions: The engagement with the Jooay App presented an expected decrease during the first wave of the COVID-19 pandemic. The addition of online adapted leisure activities to the app?s listings during the pandemic increased app use. Access to information about inclusive activities is a barrier for children with disabilities to engage in leisure. Mobile health solutions can be responsive to contextual factors and consider the social determinants of health such as socioeconomic and public health emergency issues that can impact the participation of vulnerable populations such as children with disabilities and help eliminate barriers to participation. The provision of online leisure opportunities during the pandemic could facilitate participation in these activities during the pandemic and beyond, which is essential and beneficial for the physical and mental well-being of children with disabilities and their families. UR - https://pediatrics.jmir.org/2022/1/e32274 UR - http://dx.doi.org/10.2196/32274 UR - http://www.ncbi.nlm.nih.gov/pubmed/35100129 ID - info:doi/10.2196/32274 ER - TY - JOUR AU - Parker, Alexandra AU - Dash, Sarah AU - Bourke, Matthew AU - Patten, Rhiannon AU - Craike, Melinda AU - Baldwin, Peter AU - Hosking, Warwick AU - Levinger, Itamar AU - Apostolopoulos, Vasso AU - de Courten, Maximilian AU - Sharples, Jenny AU - Naslund, Monika AU - Stavropoulos, Vasileios AU - Woessner, Mary AU - Sonn, Christopher AU - Stansen, Caroline AU - Pascoe, Michaela PY - 2022/2/25 TI - 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 JO - JMIR Form Res SP - e35776 VL - 6 IS - 2 KW - workplace mental health KW - well-being KW - mental health promotion KW - online intervention KW - telehealth KW - COVID-19 pandemic KW - COVID-19 KW - pandemic KW - health promotion N2 - 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. UR - https://formative.jmir.org/2022/2/e35776 UR - http://dx.doi.org/10.2196/35776 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044304 ID - info:doi/10.2196/35776 ER - TY - JOUR AU - Sbardelotto, Jackson AU - Martins, Birck Bárbara AU - Buss, Caroline PY - 2022/2/25 TI - Use of Social Networks in the Context of the Dietitian?s Practice in Brazil and Changes During the COVID-19 Pandemic: Exploratory Study JO - JMIR Form Res SP - e31533 VL - 6 IS - 2 KW - dietitian KW - social networks KW - nutrition KW - health communication KW - COVID-19 KW - social media KW - Brazil KW - perception KW - health information KW - usage KW - behavior N2 - 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. UR - https://formative.jmir.org/2022/2/e31533 UR - http://dx.doi.org/10.2196/31533 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023837 ID - info:doi/10.2196/31533 ER - TY - JOUR AU - Oehmke, B. Theresa AU - Moss, B. Charles AU - Oehmke, F. James PY - 2022/2/24 TI - COVID-19 Surveillance Updates in US Metropolitan Areas: Dynamic Panel Data Modeling JO - JMIR Public Health Surveill SP - e28737 VL - 8 IS - 2 KW - surveillance system KW - COVID-19 KW - coronavirus KW - Sars-CoV-2 KW - Houston KW - dynamic panel data model KW - speed KW - jerk KW - acceleration KW - 7-Day persistence KW - modeling KW - data KW - surveillance KW - monitoring KW - public health KW - United States KW - transmission KW - response N2 - 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. UR - https://publichealth.jmir.org/2022/2/e28737 UR - http://dx.doi.org/10.2196/28737 UR - http://www.ncbi.nlm.nih.gov/pubmed/34882569 ID - info:doi/10.2196/28737 ER - TY - JOUR AU - Houben-Wilke, Sarah AU - Goërtz, MJ Yvonne AU - Delbressine, M. Jeannet AU - Vaes, W. Anouk AU - Meys, Roy AU - Machado, VC Felipe AU - van Herck, Maarten AU - Burtin, Chris AU - Posthuma, Rein AU - Franssen, ME Frits AU - Vijlbrief, Herman AU - Spies, Yvonne AU - van 't Hul, J. Alex AU - Spruit, A. Martijn AU - Janssen, JA Daisy PY - 2022/2/24 TI - The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study JO - JMIR Ment Health SP - e33704 VL - 9 IS - 2 KW - SARS-CoV-2 KW - corona KW - COVID-19 KW - post-traumatic stress disorder KW - anxiety KW - depression KW - PASC N2 - 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. UR - https://mental.jmir.org/2022/2/e33704 UR - http://dx.doi.org/10.2196/33704 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200155 ID - info:doi/10.2196/33704 ER - TY - JOUR AU - Kreps, Sarah AU - George, Julie AU - Watson, Noah AU - Cai, Gloria AU - Ding, Keyi PY - 2022/2/24 TI - (Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic JO - JMIR Infodemiology SP - e31793 VL - 2 IS - 1 KW - internet KW - social media KW - misinformation KW - COVID-19 KW - Twitter KW - Weibo KW - prevalence KW - discourse KW - content KW - communication KW - public health KW - context KW - content analysis N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e31793 UR - http://dx.doi.org/10.2196/31793 UR - http://www.ncbi.nlm.nih.gov/pubmed/36406147 ID - info:doi/10.2196/31793 ER - TY - JOUR AU - Alpert, M. Jordan AU - Taylor, Greenberry AU - Hampton, N. Chelsea AU - Paige, Samantha AU - Markham, Jennifer Merry AU - Bylund, L. Carma PY - 2022/2/24 TI - Clinicians? Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study JO - JMIR Cancer SP - e34895 VL - 8 IS - 1 KW - teleoncology KW - telemedicine KW - qualitative KW - COVID-19 KW - telehealth KW - cancer care KW - cancer KW - oncology KW - digital health KW - pandemic N2 - 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. UR - https://cancer.jmir.org/2022/1/e34895 UR - http://dx.doi.org/10.2196/34895 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142622 ID - info:doi/10.2196/34895 ER - TY - JOUR AU - Shah, K. Sumit AU - McElfish, A. Pearl PY - 2022/2/24 TI - Cancer Screening Recommendations During the COVID-19 Pandemic: Scoping Review JO - JMIR Cancer SP - e34392 VL - 8 IS - 1 KW - COVID-19 KW - cancer prevention and early detection KW - cancer screenings KW - breast cancer screening KW - cervical cancer screening KW - colorectal cancer screening N2 - 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. UR - https://cancer.jmir.org/2022/1/e34392 UR - http://dx.doi.org/10.2196/34392 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142621 ID - info:doi/10.2196/34392 ER - TY - JOUR AU - Agarwal, K. Anish AU - Southwick, Lauren AU - Schneider, Rachelle AU - Pelullo, Arthur AU - Ortiz, Robin AU - Klinger, V. Elissa AU - Gonzales, E. Rachel AU - Rosin, Roy AU - Merchant, M. Raina PY - 2022/2/23 TI - Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study JO - JMIR Ment Health SP - e31909 VL - 9 IS - 2 KW - COVID-19 KW - mHealth KW - CHW KW - digital health KW - platform KW - crowdsource KW - support KW - community KW - health system KW - monitoring KW - virtual care KW - text message KW - model KW - community health worker KW - pilot study KW - feasibility N2 - 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. UR - https://mental.jmir.org/2022/2/e31909 UR - http://dx.doi.org/10.2196/31909 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037886 ID - info:doi/10.2196/31909 ER - TY - JOUR AU - Cummins, Alexander Jack PY - 2022/2/23 TI - Getting a Vaccine, Jab, or Vax Is More Than a Regular Expression. Comment on ?COVID-19 Vaccine-Related Discussion on Twitter: Topic Modeling and Sentiment Analysis? JO - J Med Internet Res SP - e31978 VL - 24 IS - 2 KW - COVID-19 KW - vaccine KW - vaccination KW - Twitter KW - infodemiology KW - infoveillance KW - topic KW - sentiment KW - opinion KW - discussion KW - communication KW - social media KW - perception KW - concern KW - emotion KW - natural language processing UR - https://www.jmir.org/2022/2/e31978 UR - http://dx.doi.org/10.2196/31978 UR - http://www.ncbi.nlm.nih.gov/pubmed/35195531 ID - info:doi/10.2196/31978 ER - TY - JOUR AU - Jarratt, LynnMarie AU - Situ, Jenny AU - King, D. Rachel AU - Montanez Ramos, Estefania AU - Groves, Hannah AU - Ormesher, Ryen AU - Cossé, Melissa AU - Raboff, Alyse AU - Mahajan, Avanika AU - Thompson, Jennifer AU - Ko, F. Randy AU - Paltrow-Krulwich, Samantha AU - Price, Allison AU - Hurwitz, May-Ling Ariel AU - CampBell, Timothy AU - Epler, T. Lauren AU - Nguyen, Fiona AU - Wolinsky, Emma AU - Edwards-Fligner, Morgan AU - Lobo, Jolene AU - Rivera, Danielle AU - Langsjoen, Jens AU - Sloane, Lori AU - Hendrix, Ingrid AU - Munde, O. Elly AU - Onyango, O. Clinton AU - Olewe, K. Perez AU - Anyona, B. Samuel AU - Yingling, V. Alexandra AU - Lauve, R. Nicolas AU - Kumar, Praveen AU - Stoicu, Shawn AU - Nestsiarovich, Anastasiya AU - Bologa, G. Cristian AU - Oprea, I. Tudor AU - Tollestrup, Kristine AU - Myers, B. Orrin AU - Anixter, Mari AU - Perkins, J. Douglas AU - Lambert, Gerard Christophe PY - 2022/2/23 TI - A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study JO - JMIR Med Educ SP - e23845 VL - 8 IS - 1 KW - COVID-19 KW - pandemic KW - daily report KW - policy KW - epidemics KW - global health KW - SARS-CoV-2 KW - New Mexico KW - medical education N2 - 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. UR - https://mededu.jmir.org/2022/1/e23845 UR - http://dx.doi.org/10.2196/23845 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142625 ID - info:doi/10.2196/23845 ER - TY - JOUR AU - Joseph, Gili AU - Schori, Hadas PY - 2022/2/23 TI - The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study JO - JMIR Form Res SP - e27286 VL - 6 IS - 2 KW - sleep quality KW - exercise KW - well-being KW - undergraduate students KW - COVID-19 lockdown KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2022/2/e27286 UR - http://dx.doi.org/10.2196/27286 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072635 ID - info:doi/10.2196/27286 ER - TY - JOUR AU - Dura-Perez, Elena AU - Goodman-Casanova, Marian Jessica AU - Vega-Nuñez, Amanda AU - Guerrero-Pertiñez, Gloria AU - Varela-Moreno, Esperanza AU - Garolera, Maite AU - Quintana, Maria AU - Cuesta-Vargas, I. Antonio AU - Barnestein-Fonseca, Pilar AU - Gómez Sánchez-Lafuente, Carlos AU - Mayoral-Cleries, Fermin AU - Guzman-Parra, Jose PY - 2022/2/22 TI - The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study JO - J Med Internet Res SP - e30598 VL - 24 IS - 2 KW - COVID-19 KW - cognition KW - quality of life KW - social isolation KW - mental health KW - social support KW - technology KW - physical distancing KW - leisure activities KW - nursing N2 - Background: COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. Objective: This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. Methods: This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. Results: The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Conclusions: Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): RR2-10.2196/26431 UR - https://www.jmir.org/2022/2/e30598 UR - http://dx.doi.org/10.2196/30598 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049505 ID - info:doi/10.2196/30598 ER - TY - JOUR AU - Santarossa, Sara AU - Rapp, Ashley AU - Sardinas, Saily AU - Hussein, Janine AU - Ramirez, Alex AU - Cassidy-Bushrow, E. Andrea AU - Cheng, Philip AU - Yu, Eunice PY - 2022/2/22 TI - Understanding the #longCOVID and #longhaulers Conversation on Twitter: Multimethod Study JO - JMIR Infodemiology SP - e31259 VL - 2 IS - 1 KW - COVID-19 KW - postacute sequela of COVID-19 KW - PASC KW - patient-centered care KW - social media KW - social network analysis KW - long term KW - symptom KW - Twitter KW - communication KW - insight KW - perception KW - experience KW - patient-centered N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e31259 UR - http://dx.doi.org/10.2196/31259 UR - http://www.ncbi.nlm.nih.gov/pubmed/35229074 ID - info:doi/10.2196/31259 ER - TY - JOUR AU - Postill, Gemma AU - Murray, Regan AU - Wilton, S. Andrew AU - Wells, A. Richard AU - Sirbu, Renee AU - Daley, J. Mark AU - Rosella, Laura PY - 2022/2/21 TI - The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study JO - JMIR Public Health Surveill SP - e32426 VL - 8 IS - 2 KW - excess deaths KW - real-time mortality KW - cremation KW - COVID-19 KW - SARS-CoV-2 KW - mortality KW - estimate KW - impact KW - public health KW - validation KW - pattern KW - trend KW - utility KW - Canada KW - mortality data KW - pandemic KW - death KW - cremation data KW - cause of death KW - vital statistics KW - excess mortality N2 - 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. UR - https://publichealth.jmir.org/2022/2/e32426 UR - http://dx.doi.org/10.2196/32426 UR - http://www.ncbi.nlm.nih.gov/pubmed/35038302 ID - info:doi/10.2196/32426 ER - TY - JOUR AU - Suraj, Varun AU - Del Vecchio Fitz, Catherine AU - Kleiman, B. Laura AU - Bhavnani, K. Suresh AU - Jani, Chinmay AU - Shah, Surbhi AU - McKay, R. Rana AU - Warner, Jeremy AU - Alterovitz, Gil PY - 2022/2/18 TI - SMART COVID Navigator, a Clinical Decision Support Tool for COVID-19 Treatment: Design and Development Study JO - J Med Internet Res SP - e29279 VL - 24 IS - 2 KW - COVID-19 KW - clinical decision support KW - precision medicine KW - web application KW - FHIR N2 - 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. UR - https://www.jmir.org/2022/2/e29279 UR - http://dx.doi.org/10.2196/29279 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932493 ID - info:doi/10.2196/29279 ER - TY - JOUR AU - Engel-Rebitzer, Eden AU - Stokes, C. Daniel AU - Meisel, F. Zachary AU - Purtle, Jonathan AU - Doyle, Rebecca AU - Buttenheim, M. Alison PY - 2022/2/18 TI - Partisan Differences in Legislators? Discussion of Vaccination on Twitter During the COVID-19 Era: Natural Language Processing Analysis JO - JMIR Infodemiology SP - e32372 VL - 2 IS - 1 KW - social media KW - Twitter KW - vaccination KW - partisanship KW - COVID-19 KW - vaccine KW - natural language processing KW - NLP KW - hesitancy KW - politicization KW - communication KW - linguistic KW - pattern N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e32372 UR - http://dx.doi.org/10.2196/32372 UR - http://www.ncbi.nlm.nih.gov/pubmed/35229075 ID - info:doi/10.2196/32372 ER - TY - JOUR AU - Spitale, Giovanni AU - Biller-Andorno, Nikola AU - Germani, Federico PY - 2022/2/16 TI - Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach JO - J Med Internet Res SP - e34385 VL - 24 IS - 2 KW - green pass KW - COVID-19 KW - COVID-19 pandemic KW - vaccines KW - vaccination hesitancy KW - freedom KW - social listening KW - social media KW - infodemic KW - bioethics KW - telegram N2 - 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. UR - https://www.jmir.org/2022/2/e34385 UR - http://dx.doi.org/10.2196/34385 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156930 ID - info:doi/10.2196/34385 ER - TY - JOUR AU - Ozawa, Sachiko AU - Billings, Joanna AU - Sun, Yujiao AU - Yu, Sushan AU - Penley, Benjamin PY - 2022/2/16 TI - COVID-19 Treatments Sold Online Without Prescription Requirements in the United States: Cross-sectional Study Evaluating Availability, Safety and Marketing of Medications JO - J Med Internet Res SP - e27704 VL - 24 IS - 2 KW - COVID-19 KW - medication KW - internet KW - online pharmacy KW - drug N2 - 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. UR - https://www.jmir.org/2022/2/e27704 UR - http://dx.doi.org/10.2196/27704 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662286 ID - info:doi/10.2196/27704 ER - TY - JOUR AU - Sarabadani, Sarah AU - Baruah, Gaurav AU - Fossat, Yan AU - Jeon, Jouhyun PY - 2022/2/16 TI - Longitudinal Changes of COVID-19 Symptoms in Social Media: Observational Study JO - J Med Internet Res SP - e33959 VL - 24 IS - 2 KW - COVID-19 KW - symptom KW - diagnosis KW - treatment KW - social media KW - Reddit KW - longitudinal KW - observational KW - machine learning N2 - 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. UR - https://www.jmir.org/2022/2/e33959 UR - http://dx.doi.org/10.2196/33959 UR - http://www.ncbi.nlm.nih.gov/pubmed/35076400 ID - info:doi/10.2196/33959 ER - TY - JOUR AU - Komenda, Martin AU - ?erný, Vladimír AU - ?najdárek, Petr AU - Karolyi, Mat?j AU - Hejný, Milo? AU - Pano?ka, Petr AU - Jarkovský, Ji?í AU - Gregor, Jakub AU - Bulhart, Vojt?ch AU - ?najdrová, Lenka AU - Májek, Ond?ej AU - Vymazal, Tomá? AU - Blatný, Jan AU - Du?ek, Ladislav PY - 2022/2/16 TI - Control Centre for Intensive Care as a Tool for Effective Coordination, Real-Time Monitoring, and Strategic Planning During the COVID-19 Pandemic JO - J Med Internet Res SP - e33149 VL - 24 IS - 2 KW - COVID-19 KW - coronavirus KW - intensive care KW - inpatient care KW - online control center KW - prescription KW - open data KW - ICU KW - monitoring KW - strategy KW - development KW - app KW - function KW - Czech Republic KW - inpatient KW - crisis management UR - https://www.jmir.org/2022/2/e33149 UR - http://dx.doi.org/10.2196/33149 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995207 ID - info:doi/10.2196/33149 ER - TY - JOUR AU - Kadakia, Shevali AU - Stratton, Catherine AU - Wu, Yinfei AU - Feliciano, Josemari AU - Tuakli-Wosornu, A. Yetsa PY - 2022/2/15 TI - 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 JO - JMIR Form Res SP - e34176 VL - 6 IS - 2 KW - persons with disabilities KW - disability KW - exercise KW - physical activity KW - digital health KW - YouTube KW - accessibility KW - fitness KW - COVID-19 KW - text analysis KW - social media KW - video N2 - 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. UR - https://formative.jmir.org/2022/2/e34176 UR - http://dx.doi.org/10.2196/34176 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044305 ID - info:doi/10.2196/34176 ER - TY - JOUR AU - Bachu, S. Vismaya AU - Mahjoub, Heba AU - Holler, E. Albert AU - Crihalmeanu, Tudor AU - Bachu, M. Dheevena AU - Ayyaswami, Varun AU - Parker, D. Pearman AU - Prabhu, V. Arpan PY - 2022/2/11 TI - Assessing COVID-19 Health Information on Google Using the Quality Evaluation Scoring Tool (QUEST): Cross-sectional and Readability Analysis JO - JMIR Form Res SP - e32443 VL - 6 IS - 2 KW - COVID-19 KW - COVID-19 pandemic KW - health literacy KW - readability KW - QUEST KW - online health information KW - cross-sectional KW - trend KW - internet KW - spread KW - symptom KW - quality KW - United States N2 - 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. UR - https://formative.jmir.org/2022/2/e32443 UR - http://dx.doi.org/10.2196/32443 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995206 ID - info:doi/10.2196/32443 ER - TY - JOUR AU - Yan, Mengqing AU - Kang, Wenjun AU - Guo, Zhifeng AU - Wang, Qi AU - Wang, Peter Peizhong AU - Zhu, Yun AU - Yang, Yongli AU - Wang, Wei PY - 2022/2/10 TI - Determining the Case Fatality Rate of COVID-19 in Italy: Novel Epidemiological Study JO - JMIR Public Health Surveill SP - e32638 VL - 8 IS - 2 KW - COVID-19 KW - case fatality rate KW - discharged case fatality rate KW - new infectious diseases N2 - 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. UR - https://publichealth.jmir.org/2022/2/e32638 UR - http://dx.doi.org/10.2196/32638 UR - http://www.ncbi.nlm.nih.gov/pubmed/34963659 ID - info:doi/10.2196/32638 ER - TY - JOUR AU - Stevens, Hannah AU - Palomares, A. Nicholas PY - 2022/2/10 TI - 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 JO - JMIR Infodemiology SP - e29246 VL - 2 IS - 1 KW - COVID-19 KW - outbreak KW - mass communication KW - Twitter KW - goal inferences KW - political agendas KW - misinformation KW - infodemic KW - partisanship KW - health information N2 - 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 (?=.47; t249=2.59; P=.01) but not among Democrats (?=.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. UR - https://infodemiology.jmir.org/2022/1/e29246 UR - http://dx.doi.org/10.2196/29246 UR - http://www.ncbi.nlm.nih.gov/pubmed/37113808 ID - info:doi/10.2196/29246 ER - TY - JOUR AU - Grevelding, Pete AU - Hrdlicka, Charles Henry AU - Holland, Steve AU - Cullen, Lorraine AU - Meyer, Amanda AU - Connors, Catherine AU - Cooper, Darielle AU - Greco, Allison PY - 2022/2/10 TI - Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study JO - JMIR Rehabil Assist Technol SP - e31502 VL - 9 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - post?COVID-19 KW - subacute COVID-19 KW - postacute care KW - long-term acute care hospital KW - pulmonary KW - speech therapy KW - speech-language pathology KW - rehabilitation KW - physical therapy KW - occupational therapy KW - respiratory therapy N2 - 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. UR - https://rehab.jmir.org/2022/1/e31502 UR - http://dx.doi.org/10.2196/31502 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023835 ID - info:doi/10.2196/31502 ER - TY - JOUR AU - Connors, Catherine AU - McNeill, Stephanie AU - Hrdlicka, Charles Henry PY - 2022/2/10 TI - 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 JO - JMIR Rehabil Assist Technol SP - e30794 VL - 9 IS - 1 KW - Gullian-Barre syndrome KW - COVID-19 KW - SARS-CoV-2 KW - occupational therapy KW - physical therapy KW - long-term acute care hospital KW - rehabilitation KW - case report KW - treatment KW - diagnosis N2 - 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. UR - https://rehab.jmir.org/2022/1/e30794 UR - http://dx.doi.org/10.2196/30794 UR - http://www.ncbi.nlm.nih.gov/pubmed/35023838 ID - info:doi/10.2196/30794 ER - TY - JOUR AU - Gilley, N. Kristen AU - Baroudi, Loubna AU - Yu, Miao AU - Gainsburg, Izzy AU - Reddy, Niyanth AU - Bradley, Christina AU - Cislo, Christine AU - Rozwadowski, Lois Michelle AU - Clingan, Ashley Caroline AU - DeMoss, Stephen Matthew AU - Churay, Tracey AU - Birditt, Kira AU - Colabianchi, Natalie AU - Chowdhury, Mosharaf AU - Forger, Daniel AU - Gagnier, Joel AU - Zernicke, F. Ronald AU - Cunningham, Lee Julia AU - Cain, M. Stephen AU - Tewari, Muneesh AU - Choi, Won Sung PY - 2022/2/10 TI - 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 JO - JMIR Ment Health SP - e34645 VL - 9 IS - 2 KW - mHealth KW - mobile health KW - college student KW - mental health KW - wearable devices KW - wearable KW - student KW - risk factor KW - risk KW - COVID-19 KW - physical health KW - observational KW - crisis KW - self-report KW - outcome KW - physical activity KW - wellbeing KW - well-being N2 - 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 UR - https://mental.jmir.org/2022/2/e34645 UR - http://dx.doi.org/10.2196/34645 UR - http://www.ncbi.nlm.nih.gov/pubmed/34992051 ID - info:doi/10.2196/34645 ER - TY - JOUR AU - MacDonald, J. James AU - Baxter-King, Ryan AU - Vavreck, Lynn AU - Naeim, Arash AU - Wenger, Neil AU - Sepucha, Karen AU - Stanton, L. Annette PY - 2022/2/10 TI - Depressive Symptoms and Anxiety During the COVID-19 Pandemic: Large, Longitudinal, Cross-sectional Survey JO - JMIR Ment Health SP - e33585 VL - 9 IS - 2 KW - COVID-19 KW - depression KW - anxiety KW - pandemic KW - mental health KW - public health KW - psychological variables KW - younger adults KW - symptom monitoring KW - health intervention N2 - Background: The COVID-19 pandemic has influenced the mental health of millions across the globe. Understanding factors associated with depressive symptoms and anxiety across 12 months of the pandemic can help identify groups at higher risk and psychological processes that can be targeted to mitigate the long-term mental health impact of the pandemic. Objective: This study aims to determine sociodemographic features, COVID-19-specific factors, and general psychological variables associated with depressive symptoms and anxiety over 12 months of the pandemic. Methods: Nationwide, cross-sectional electronic surveys were implemented in May (n=14,636), July (n=14,936), October (n=14,946), and December (n=15,265) 2020 and March/April 2021 (n=14,557) in the United States. Survey results were weighted to be representative of the US population. The samples were drawn from a market research platform, with a 69% cooperation rate. Surveys assessed depressive symptoms in the past 2 weeks and anxiety in the past week, as well as sociodemographic features; COVID-19 restriction stress, worry, perceived risk, coping strategies, and exposure; intolerance of uncertainty; and loneliness. Results: Across 12 months, an average of 24% of respondents reported moderate-to-severe depressive symptoms and 32% reported moderate-to-severe anxiety. Of the sociodemographic variables, age was most consistently associated with depressive symptoms and anxiety, with younger adults more likely to report higher levels of those outcomes. Intolerance of uncertainty and loneliness were consistently and strongly associated with the outcomes. Of the COVID-19-specific variables, stress from COVID-19 restrictions, worry about COVID-19, coping behaviors, and having COVID-19 were associated with a higher likelihood of depressive symptoms and anxiety. Conclusions: Depressive symptoms and anxiety were high in younger adults, adults who reported restriction stress or worry about COVID-19 or who had had COVID-19, and those with intolerance of uncertainty and loneliness. Symptom monitoring as well as early and accessible intervention are recommended. UR - https://mental.jmir.org/2022/2/e33585 UR - http://dx.doi.org/10.2196/33585 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142619 ID - info:doi/10.2196/33585 ER - TY - JOUR AU - Lwin, O. May AU - Sheldenkar, Anita AU - Lu, Jiahui AU - Schulz, Johannes Peter AU - Shin, Wonsun AU - Panchapakesan, Chitra AU - Gupta, Kumar Raj AU - Yang, Yinping PY - 2022/2/10 TI - The Evolution of Public Sentiments During the COVID-19 Pandemic: Case Comparisons of India, Singapore, South Korea, the United Kingdom, and the United States JO - JMIR Infodemiology SP - e31473 VL - 2 IS - 1 KW - COVID-19 KW - public sentiment KW - Twitter KW - crisis communication KW - cross-country comparison KW - sentiment KW - social media KW - communication KW - public health KW - health information KW - emotion KW - perception KW - health literacy KW - information literacy KW - digital literacy KW - community health N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e31473 UR - http://dx.doi.org/10.2196/31473 UR - http://www.ncbi.nlm.nih.gov/pubmed/37113803 ID - info:doi/10.2196/31473 ER - TY - JOUR AU - Tang, Hao AU - Kim, Sungwoo AU - Laforet, E. Priscila AU - Tettey, Naa-Solo AU - Basch, H. Corey PY - 2022/2/9 TI - Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos JO - JMIR Form Res SP - e35164 VL - 6 IS - 2 KW - COVID-19 KW - quarantine KW - weight loss KW - weight gain KW - social media KW - YouTube N2 - 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 (?21=6.05; P=.01), weight loss (?21=13.39; P<.001), negative feelings during quarantine (?21=4.75; P=.03), instructions for losing weight (?21=9.17; P=.002), self-love (?21=6.01; P=.01), body shaming (?21=4.36; P=.04), and special dietary practices (?21=11.10; P<.001) but were less likely to include food recipes (?21=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. UR - https://formative.jmir.org/2022/2/e35164 UR - http://dx.doi.org/10.2196/35164 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978534 ID - info:doi/10.2196/35164 ER - TY - JOUR AU - Fitzsimon, Jonathan AU - Gervais, Oliver AU - Lanos, Chelsea PY - 2022/2/8 TI - COVID-19 Assessment and Testing in Rural Communities During the Pandemic: Cross-sectional Analysis JO - JMIR Public Health Surveill SP - e30063 VL - 8 IS - 2 KW - healthcare KW - virtual care KW - access KW - COVID-19 KW - pandemic KW - assessment KW - testing KW - community paramed KW - digital health KW - online health KW - physician KW - virtual health N2 - 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. UR - https://publichealth.jmir.org/2022/2/e30063 UR - http://dx.doi.org/10.2196/30063 UR - http://www.ncbi.nlm.nih.gov/pubmed/35022158 ID - info:doi/10.2196/30063 ER - TY - JOUR AU - Chen, Emily AU - Jiang, Julie AU - Chang, Herbert Ho-Chun AU - Muric, Goran AU - Ferrara, Emilio PY - 2022/2/8 TI - Charting the Information and Misinformation Landscape to Characterize Misinfodemics on Social Media: COVID-19 Infodemiology Study at a Planetary Scale JO - JMIR Infodemiology SP - e32378 VL - 2 IS - 1 KW - social media KW - social networks KW - Twitter KW - COVID-19 KW - infodemics KW - misinfodemics KW - infodemiology KW - misinformation N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e32378 UR - http://dx.doi.org/10.2196/32378 UR - http://www.ncbi.nlm.nih.gov/pubmed/35190798 ID - info:doi/10.2196/32378 ER - TY - JOUR AU - Joseph, A. Heather AU - Ingber, Z. Susan AU - Austin, Chelsea AU - Westnedge, Caroline AU - Strona, V. F. AU - Lee, Leslie AU - Shah, B. Ami AU - Roper, Lauren AU - Patel, Anita PY - 2022/2/7 TI - An Evaluation of the Text Illness Monitoring (TIM) Platform for COVID-19: Cross-sectional Online Survey of Public Health Users JO - JMIR Public Health Surveill SP - e32680 VL - 8 IS - 2 KW - COVID-19 KW - contact tracing KW - SMS text system KW - symptom monitoring N2 - 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. UR - https://publichealth.jmir.org/2022/2/e32680 UR - http://dx.doi.org/10.2196/32680 UR - http://www.ncbi.nlm.nih.gov/pubmed/34882572 ID - info:doi/10.2196/32680 ER - TY - JOUR AU - Grens, Hilde AU - de Bruin, Peter Jan AU - Huppelschoten, Aleida AU - Kremer, M. Jan A. PY - 2022/2/7 TI - Fertility Workup With Video Consultation During the COVID-19 Pandemic: Pilot Quantitative and Qualitative Study JO - JMIR Form Res SP - e32000 VL - 6 IS - 2 KW - COVID-19 KW - patient centeredness KW - video consultation KW - fertility care KW - telemedicine KW - shared decision making N2 - 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. UR - https://formative.jmir.org/2022/2/e32000 UR - http://dx.doi.org/10.2196/32000 UR - http://www.ncbi.nlm.nih.gov/pubmed/34936981 ID - info:doi/10.2196/32000 ER - TY - JOUR AU - Neely, Stephen AU - Eldredge, Christina AU - Sanders, Ronald PY - 2022/2/4 TI - Authors? Reply: Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on ?Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study? JO - J Med Internet Res SP - e31569 VL - 24 IS - 2 KW - social media KW - internet KW - communication KW - public health KW - COVID-19 KW - usage KW - United States KW - information seeking KW - web-based health information KW - online health information KW - survey KW - mistrust KW - vaccination KW - misinformation UR - https://www.jmir.org/2022/2/e31569 UR - http://dx.doi.org/10.2196/31569 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119376 ID - info:doi/10.2196/31569 ER - TY - JOUR AU - Boudreau, Hunter AU - Singh, Nikhi AU - Boyd, J. Carter PY - 2022/2/4 TI - Understanding the Impact of Social Media Information and Misinformation Producers on Health Information Seeking. Comment on ?Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study? JO - J Med Internet Res SP - e31415 VL - 24 IS - 2 KW - social media KW - internet KW - communication KW - public health KW - COVID-19 KW - usage KW - United States KW - information seeking KW - web-based health information KW - online health information KW - survey KW - mistrust KW - vaccination KW - misinformation UR - https://www.jmir.org/2022/2/e31415 UR - http://dx.doi.org/10.2196/31415 UR - http://www.ncbi.nlm.nih.gov/pubmed/35076408 ID - info:doi/10.2196/31415 ER - TY - JOUR AU - Kane, Hélène AU - Gourret Baumgart, Jade AU - El-Hage, Wissam AU - Deloyer, Jocelyn AU - Maes, Christine AU - Lebas, Marie-Clotilde AU - Marazziti, Donatella AU - Thome, Johannes AU - Fond-Harmant, Laurence AU - Denis, Frédéric PY - 2022/2/4 TI - Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review JO - JMIR Hum Factors SP - e30359 VL - 9 IS - 1 KW - COVID-19 KW - e?mental health KW - professional practices KW - quality of care KW - telepsychiatry KW - videoconferencing N2 - Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. UR - https://humanfactors.jmir.org/2022/1/e30359 UR - http://dx.doi.org/10.2196/30359 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736224 ID - info:doi/10.2196/30359 ER - TY - JOUR AU - Blanchard, Marc AU - Backhaus, Lars AU - Ming Azevedo, Pedro AU - Hügle, Thomas PY - 2022/2/4 TI - An mHealth App for Fibromyalgia-like Post?COVID-19 Syndrome: Protocol for the Analysis of User Experience and Clinical Data JO - JMIR Res Protoc SP - e32193 VL - 11 IS - 2 KW - post?COVID-19 syndrome KW - COVID-19 KW - SARS-CoV-2 KW - mobile health KW - application KW - user experience KW - testing KW - user interface KW - long-covid syndrome KW - mHealth KW - app KW - protocol KW - reinforcement KW - learning KW - strategy KW - symptom KW - outcome KW - patient-reported outcome KW - therapy KW - rehabilitation KW - monitoring N2 - 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 UR - https://www.researchprotocols.org/2022/2/e32193 UR - http://dx.doi.org/10.2196/32193 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982039 ID - info:doi/10.2196/32193 ER - TY - JOUR AU - Mageswaran, Nanthini AU - Ismail, Shareela Noor Akmal PY - 2022/2/3 TI - Preparing Medical Students for the Final Examinations During the COVID-19 Crisis: A Bumpy Ride to the Finishing Line JO - JMIR Med Educ SP - e31392 VL - 8 IS - 1 KW - COVID-19 KW - undergraduate medical education KW - medical students KW - clinical competency KW - pandemic UR - https://mededu.jmir.org/2022/1/e31392 UR - http://dx.doi.org/10.2196/31392 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084354 ID - info:doi/10.2196/31392 ER - TY - JOUR AU - Bin, Jia Kaio AU - Melo, Ribeiro Adler Araujo AU - da Rocha, Franco José Guilherme Moraes AU - de Almeida, Pivi Renata AU - Cobello Junior, Vilson AU - Maia, Liebhart Fernando AU - de Faria, Elizabeth AU - Pereira, José Antonio AU - Battistella, Rizzo Linamara AU - Ono, Kioko Suzane PY - 2022/2/1 TI - The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study JO - JMIR Form Res SP - e29012 VL - 6 IS - 2 KW - COVID-19 KW - artificial intelligence KW - robotic process automation KW - digital health KW - health care management KW - pandemic KW - waiting time KW - queue KW - nonvalue-added activities N2 - 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. UR - https://formative.jmir.org/2022/2/e29012 UR - http://dx.doi.org/10.2196/29012 UR - http://www.ncbi.nlm.nih.gov/pubmed/35103611 ID - info:doi/10.2196/29012 ER - TY - JOUR AU - Lundberg, L. Alexander AU - Lorenzo-Redondo, Ramon AU - Ozer, A. Egon AU - Hawkins, A. Claudia AU - Hultquist, F. Judd AU - Welch, B. Sarah AU - Prasad, Vara P. V. AU - Oehmke, F. James AU - Achenbach, J. Chad AU - Murphy, L. Robert AU - White, I. Janine AU - Havey, J. Robert AU - Post, Ann Lori PY - 2022/1/31 TI - Has Omicron Changed the Evolution of the Pandemic? JO - JMIR Public Health Surveill SP - e35763 VL - 8 IS - 1 KW - Omicron KW - SARS-CoV-2 KW - public health surveillance KW - VOC KW - variant of concern KW - Delta KW - Beta KW - COVID-19 KW - sub-Saharan Africa KW - public health KW - pandemic KW - epidemiology N2 - 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. UR - https://publichealth.jmir.org/2022/1/e35763 UR - http://dx.doi.org/10.2196/35763 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072638 ID - info:doi/10.2196/35763 ER - TY - JOUR AU - Jung, Soyoung AU - Jung, Sooin PY - 2022/1/31 TI - The Impact of the COVID-19 Infodemic on Depression and Sleep Disorders: Focusing on Uncertainty Reduction Strategies and Level of Interpretation Theory JO - JMIR Form Res SP - e32552 VL - 6 IS - 1 KW - COVID-19 KW - social media KW - infodemic KW - construal level theory KW - uncertainty reduction strategy KW - depression KW - sleep disorder KW - preventive actions, affective reaction KW - infodemiology KW - misinformation KW - uncertainty KW - strategy KW - mental health KW - sleep KW - prevention KW - survey KW - usage KW - behavior N2 - Background: During the COVID-19 pandemic, information diffusion about the COVID-19 has attracted public attention through social media. The World Health Organization declared an infodemic of COVID-19 on February 15, 2020. Misinformation and disinformation, including overwhelming amounts of information about COVID-19 on social media, could promote adverse psychological effects. Objective: This study used the Psychological Distance and Level of Construal theory (CLT) to predict peoples? negative psychological symptoms from social media usage. In this study, the CLT intended to show peoples? psychological proximity to objects and events with respect to the COVID-19 pandemic. Furthermore, this study links the uncertainty reduction strategy (URS) and CLT for COVID-19?related preventive behaviors and affective reactions to assess their effects on mental health problems. Methods: A path model was tested (N=297) with data from a web-based survey to examine how social media usage behaviors are associated with URS and psychological distance with COVID-19 (based on the CLT), leading to preventive behaviors and affective reactions. Finally, the path model was used to examine how preventive behaviors and affective reactions are associated with mental health problems including anxiety and sleep disorder. Results: After measuring participants? social media usage behavior, we found that an increase in general social media usage led to higher use of the URS and lower construal level on COVID-19. The URS is associated with preventive behaviors, but the CLT did not show any association with preventive behaviors; however, it increases affective reactions. Moreover, increased preventive behavior showed negative associations with symptoms of mental health problems; that is, depression and sleep disorder. However, the affective reaction tends to be positively associated with depression and sleep disorder. Owing to the infodemic of COVID-19, the psychological perception of the pandemic negatively influenced users? mental health problems. Conclusions: Our results imply that the information from social media usage heightened concerns and had a lower construal level; this does not facilitate taking preventive actions but rather reinforces the negative emotional reaction and mental health problems. Thus, higher URS usage is desirable. UR - https://formative.jmir.org/2022/1/e32552 UR - http://dx.doi.org/10.2196/32552 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870609 ID - info:doi/10.2196/32552 ER - TY - JOUR AU - Gansner, Meredith AU - Nisenson, Melanie AU - Lin, Vanessa AU - Pong, Sovannarath AU - Torous, John AU - Carson, Nicholas PY - 2022/1/28 TI - Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study JO - JMIR Ment Health SP - e33114 VL - 9 IS - 1 KW - COVID-19 KW - problematic internet use KW - ecological momentary assessment KW - internet KW - app KW - youth KW - young adult KW - teenager KW - outpatient KW - mental health KW - treatment KW - pilot KW - cohort KW - change N2 - Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many ?in-person? coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple?s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. UR - https://mental.jmir.org/2022/1/e33114 UR - http://dx.doi.org/10.2196/33114 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089157 ID - info:doi/10.2196/33114 ER - TY - JOUR AU - Skime, K. Michelle AU - Puspitasari, J. Ajeng AU - Gentry, T. Melanie AU - Heredia Jr, Dagoberto AU - Sawchuk, N. Craig AU - Moore, R. Wendy AU - Taylor-Desir, J. Monica AU - Schak, M. Kathryn PY - 2022/1/28 TI - Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study JO - JMIR Ment Health SP - e30204 VL - 9 IS - 1 KW - COVID-19 KW - telemental health KW - teletherapy KW - telepsychiatry KW - telemedicine KW - intensive outpatient KW - patient satisfaction N2 - Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients? feedback on future improvements should be considered to help ensure long-term success. UR - https://mental.jmir.org/2022/1/e30204 UR - http://dx.doi.org/10.2196/30204 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878999 ID - info:doi/10.2196/30204 ER - TY - JOUR AU - Vogt, Louise Emily AU - Welch, M. Brandon AU - Bunnell, E. Brian AU - Barrera, F. Janelle AU - Paige, R. Samantha AU - Owens, Marisa AU - Coffey, Patricia AU - Diazgranados, Nancy AU - Goldman, David PY - 2022/1/28 TI - Quantifying the Impact of COVID-19 on Telemedicine Utilization: Retrospective Observational Study JO - Interact J Med Res SP - e29880 VL - 11 IS - 1 KW - telemedicine KW - COVID-19 KW - utilization KW - impact KW - retrospective KW - observational KW - trend KW - telehealth KW - health policy KW - policy N2 - 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. UR - https://www.i-jmr.org/2022/1/e29880 UR - http://dx.doi.org/10.2196/29880 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751158 ID - info:doi/10.2196/29880 ER - TY - JOUR AU - Lekkas, Damien AU - Gyorda, A. Joseph AU - Price, D. George AU - Wortzman, Zoe AU - Jacobson, C. Nicholas PY - 2022/1/27 TI - Using the COVID-19 Pandemic to Assess the Influence of News Affect on Online Mental Health-Related Search Behavior Across the United States: Integrated Sentiment Analysis and the Circumplex Model of Affect JO - J Med Internet Res SP - e32731 VL - 24 IS - 1 KW - affect KW - sentiment KW - circumplex KW - news KW - mental health KW - online search behavior KW - generalized mixed models KW - natural language processing KW - anxiety KW - depression KW - coronavirus KW - internet KW - information seeking KW - behavior KW - online health information KW - COVID-19 N2 - Background: The digital era has ushered in an unprecedented volume of readily accessible information, including news coverage of current events. Research has shown that the sentiment of news articles can evoke emotional responses from readers on a daily basis with specific evidence for increased anxiety and depression in response to coverage of the recent COVID-19 pandemic. Given the primacy and relevance of such information exposure, its daily impact on the mental health of the general population within this modality warrants further nuanced investigation. Objective: Using the COVID-19 pandemic as a subject-specific example, this work aimed to profile and examine associations between the dynamics of semantic affect in online local news headlines and same-day online mental health term search behavior over time across the United States. Methods: Using COVID-19?related news headlines from a database of online news stories in conjunction with mental health?related online search data from Google Trends, this paper first explored the statistical and qualitative affective properties of state-specific COVID-19 news coverage across the United States from January 23, 2020, to October 22, 2020. The resultant operationalizations and findings from the joint application of dictionary-based sentiment analysis and the circumplex theory of affect informed the construction of subsequent hypothesis-driven mixed effects models. Daily state-specific counts of mental health search queries were regressed on circumplex-derived features of semantic affect, time, and state (as a random effect) to model the associations between the dynamics of news affect and search behavior throughout the pandemic. Search terms were also grouped into depression symptoms, anxiety symptoms, and nonspecific depression and anxiety symptoms to model the broad impact of news coverage on mental health. Results: Exploratory efforts revealed patterns in day-to-day news headline affect variation across the first 9 months of the pandemic. In addition, circumplex mapping of the most frequently used words in state-specific headlines uncovered time-agnostic similarities and differences across the United States, including the ubiquitous use of negatively valenced and strongly arousing language. Subsequent mixed effects modeling implicated increased consistency in affective tone (SpinVA ?=?.207; P<.001) as predictive of increased depression-related search term activity, with emotional language patterns indicative of affective uncontrollability (FluxA ?=.221; P<.001) contributing generally to an increase in online mental health search term frequency. Conclusions: This study demonstrated promise in applying the circumplex model of affect to written content and provided a practical example for how circumplex theory can be integrated with sentiment analysis techniques to interrogate mental health?related associations. The findings from pandemic-specific news headlines highlighted arousal, flux, and spin as potentially significant affect-based foci for further study. Future efforts may also benefit from more expansive sentiment analysis approaches to more broadly test the practical application and theoretical capabilities of the circumplex model of affect on text-based data. UR - https://www.jmir.org/2022/1/e32731 UR - http://dx.doi.org/10.2196/32731 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932494 ID - info:doi/10.2196/32731 ER - TY - JOUR AU - Chejfec-Ciociano, Matias Jonathan AU - Martínez-Herrera, Pablo Juan AU - Parra-Guerra, Darianna Alexa AU - Chejfec, Ricardo AU - Barbosa-Camacho, José Francisco AU - Ibarrola-Peña, Carlos Juan AU - Cervantes-Guevara, Gabino AU - Cervantes-Cardona, Alonso Guillermo AU - Fuentes-Orozco, Clotilde AU - Cervantes-Pérez, Enrique AU - García-Reyna, Benjamín AU - González-Ojeda, Alejandro PY - 2022/1/27 TI - Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study JO - JMIR Infodemiology SP - e29894 VL - 2 IS - 1 KW - coronavirus KW - COVID-19 KW - Google Trends KW - chlorine dioxide KW - COVID-19 misinformation KW - public health surveillance KW - infodemiology KW - internet behavior KW - digital epidemiology KW - internet KW - mHealth KW - mobile health KW - pandemic KW - tele-epidemiology N2 - 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. UR - https://infodemiology.jmir.org/2022/1/e29894 UR - http://dx.doi.org/10.2196/29894 UR - http://www.ncbi.nlm.nih.gov/pubmed/35155994 ID - info:doi/10.2196/29894 ER - TY - JOUR AU - Hendricks-Sturrup, Rachele PY - 2022/1/27 TI - Pulse Oximeter App Privacy Policies During COVID-19: Scoping Assessment JO - JMIR Mhealth Uhealth SP - e30361 VL - 10 IS - 1 KW - COVID-19 KW - pulse oximeters KW - mobile apps KW - mHealth KW - privacy N2 - Background: Pulse oximeter apps became of interest to consumers during the COVID-19 pandemic, particularly when traditional over-the-counter pulse oximeter devices were in short supply. Yet, no study to date has examined or scoped the state of privacy policies and notices for the top-rated and most downloaded pulse oximeter apps during COVID-19. Objective: The aim of this study was to examine, through a high-level qualitative assessment, the state and nature of privacy policies for the downloaded and top-rated pulse oximeter apps during the COVID-19 pandemic to (1) compare findings against comparable research involving other mobile health (mHealth) apps and (2) begin discussions on opportunities for future research or investigation. Methods: During August-October 2020, privacy policies were reviewed for pulse oximeter apps that had either at least 500 downloads (Google Play Store apps only) or a three out of five-star rating (Apple Store apps only). In addition to determining if the apps had an accessible privacy policy, other key privacy policy?related details that were extracted included, but were not limited to, app developer location (country); whether the app was free or required paid use/subscription; whether an ads disclosure was provided on the app?s site; the scope of personal data collected; proportionality, fundamental rights, and data protection and privacy issues; and privacy safeguards. Results: Six pulse oximeter apps met the inclusion criteria and only 33% (n=2) of the six apps had an accessible privacy policy that was specific to the pulse oximeter app feature (vs the app developer?s website or at all). Variation was found in both the regulatory nature and data privacy protections offered by pulse oximeter apps, with notable privacy protection limitations and gaps, although each app provided at least some information about the scope of personal data collected upon installing the app. Conclusions: Pulse oximeter app developers should invest in offering stronger privacy protections for their app users, and should provide more accessible and transparent privacy policies. This is a necessary first step to ensure that the data privacy of mHealth consumers is not exploited during public health emergency situations such as the COVID-19 pandemic, where over-the-counter personal health monitoring devices could be in short supply and patients and consumers may, as a result, turn to mHealth apps to fill such supply gaps. Future research considerations and recommendations are also suggested for mHealth technology and privacy researchers who are interested in examining privacy implications associated with the use of pulse oximeter apps during and after the COVID-19 pandemic. UR - https://mhealth.jmir.org/2022/1/e30361 UR - http://dx.doi.org/10.2196/30361 UR - http://www.ncbi.nlm.nih.gov/pubmed/35084348 ID - info:doi/10.2196/30361 ER - TY - JOUR AU - Corman, Peterson Benjamin Harris AU - Rajupet, Sritha AU - Ye, Fan AU - Schoenfeld, Randi Elinor PY - 2022/1/26 TI - The Role of Unobtrusive Home-Based Continuous Sensing in the Management of Postacute Sequelae of SARS CoV-2 JO - J Med Internet Res SP - e32713 VL - 24 IS - 1 KW - SARS CoV-2 KW - COVID-19 KW - post-acute sequelae of SARS CoV-2 (PASC) KW - post-COVID KW - long COVID KW - continuous sensing KW - passive monitoring KW - wearable sensors KW - contactless sensors KW - vital sign monitoring UR - https://www.jmir.org/2022/1/e32713 UR - http://dx.doi.org/10.2196/32713 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932496 ID - info:doi/10.2196/32713 ER - TY - JOUR AU - Yue, Han AU - Mail, Victoria AU - DiSalvo, Maura AU - Borba, Christina AU - Piechniczek-Buczek, Joanna AU - Yule, M. Amy PY - 2022/1/26 TI - Patient Preferences for Patient Portal?Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study JO - JMIR Form Res SP - e33697 VL - 6 IS - 1 KW - patient portal KW - telemedicine KW - telepsychiatry KW - COVID-19 KW - portal KW - mental health KW - psychiatry KW - engagement KW - behavior KW - video KW - hospital KW - urban KW - outreach N2 - 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. UR - https://formative.jmir.org/2022/1/e33697 UR - http://dx.doi.org/10.2196/33697 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932497 ID - info:doi/10.2196/33697 ER - TY - JOUR AU - Ietto, Giuseppe AU - Mortara, Lorenzo AU - Dalla Gasperina, Daniela AU - Iovino, Domenico AU - Azzi, Lorenzo AU - Baj, Andreina AU - Ageno, Walter AU - Genoni, Paolo Angelo AU - Acquati, Francesco AU - Gallazzi, Matteo AU - Spina, Giorgia AU - Coco, Grace AU - Pierin, Federica AU - Noonan, Douglas AU - Vigezzi, Andrea AU - Monti, Elisa AU - Iori, Valentina AU - Masci, Federica AU - Franchi, Caterina AU - Di Saverio, Salomone AU - Carcano, Giulio PY - 2022/1/25 TI - Immune-Mediated Mechanisms in Patients Testing Positive for SARS-CoV-2: Protocol for a Multianalysis Study JO - JMIR Res Protoc SP - e29892 VL - 11 IS - 1 KW - SARS-CoV-2 KW - COVID-19 KW - immunomodulation KW - severe acute respiratory syndrome KW - mechanism KW - phenotype KW - immunology KW - white blood cell KW - immune system KW - monocyte KW - natural killer cell KW - blood KW - infectious disease KW - immune response KW - antigen KW - vaccine KW - immunity KW - protection KW - genetics KW - epidemiology N2 - 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 UR - https://www.researchprotocols.org/2022/1/e29892 UR - http://dx.doi.org/10.2196/29892 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854818 ID - info:doi/10.2196/29892 ER - TY - JOUR AU - Buhr, Lorina AU - Schicktanz, Silke AU - Nordmeyer, Eike PY - 2022/1/24 TI - Attitudes Toward Mobile Apps for Pandemic Research Among Smartphone Users in Germany: National Survey JO - JMIR Mhealth Uhealth SP - e31857 VL - 10 IS - 1 KW - user KW - pandemic KW - smartphone apps KW - mobile apps KW - telephone-based survey KW - Germany KW - data sharing KW - data donation KW - ethics KW - trust KW - COVID-19 KW - mHealth KW - mobile applications KW - digital health KW - health applications N2 - Background: During the COVID-19 pandemic, but also in the context of previous epidemic diseases, mobile apps for smartphones were developed with different goals and functions, such as digital contact tracing, test management, symptom monitoring, quarantine compliance, and epidemiological and public health research. Objective: The aim of this study was to explore the potential for the acceptance of research-orientated apps (ROAs) in the German population. To this end, we identified distinctive attitudes toward pandemic apps and data sharing for research purposes among smartphone users in general and with a focus on differences in attitudes between app users and nonusers in particular. Methods: We conducted a cross-sectional, national, telephone-based survey of 1003 adults in Germany, of which 924 were useable for statistical analysis. The 17-item survey assessed current usage of pandemic apps, motivations for using or not using pandemic apps, trust in app distributors and attitudes toward data handling (data storage and transmission), willingness to share coded data with researchers using a pandemic app, social attitudes toward app use, and demographic and personal characteristics. Results: A vast majority stated that they used a smartphone (778/924, 84.2%), but less than half of the smartphone users stated that they used a pandemic app (326/778, 41.9%). The study focused on the subsample of smartphone users. Interestingly, when asked about preferred organizations for data storage and app distribution, trust in governmental (federal or state government, regional health office), public-appointed (statutory health insurance), or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology [IT] companies). Having a university degree significantly (P<.001) increased the likelihood of using a pandemic app, while having a migration background significantly (P<.001) decreased it. The overwhelming majority (653/778, 83.9%) of smartphone users were willing to provide their app data for state-funded research. Regarding attitudes toward app usage, striking differences between users and nonusers were found. Almost all app users (317/327, 96.9%) stated they would be willing to share data, whereas only 74.3% (336/452) of nonusers supported data sharing via an app. Two-thirds (216/326, 66.3%) of app users fully or rather agreed with the statement that using a pandemic app is a social duty, whereas almost the same proportion of nonusers entirely or rather disagreed with that statement (273/451, 60.5%). Conclusions: These findings indicate a high potential for the adoption of ROAs among smartphone users in Germany as long as organizational providers engaged in development, operation, and distribution are state-funded or governmental institutions and transparency about data-using research institutions is provided. UR - https://mhealth.jmir.org/2022/1/e31857 UR - http://dx.doi.org/10.2196/31857 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072646 ID - info:doi/10.2196/31857 ER - TY - JOUR AU - Jung, Dukyoo AU - De Gagne, C. Jennie AU - Choi, Eunju AU - Lee, Kyuri PY - 2022/1/24 TI - An Online International Collaborative Learning Program During the COVID-19 Pandemic for Nursing Students: Mixed Methods Study JO - JMIR Med Educ SP - e34171 VL - 8 IS - 1 KW - COVID-19 KW - distance education KW - global competencies KW - nursing students KW - program evaluation KW - synchronous virtual classroom KW - video conferencing N2 - Background: Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments. Objective: We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students? international and global competencies in South Korea. Methods: We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants? global leadership competencies, and the focus group interviews were used to evaluate the program?s effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods. Results: Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative. Conclusions: The online international collaborative learning program had a positive impact on the development of students? international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era. UR - https://mededu.jmir.org/2022/1/e34171 UR - http://dx.doi.org/10.2196/34171 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982035 ID - info:doi/10.2196/34171 ER - TY - JOUR AU - Nakayama, Kazuhiro AU - Yonekura, Yuki AU - Danya, Hitomi AU - Hagiwara, Kanako PY - 2022/1/24 TI - COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study JO - JMIR Form Res SP - e34966 VL - 6 IS - 1 KW - coronavirus KW - COVID-19 KW - health literacy KW - health information KW - decision-making KW - health promotion KW - prevention KW - behavior KW - survey KW - evaluation N2 - 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: ?=.11; information evaluation: ?=.13; decision-making: ?=.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. UR - https://formative.jmir.org/2022/1/e34966 UR - http://dx.doi.org/10.2196/34966 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982036 ID - info:doi/10.2196/34966 ER - TY - JOUR AU - He, Fang AU - Page, H. John AU - Weinberg, R. Kerry AU - Mishra, Anirban PY - 2022/1/21 TI - The Development and Validation of Simplified Machine Learning Algorithms to Predict Prognosis of Hospitalized Patients With COVID-19: Multicenter, Retrospective Study JO - J Med Internet Res SP - e31549 VL - 24 IS - 1 KW - COVID-19 KW - predictive algorithm KW - prognostic model KW - machine learning N2 - 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. UR - https://www.jmir.org/2022/1/e31549 UR - http://dx.doi.org/10.2196/31549 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951865 ID - info:doi/10.2196/31549 ER - TY - JOUR AU - Grimes, Amanda AU - Lightner, S. Joseph AU - Pina, Kimberly AU - Donis de Miranda, S. Evelyn AU - Meissen-Sebelius, Emily AU - Shook, P. Robin AU - Hurley, A. Emily PY - 2022/1/21 TI - Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19?Related Health Challenges: Formative Research Study JO - JMIR Form Res SP - e33322 VL - 6 IS - 1 KW - intervention KW - physical activity KW - nutrition KW - adolescents KW - formative research KW - COVID-19 KW - exercise KW - young adult KW - teenager KW - focus group KW - qualitative KW - interview KW - urban KW - barrier N2 - Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. UR - https://formative.jmir.org/2022/1/e33322 UR - http://dx.doi.org/10.2196/33322 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932499 ID - info:doi/10.2196/33322 ER - TY - JOUR AU - Turner, Kea AU - Bobonis Babilonia, Margarita AU - Naso, Cristina AU - Nguyen, Oliver AU - Gonzalez, D. Brian AU - Oswald, B. Laura AU - Robinson, Edmondo AU - Elston Lafata, Jennifer AU - Ferguson, J. Robert AU - Alishahi Tabriz, Amir AU - Patel, B. Krupal AU - Hallanger-Johnson, Julie AU - Aldawoodi, Nasrin AU - Hong, Young-Rock AU - Jim, L. Heather S. AU - Spiess, E. Philippe PY - 2022/1/19 TI - Health Care Providers? and Professionals? Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study JO - J Med Internet Res SP - e29635 VL - 24 IS - 1 KW - telehealth KW - telemedicine KW - teleoncology KW - digital health KW - remote monitoring KW - cancer KW - oncology KW - coronavirus disease KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2022/1/e29635 UR - http://dx.doi.org/10.2196/29635 UR - http://www.ncbi.nlm.nih.gov/pubmed/34907900 ID - info:doi/10.2196/29635 ER - TY - JOUR AU - Singh, Kumar Asmit AU - Mehan, Paras AU - Sharma, Divyanshu AU - Pandey, Rohan AU - Sethi, Tavpritesh AU - Kumaraguru, Ponnurangam PY - 2022/1/18 TI - COVID-19 Mask Usage and Social Distancing in Social Media Images: Large-scale Deep Learning Analysis JO - JMIR Public Health Surveill SP - e26868 VL - 8 IS - 1 KW - COVID-19 KW - mask detection KW - deep learning KW - classification KW - segmentation KW - social media analysis N2 - 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. UR - https://publichealth.jmir.org/2022/1/e26868 UR - http://dx.doi.org/10.2196/26868 UR - http://www.ncbi.nlm.nih.gov/pubmed/34479183 ID - info:doi/10.2196/26868 ER - TY - JOUR AU - Schluter, J. Philip AU - Généreux, Mélissa AU - Hung, KC Kevin AU - Landaverde, Elsa AU - Law, P. Ronald AU - Mok, Yin Catherine Pui AU - Murray, Virginia AU - O'Sullivan, Tracey AU - Qadar, Zeeshan AU - Roy, Mathieu PY - 2022/1/17 TI - Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study JO - JMIR Public Health Surveill SP - e32140 VL - 8 IS - 1 KW - pandemic KW - infodemic KW - psychosocial impacts KW - sense of coherence KW - suicide ideation KW - epidemiology KW - suicide KW - pattern KW - COVID-19 KW - cross-sectional KW - mental health KW - misinformation KW - risk KW - prevalence KW - gender KW - age KW - sociodemographic N2 - 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. UR - https://publichealth.jmir.org/2022/1/e32140 UR - http://dx.doi.org/10.2196/32140 UR - http://www.ncbi.nlm.nih.gov/pubmed/34727524 ID - info:doi/10.2196/32140 ER - TY - JOUR AU - Walrave, Michel AU - Waeterloos, Cato AU - Ponnet, Koen PY - 2022/1/14 TI - Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e22113 VL - 8 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - contact tracing KW - proximity tracing KW - mHealth KW - mobile app KW - user acceptability KW - surveillance KW - privacy N2 - 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. UR - https://publichealth.jmir.org/2022/1/e22113 UR - http://dx.doi.org/10.2196/22113 UR - http://www.ncbi.nlm.nih.gov/pubmed/34794117 ID - info:doi/10.2196/22113 ER - TY - JOUR AU - Yalamanchili, Bhavya AU - Donelle, Lorie AU - Jurado, Leo-Felix AU - Fera, Joseph AU - Basch, H. Corey PY - 2022/1/14 TI - Investigating #covidnurse Messages on TikTok: Descriptive Study JO - JMIR Nursing SP - e35274 VL - 5 IS - 1 KW - COVID-19 pandemic KW - nurse KW - burnout KW - social media KW - stress KW - TikTok KW - nursing KW - COVID-19 KW - pandemic KW - social support KW - digital peer support KW - health communication KW - peer support N2 - 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. UR - https://nursing.jmir.org/2022/1/e35274 UR - http://dx.doi.org/10.2196/35274 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029536 ID - info:doi/10.2196/35274 ER - TY - JOUR AU - Chaudhry, Moalla Beenish AU - Islam, Ashraful AU - Matthieu, Monica PY - 2022/1/13 TI - Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study JO - JMIR Form Res SP - e30640 VL - 6 IS - 1 KW - mental health KW - stress KW - mHealth KW - frontline health worker KW - design requirements KW - pandemic KW - COVID-19 KW - design KW - intervention KW - burnout KW - perspective KW - need KW - user design N2 - Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs? own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. UR - https://formative.jmir.org/2022/1/e30640 UR - http://dx.doi.org/10.2196/30640 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806985 ID - info:doi/10.2196/30640 ER - TY - JOUR AU - Schuster, M. Amy AU - Cotten, R. Shelia PY - 2022/1/12 TI - COVID-19?s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators JO - JMIR Aging SP - e32442 VL - 5 IS - 1 KW - COVID-19 KW - pandemic KW - socioemotional needs KW - long-term care KW - nursing home facility KW - assisted living facility KW - elderly KW - older adults KW - information and communication technologies KW - support KW - emotion KW - needs KW - access KW - connection KW - communication KW - engagement N2 - Background: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. Objective: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. Methods: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. Results: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents? use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents? use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. Conclusions: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents? engagement and communication opportunities, such as another pandemic. UR - https://aging.jmir.org/2022/1/e32442 UR - http://dx.doi.org/10.2196/32442 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878989 ID - info:doi/10.2196/32442 ER - TY - JOUR AU - Eum, Ji Nam AU - Kim, Hyun Seung PY - 2022/1/7 TI - The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study JO - JMIR Public Health Surveill SP - e31066 VL - 8 IS - 1 KW - health policy KW - telehealth KW - physical distancing KW - disease transmission KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2022/1/e31066 UR - http://dx.doi.org/10.2196/31066 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817392 ID - info:doi/10.2196/31066 ER - TY - JOUR AU - Lee, Minjung AU - You, Myoungsoon PY - 2022/1/6 TI - Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey JO - J Med Internet Res SP - e32329 VL - 24 IS - 1 KW - COVID-19 KW - coronavirus KW - vaccination KW - vaccine hesitancy KW - media use KW - social media KW - public health KW - pandemic KW - epidemiology KW - online information KW - health information N2 - 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. UR - https://www.jmir.org/2022/1/e32329 UR - http://dx.doi.org/10.2196/32329 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870605 ID - info:doi/10.2196/32329 ER - TY - JOUR AU - Alves-Cabratosa, Lia AU - Comas-Cufí, Marc AU - Blanch, Jordi AU - Martí-Lluch, Ruth AU - Ponjoan, Anna AU - Castro-Guardiola, Antoni AU - Hurtado-Ganoza, Abelardo AU - Pérez-Jaén, Ana AU - Rexach-Fumaña, Maria AU - Faixedas-Brunsoms, Delfi AU - Gispert-Ametller, Angels Maria AU - Guell-Cargol, Anna AU - Rodriguez-Batista, Maria AU - Santaularia-Font, Ferran AU - Orriols, Ramon AU - Bonnin-Vilaplana, Marc AU - Calderón López, Carlos Juan AU - Sabater-Talaverano, Gladis AU - Queralt Moles, Xavier Francesc AU - Rodriguez-Requejo, Sara AU - Avellana-Revuelta, Esteve AU - Balló, Elisabet AU - Fages-Masmiquel, Ester AU - Sirvent, Josep-Maria AU - Lorencio, Carol AU - Morales-Pedrosa, Miquel Josep AU - Ortiz-Ballujera, Patricia AU - Ramos, Rafel PY - 2022/1/6 TI - Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data JO - JMIR Public Health Surveill SP - e30006 VL - 8 IS - 1 KW - epidemiology KW - SARS-CoV-2 KW - COVID-19 KW - timeline KW - comparison KW - pandemic KW - waves KW - population characteristics N2 - 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. UR - https://publichealth.jmir.org/2022/1/e30006 UR - http://dx.doi.org/10.2196/30006 UR - http://www.ncbi.nlm.nih.gov/pubmed/34797774 ID - info:doi/10.2196/30006 ER - TY - JOUR AU - Klein, Z. Ari AU - O'Connor, Karen AU - Gonzalez-Hernandez, Graciela PY - 2022/1/6 TI - Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification JO - JMIR Form Res SP - e33792 VL - 6 IS - 1 KW - natural language processing KW - social media KW - COVID-19 KW - data mining KW - COVID-19 vaccine KW - pregnancy outcomes N2 - 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. UR - https://formative.jmir.org/2022/1/e33792 UR - http://dx.doi.org/10.2196/33792 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870607 ID - info:doi/10.2196/33792 ER - TY - JOUR AU - Agarwal, Arnav AU - Basmaji, John AU - Fernando, M. Shannon AU - Ge, Zhou Fang AU - Xiao, Yingqi AU - Faisal, Haseeb AU - Honarmand, Kimia AU - Hylands, Mathieu AU - Lau, I. Vincent AU - Lewis, Kimberley AU - Couban, Rachel AU - Lamontagne, François AU - Adhikari, KJ Neill PY - 2022/1/6 TI - Administration of Parenteral Vitamin C in Patients With Severe Infection: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e33989 VL - 11 IS - 1 KW - vitamin C KW - ascorbic acid KW - severe infection KW - sepsis KW - COVID-19 KW - SARS-CoV-2 KW - infection KW - parenteral KW - vitamin KW - infectious disease KW - protocol KW - review KW - meta-analysis KW - treatment KW - inflammation KW - oxidation KW - effectiveness KW - safety KW - critical care N2 - 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 UR - https://www.researchprotocols.org/2022/1/e33989 UR - http://dx.doi.org/10.2196/33989 UR - http://www.ncbi.nlm.nih.gov/pubmed/34910661 ID - info:doi/10.2196/33989 ER - TY - JOUR AU - Lairez, Olivier AU - Blanchard, Virginie AU - Balardy, Laurent AU - Vardon-Bounes, Fanny AU - Cazalbou, Stéphanie AU - Ruiz, Stéphanie AU - Collot, Samia AU - Houard, Valérie AU - Rolland, Yves AU - Conil, Jean-Marie AU - Minville, Vincent PY - 2022/1/6 TI - COCARDE Study?Cardiac Imaging Phenotype in Patients With COVID-19: Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e24931 VL - 11 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - cardiac imaging KW - echocardiography KW - cardiac MRI KW - hyperinflammation KW - inflammation N2 - 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 UR - https://www.researchprotocols.org/2022/1/e24931 UR - http://dx.doi.org/10.2196/24931 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751159 ID - info:doi/10.2196/24931 ER - TY - JOUR AU - Tsai, Richard AU - Hervey, John AU - Hoffman, Kathleen AU - Wood, Jessica AU - Johnson, Jennifer AU - Deighton, Dana AU - Clermont, Donald AU - Loew, Brian AU - Goldberg, L. Stuart PY - 2022/1/5 TI - COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey JO - JMIR Public Health Surveill SP - e29872 VL - 8 IS - 1 KW - COVID-19 KW - vaccine KW - hesitancy KW - cancer KW - autoimmune diseases KW - vaccination KW - comorbidities KW - SARS-CoV-2 KW - survey KW - cross-sectional KW - incidence KW - safety KW - vulnerable KW - perception KW - attitude N2 - 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. UR - https://publichealth.jmir.org/2022/1/e29872 UR - http://dx.doi.org/10.2196/29872 UR - http://www.ncbi.nlm.nih.gov/pubmed/34709184 ID - info:doi/10.2196/29872 ER - TY - JOUR AU - Kruse, Clemens AU - Heinemann, Katharine PY - 2022/1/4 TI - Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review JO - J Med Internet Res SP - e31752 VL - 24 IS - 1 KW - telemedicine KW - pandemic KW - technology acceptance KW - COVID-19 KW - digital health KW - telehealth KW - health policy KW - health care N2 - 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. UR - https://www.jmir.org/2022/1/e31752 UR - http://dx.doi.org/10.2196/31752 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854815 ID - info:doi/10.2196/31752 ER - TY - JOUR AU - Würstle, Silvia AU - Erber, Johanna AU - Hanselmann, Michael AU - Hoffmann, Dieter AU - Werfel, Stanislas AU - Hering, Svenja AU - Weidlich, Simon AU - Schneider, Jochen AU - Franke, Ralf AU - Maier, Michael AU - Henkel, G. Andreas AU - Schmid, M. Roland AU - Protzer, Ulrike AU - Laxy, Michael AU - Spinner, D. Christoph PY - 2022/1/4 TI - A Telemedicine-Guided Self-Collection Approach for PCR-Based SARS-CoV-2 Testing: Comparative Study JO - JMIR Form Res SP - e32564 VL - 6 IS - 1 KW - self-sampling KW - telemedicine KW - test strategy effectiveness KW - simulation model KW - SARS-CoV-2 KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2022/1/e32564 UR - http://dx.doi.org/10.2196/32564 UR - http://www.ncbi.nlm.nih.gov/pubmed/34803022 ID - info:doi/10.2196/32564 ER - TY - JOUR AU - Zimba, Rebecca AU - Romo, L. Matthew AU - Kulkarni, G. Sarah AU - Berry, Amanda AU - You, William AU - Mirzayi, Chloe AU - Westmoreland, A. Drew AU - Parcesepe, M. Angela AU - Waldron, Levi AU - Rane, S. Madhura AU - Kochhar, Shivani AU - Robertson, M. McKaylee AU - Maroko, R. Andrew AU - Grov, Christian AU - Nash, Denis PY - 2021/12/30 TI - Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e32846 VL - 7 IS - 12 KW - SARS-CoV-2 KW - testing KW - discrete choice experiment KW - latent class analysis KW - COVID-19 KW - pattern KW - trend KW - preference KW - cohort KW - United States KW - discrete choice KW - diagnostic KW - transmission KW - vaccine KW - uptake KW - public health N2 - 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. UR - https://publichealth.jmir.org/2021/12/e32846 UR - http://dx.doi.org/10.2196/32846 UR - http://www.ncbi.nlm.nih.gov/pubmed/34793320 ID - info:doi/10.2196/32846 ER - TY - JOUR AU - Kahanek, Alexander AU - Yu, Xinchen AU - Hong, Lingzi AU - Cleveland, Ana AU - Philbrick, Jodi PY - 2021/12/30 TI - Temporal Variations and Spatial Disparities in Public Sentiment Toward COVID-19 and Preventive Practices in the United States: Infodemiology Study of Tweets JO - JMIR Infodemiology SP - e31671 VL - 1 IS - 1 KW - COVID-19 KW - preventive practices KW - temporal variations KW - spatial disparities KW - Twitter KW - public sentiment KW - socioeconomic factors N2 - 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. UR - https://infodemiology.jmir.org/2021/1/e31671 UR - http://dx.doi.org/10.2196/31671 UR - http://www.ncbi.nlm.nih.gov/pubmed/35013722 ID - info:doi/10.2196/31671 ER - TY - JOUR AU - Beliga, Slobodan AU - Martin?i?-Ip?i?, Sanda AU - Mate?i?, Mihaela AU - Petrijev?anin Vuksanovi?, Irena AU - Me?trovi?, Ana PY - 2021/12/24 TI - Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing JO - JMIR Public Health Surveill SP - e31540 VL - 7 IS - 12 KW - COVID-19 KW - pandemic KW - online media KW - news coverage KW - infoveillance KW - infodemic KW - infodemiology KW - natural language processing KW - name entity recognition KW - longitudinal study N2 - 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. UR - https://publichealth.jmir.org/2021/12/e31540 UR - http://dx.doi.org/10.2196/31540 UR - http://www.ncbi.nlm.nih.gov/pubmed/34739388 ID - info:doi/10.2196/31540 ER - TY - JOUR AU - Ning, Peishan AU - Cheng, Peixia AU - Li, Jie AU - Zheng, Ming AU - Schwebel, C. David AU - Yang, Yang AU - Lu, Peng AU - Mengdi, Li AU - Zhang, Zhuo AU - Hu, Guoqing PY - 2021/12/23 TI - COVID-19?Related Rumor Content, Transmission, and Clarification Strategies in China: Descriptive Study JO - J Med Internet Res SP - e27339 VL - 23 IS - 12 KW - COVID-19 KW - rumor KW - strategy KW - China KW - social media N2 - 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 (?=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: ?12=0.315, P=.58; both rumors: ?12=0.025, P=.88; first rumor and last correct report: ?12=1.287, P=.26; first correct report and last rumor: ?12=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. UR - https://www.jmir.org/2021/12/e27339 UR - http://dx.doi.org/10.2196/27339 UR - http://www.ncbi.nlm.nih.gov/pubmed/34806992 ID - info:doi/10.2196/27339 ER - TY - JOUR AU - Tan, YQ Edina AU - Wee, RE Russell AU - Saw, Ern Young AU - Heng, JQ Kylie AU - Chin, WE Joseph AU - Tong, MW Eddie AU - Liu, CJ Jean PY - 2021/12/23 TI - Tracking Private WhatsApp Discourse About COVID-19 in Singapore: Longitudinal Infodemiology Study JO - J Med Internet Res SP - e34218 VL - 23 IS - 12 KW - social media KW - WhatsApp KW - infodemiology KW - misinformation KW - COVID-19 KW - tracking KW - surveillance KW - app KW - longitudinal KW - Singapore KW - characteristic KW - usage KW - pattern KW - well-being KW - communication KW - risk N2 - 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 UR - https://www.jmir.org/2021/12/e34218 UR - http://dx.doi.org/10.2196/34218 UR - http://www.ncbi.nlm.nih.gov/pubmed/34881720 ID - info:doi/10.2196/34218 ER - TY - JOUR AU - Silenou, C. Bernard AU - Nyirenda, Z. John L. AU - Zaghloul, Ahmed AU - Lange, Berit AU - Doerrbecker, Juliane AU - Schenkel, Karl AU - Krause, Gérard PY - 2021/12/23 TI - Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis JO - JMIR Public Health Surveill SP - e30106 VL - 7 IS - 12 KW - mobile applications KW - mHealth KW - epidemiological surveillance KW - communicable diseases KW - outbreak response KW - health information management KW - public health KW - review KW - transmission network N2 - 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. UR - https://publichealth.jmir.org/2021/12/e30106 UR - http://dx.doi.org/10.2196/30106 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941551 ID - info:doi/10.2196/30106 ER - TY - JOUR AU - Benham, L. Jamie AU - Atabati, Omid AU - Oxoby, J. Robert AU - Mourali, Mehdi AU - Shaffer, Blake AU - Sheikh, Hasan AU - Boucher, Jean-Christophe AU - Constantinescu, Cora AU - Parsons Leigh, Jeanna AU - Ivers, M. Noah AU - Ratzan, C. Scott AU - Fullerton, M. Madison AU - Tang, Theresa AU - Manns, J. Braden AU - Marshall, A. Deborah AU - Hu, Jia AU - Lang, Raynell PY - 2021/12/23 TI - COVID-19 Vaccine?Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis JO - JMIR Public Health Surveill SP - e30424 VL - 7 IS - 12 KW - coronavirus KW - COVID-19 KW - public health KW - marketing KW - behavior KW - risk reduction KW - attitudes KW - compliance KW - vaccine KW - hesitancy KW - risk KW - belief KW - communication KW - cross-sectional KW - Canada KW - gender KW - education KW - income KW - race KW - ethnicity N2 - 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. UR - https://publichealth.jmir.org/2021/12/e30424 UR - http://dx.doi.org/10.2196/30424 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779784 ID - info:doi/10.2196/30424 ER - TY - JOUR AU - Husnayain, Atina AU - Shim, Eunha AU - Fuad, Anis AU - Su, Chia-Yu Emily PY - 2021/12/22 TI - Predicting New Daily COVID-19 Cases and Deaths Using Search Engine Query Data in South Korea From 2020 to 2021: Infodemiology Study JO - J Med Internet Res SP - e34178 VL - 23 IS - 12 KW - prediction KW - internet search KW - COVID-19 KW - South Korea KW - infodemiology N2 - 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. UR - https://www.jmir.org/2021/12/e34178 UR - http://dx.doi.org/10.2196/34178 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762064 ID - info:doi/10.2196/34178 ER - TY - JOUR AU - Drescher, S. Larissa AU - Roosen, Jutta AU - Aue, Katja AU - Dressel, Kerstin AU - Schär, Wiebke AU - Götz, Anne PY - 2021/12/22 TI - The Spread of COVID-19 Crisis Communication by German Public Authorities and Experts on Twitter: Quantitative Content Analysis JO - JMIR Public Health Surveill SP - e31834 VL - 7 IS - 12 KW - COVID-19 KW - crisis communication KW - content analysis KW - Twitter KW - experts KW - authorities KW - Germany KW - negative binomial regression KW - social media KW - communication KW - crisis KW - information KW - development N2 - Background: The COVID-19 pandemic led to the necessity of immediate crisis communication by public health authorities. In Germany, as in many other countries, people choose social media, including Twitter, to obtain real-time information and understanding of the pandemic and its consequences. Next to authorities, experts such as virologists and science communicators were very prominent at the beginning of German Twitter COVID-19 crisis communication. Objective: The aim of this study was to detect similarities and differences between public authorities and individual experts in COVID-19 crisis communication on Twitter during the first year of the pandemic. Methods: Descriptive analysis and quantitative content analysis were carried out on 8251 original tweets posted from January 1, 2020, to January 15, 2021. COVID-19?related tweets of 21 authorities and 18 experts were categorized into structural, content, and style components. Negative binomial regressions were performed to evaluate tweet spread measured by the retweet and like counts of COVID-19?related tweets. Results: Descriptive statistics revealed that authorities and experts increasingly tweeted about COVID-19 over the period under study. Two experts and one authority were responsible for 70.26% (544,418/774,865) of all retweets, thus representing COVID-19 influencers. Altogether, COVID-19 tweets by experts reached a 7-fold higher rate of retweeting (t8,249=26.94, P<.001) and 13.9 times the like rate (t8,249=31.27, P<.001) compared with those of authorities. Tweets by authorities were much more designed than those by experts, with more structural and content components; for example, 91.99% (4997/5432) of tweets by authorities used hashtags in contrast to only 19.01% (536/2819) of experts? COVID-19 tweets. Multivariate analysis revealed that such structural elements reduce the spread of the tweets, and the incidence rate of retweets for authorities? tweets using hashtags was approximately 0.64 that of tweets without hashtags (Z=?6.92, P<.001). For experts, the effect of hashtags on retweets was insignificant (Z=1.56, P=.12). Conclusions: Twitter data are a powerful information source and suitable for crisis communication in Germany. COVID-19 tweet activity mirrors the development of COVID-19 cases in Germany. Twitter users retweet and like communications regarding COVID-19 by experts more than those delivered by authorities. Tweets have higher coverage for both authorities and experts when they are plain and for authorities when they directly address people. For authorities, it appears that it was difficult to win recognition during COVID-19. For all stakeholders studied, the association between number of followers and number of retweets was highly significantly positive (authorities Z=28.74, P<.001; experts Z=25.99, P<.001). Updated standards might be required for successful crisis communication by authorities. UR - https://publichealth.jmir.org/2021/12/e31834 UR - http://dx.doi.org/10.2196/31834 UR - http://www.ncbi.nlm.nih.gov/pubmed/34710054 ID - info:doi/10.2196/31834 ER - TY - JOUR AU - Ming, Wai-kit AU - Huang, Fengqiu AU - Chen, Qiuyi AU - Liang, Beiting AU - Jiao, Aoao AU - Liu, Taoran AU - Wu, Huailiang AU - Akinwunmi, Babatunde AU - Li, Jia AU - Liu, Guan AU - Zhang, P. Casper J. AU - Huang, Jian AU - Liu, Qian PY - 2021/12/21 TI - Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries JO - JMIR Public Health Surveill SP - e26644 VL - 7 IS - 12 KW - COVID-19 KW - Google Trends KW - search peaks KW - news coverage KW - public concerns N2 - 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. UR - https://publichealth.jmir.org/2021/12/e26644 UR - http://dx.doi.org/10.2196/26644 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591781 ID - info:doi/10.2196/26644 ER - TY - JOUR AU - Fedoruk, Benjamin AU - Nelson, Harrison AU - Frost, Russell AU - Fucile Ladouceur, Kai PY - 2021/12/21 TI - The Plebeian Algorithm: A Democratic Approach to Censorship and Moderation JO - JMIR Form Res SP - e32427 VL - 5 IS - 12 KW - infodemiology KW - misinformation KW - algorithm KW - social media KW - plebeian KW - natural language processing KW - sentiment analysis KW - sentiment KW - trust KW - decision-making KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2021/12/e32427 UR - http://dx.doi.org/10.2196/32427 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854812 ID - info:doi/10.2196/32427 ER - TY - JOUR AU - Jansen-Kosterink, Stephanie AU - Hurmuz, Marian AU - den Ouden, Marjolein AU - van Velsen, Lex PY - 2021/12/20 TI - Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens JO - JMIR Form Res SP - e28416 VL - 5 IS - 12 KW - COVID-19 KW - eHealth KW - mHealth KW - contact tracing KW - symptom management KW - intention to use N2 - 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. UR - https://formative.jmir.org/2021/12/e28416 UR - http://dx.doi.org/10.2196/28416 UR - http://www.ncbi.nlm.nih.gov/pubmed/34818210 ID - info:doi/10.2196/28416 ER - TY - JOUR AU - Lee, Megan AU - Sallah, Haddy Ya AU - Petrone, Mary AU - Ringer, Matthew AU - Cosentino, Danielle AU - Vogels, F. Chantal B. AU - Fauver, R. Joseph AU - Alpert, D. Tara AU - Grubaugh, D. Nathan AU - Gupta, Shaili PY - 2021/12/17 TI - COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis JO - JMIRx Med SP - e31503 VL - 2 IS - 4 KW - infectious disease KW - COVID-19 KW - epidemiology KW - veteran KW - outcome KW - sequencing KW - genetics KW - virus KW - United States KW - impact KW - testing KW - severity KW - mortality KW - cohort N2 - 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. UR - https://med.jmirx.org/2021/4/e31503 UR - http://dx.doi.org/10.2196/31503 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014989 ID - info:doi/10.2196/31503 ER - TY - JOUR AU - Mbiine, Ronald AU - Nakanwagi, Cephas AU - Lekuya, Monka Herve AU - Aine, Joan AU - Hakim, Kawesi AU - Nabunya, Lilian AU - Tomusange, Henry PY - 2021/12/17 TI - 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 JO - JMIR Form Res SP - e27521 VL - 5 IS - 12 KW - mHealth KW - risk score for Covid-19 KW - Africa KW - mobile health KW - digital health KW - pandemic KW - COVID-19 KW - COVID KW - screening tool KW - healthcare workers KW - transmission KW - warning system N2 - 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. UR - https://formative.jmir.org/2021/12/e27521 UR - http://dx.doi.org/10.2196/27521 UR - http://www.ncbi.nlm.nih.gov/pubmed/34793321 ID - info:doi/10.2196/27521 ER - TY - JOUR AU - Collins-Pisano, Caroline AU - Velez Court, Juan AU - Johnson, Michael AU - Mois, George AU - Brooks, Jessica AU - Myers, Amanda AU - Muralidharan, Anjana AU - Storm, Marianne AU - Wright, Maggie AU - Berger, Nancy AU - Kasper, Ann AU - Fox, Anthony AU - MacDonald, Sandi AU - Schultze, Sarah AU - Fortuna, Karen PY - 2021/12/16 TI - Core Competencies to Promote Consistency and Standardization of Best Practices for Digital Peer Support: Focus Group Study JO - JMIR Ment Health SP - e30221 VL - 8 IS - 12 KW - COVID-19 KW - peer support KW - competencies KW - training KW - digital N2 - Background: As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective: The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods: Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results: Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions: The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). UR - https://mental.jmir.org/2021/12/e30221 UR - http://dx.doi.org/10.2196/30221 UR - http://www.ncbi.nlm.nih.gov/pubmed/34736223 ID - info:doi/10.2196/30221 ER - TY - JOUR AU - Gurley, Stephen AU - Bennett, Brady AU - Sullivan, Sean Patrick AU - Kiley, Maryellen AU - Linde, Jamie AU - Szczerbacki, David AU - Guest, Jodie PY - 2021/12/15 TI - COVID-19 Vaccine Perceptions, Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study JO - JMIR Public Health Surveill SP - e33739 VL - 7 IS - 12 KW - COVID-19 KW - vaccine KW - hesitancy KW - college KW - higher education KW - race KW - perception KW - intention KW - uptake KW - prospective KW - cohort KW - demographic KW - minority KW - young adult N2 - 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. UR - https://publichealth.jmir.org/2021/12/e33739 UR - http://dx.doi.org/10.2196/33739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847054 ID - info:doi/10.2196/33739 ER - TY - JOUR AU - Alkureishi, Alcocer Maria AU - Choo, Zi-Yi AU - Rahman, Ali AU - Ho, Kimberly AU - Benning-Shorb, Jonah AU - Lenti, Gena AU - Velázquez Sánchez, Itzel AU - Zhu, Mengqi AU - Shah, D. Sachin AU - Lee, Wei Wei PY - 2021/12/15 TI - Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions JO - JMIR Hum Factors SP - e33364 VL - 8 IS - 4 KW - telemedicine KW - digital divide KW - patient experience KW - qualitative study N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e33364 UR - http://dx.doi.org/10.2196/33364 UR - http://www.ncbi.nlm.nih.gov/pubmed/34705664 ID - info:doi/10.2196/33364 ER - TY - JOUR AU - Prusaczyk, Beth AU - Pietka, Kathryn AU - Landman, M. Joshua AU - Luke, A. Douglas PY - 2021/12/15 TI - Utility of Facebook?s Social Connectedness Index in Modeling COVID-19 Spread: Exponential Random Graph Modeling Study JO - JMIR Public Health Surveill SP - e33617 VL - 7 IS - 12 KW - COVID-19 KW - social media KW - social networks KW - network analysis KW - public health KW - utility KW - Facebook KW - connection KW - modeling KW - spread KW - United States KW - belief N2 - 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. UR - https://publichealth.jmir.org/2021/12/e33617 UR - http://dx.doi.org/10.2196/33617 UR - http://www.ncbi.nlm.nih.gov/pubmed/34797775 ID - info:doi/10.2196/33617 ER - TY - JOUR AU - Akhtar, Hashaam AU - Khalid, Sundas AU - Rahman, ur Fazal AU - Umar, Muhammad AU - Ali, Sabahat AU - Afridi, Maham AU - Hassan, Faheem AU - Saleh Khader, Yousef AU - Akhtar, Nasim AU - Khan, Mujeeb Muhammad AU - Ikram, Aamer PY - 2021/12/14 TI - Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e32203 VL - 7 IS - 12 KW - COVID-19 KW - indicators KW - symptoms KW - risk factors KW - comorbidities KW - severity KW - Pakistan N2 - 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. UR - https://publichealth.jmir.org/2021/12/e32203 UR - http://dx.doi.org/10.2196/32203 UR - http://www.ncbi.nlm.nih.gov/pubmed/34710053 ID - info:doi/10.2196/32203 ER - TY - JOUR AU - Strong, E. Laura AU - Middendorf, Irene AU - Turner, Michelle AU - Edwards V, K. David AU - Sama, Varun AU - Mou, Joshua AU - Adams, Colleen K. PY - 2021/12/14 TI - Usability of an At-Home Anterior Nares SARS-CoV-2 RT-PCR Sample Collection Kit: Human Factors Feasibility Study JO - JMIR Hum Factors SP - e29234 VL - 8 IS - 4 KW - COVID-19 testing KW - at-home collection kit KW - SARS-CoV-2 KW - feasibility studies KW - self-collection KW - usability study KW - COVID-19 N2 - 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. UR - https://humanfactors.jmir.org/2021/4/e29234 UR - http://dx.doi.org/10.2196/29234 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609947 ID - info:doi/10.2196/29234 ER - TY - JOUR AU - Parker, K. Jane AU - Kelly, E. Christine AU - Smith, C. Barry AU - Kirkwood, F. Aidan AU - Hopkins, Claire AU - Gane, Simon PY - 2021/12/14 TI - Patients? Perspectives on Qualitative Olfactory Dysfunction: Thematic Analysis of Social Media Posts JO - JMIR Form Res SP - e29086 VL - 5 IS - 12 KW - olfactory dysfunction KW - parosmia KW - phantosmia KW - olfactory perseveration KW - trigger foods KW - mental health KW - COVID-19 KW - patients? perspective KW - thematic analysis KW - social media KW - perspective KW - smell KW - nose KW - symptom KW - concern KW - support N2 - 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. UR - https://formative.jmir.org/2021/12/e29086 UR - http://dx.doi.org/10.2196/29086 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904953 ID - info:doi/10.2196/29086 ER - TY - JOUR AU - Goodday, M. Sarah AU - Karlin, Emma AU - Alfarano, Alexandria AU - Brooks, Alexa AU - Chapman, Carol AU - Desille, Rachelle AU - Rangwala, Shazia AU - Karlin, R. Daniel AU - Emami, Hoora AU - Woods, Fugate Nancy AU - Boch, Adrien AU - Foschini, Luca AU - Wildman, Mackenzie AU - Cormack, Francesca AU - Taptiklis, Nick AU - Pratap, Abhishek AU - Ghassemi, Marzyeh AU - Goldenberg, Anna AU - Nagaraj, Sujay AU - Walsh, Elaine AU - AU - Friend, Stephen PY - 2021/12/10 TI - An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study JO - JMIR Form Res SP - e32165 VL - 5 IS - 12 KW - stress KW - wearable KW - digital health KW - frontline KW - COVID-19 KW - health care worker KW - alternative KW - design KW - app KW - assessment KW - sensor KW - engagement KW - support KW - knowledge N2 - 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 UR - https://formative.jmir.org/2021/12/e32165 UR - http://dx.doi.org/10.2196/32165 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726607 ID - info:doi/10.2196/32165 ER - TY - JOUR AU - Koren, Ainat AU - Alam, Ul Mohammad Arif AU - Koneru, Sravani AU - DeVito, Alexa AU - Abdallah, Lisa AU - Liu, Benyuan PY - 2021/12/10 TI - Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis JO - JMIR Form Res SP - e31358 VL - 5 IS - 12 KW - mental health KW - information retrieval KW - coronavirus KW - COVID-19 KW - nursing KW - nurses KW - health care workers KW - pandemic KW - impact KW - social media analytics N2 - 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. UR - https://formative.jmir.org/2021/12/e31358 UR - http://dx.doi.org/10.2196/31358 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623957 ID - info:doi/10.2196/31358 ER - TY - JOUR AU - Newman, A. Peter AU - Chakrapani, Venkatesan AU - Williams, Charmaine AU - Massaquoi, Notisha AU - Tepjan, Suchon AU - Roungprakhon, Surachet AU - Akkakanjanasupar, Pakorn AU - Logie, Carmen AU - Rawat, Shruta PY - 2021/12/10 TI - 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) JO - JMIR Res Protoc SP - e34381 VL - 10 IS - 12 KW - COVID-19 KW - eHealth KW - RCT KW - protective behaviors KW - psychological distress KW - LGBT+ KW - India KW - Thailand N2 - 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 UR - https://www.researchprotocols.org/2021/12/e34381 UR - http://dx.doi.org/10.2196/34381 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726610 ID - info:doi/10.2196/34381 ER - TY - JOUR AU - Ng, Reuben PY - 2021/12/8 TI - Anti-Asian Sentiments During the COVID-19 Pandemic Across 20 Countries: Analysis of a 12-Billion-Word News Media Database JO - J Med Internet Res SP - e28305 VL - 23 IS - 12 KW - racism KW - COVID-19 KW - anti-Asian sentiments KW - psychomics KW - quantitative social science KW - culture KW - text as data KW - xenophobia KW - digital humanities N2 - Background: US president Joe Biden signed an executive action directing federal agencies to combat hate crimes and racism against Asians, which have percolated during the COVID-19 pandemic. This is one of the first known empirical studies to dynamically test whether global societal sentiments toward Asians have become more negative during the COVID-19 pandemic. Objective: This study aimed to investigate whether global societal sentiments toward Asians across 20 countries have become more negative, month by month, from before the pandemic (October 2019) to May 2020, along with the pandemic (incidence and mortality rates) and cultural (Hofstede?s cultural dimensions) predictors of this trend. Methods: We leveraged a 12-billion-word web-based media database, with over 30 million newspaper and magazine articles taken from over 7000 sites across 20 countries, and identified 6 synonyms of ?Asian? that are related to the coronavirus. We compiled their most frequently used descriptors (collocates) from October 2019 to May 2020 across 20 countries, culminating in 85,827 collocates that were rated by 2 independent researchers to provide a Cumulative Asian Sentiment Score (CASS) per month. This allowed us to track significant shifts in societal sentiments toward Asians from a baseline period (October to December 2019) to the onset of the pandemic (January to May 2020). We tested the competing predictors of this trend: pandemic variables of incidence and mortality rates measured monthly for all 20 countries taken from the Oxford COVID-19 Government Response Tracker, and Hofstede?s Cultural Dimensions of Individualism, Power Distance, Uncertainty Avoidance, and Masculinity for the 20 countries. Results: Before the pandemic in December 2019, Jamaica and New Zealand evidenced the most negative societal sentiments toward Asians; when news about the coronavirus was released in January 2020, the United States and Nigeria evidenced the most negative sentiments toward Asians among 20 countries. Globally, sentiments of Asians became more negative?a significant linear decline during the COVID-19 pandemic. CASS trended neutral before the pandemic during the baseline period of October to November 2019 and then plummeted in February 2020. CASS were, ironically, not predicted by COVID-19?s incidence and mortality rates, but rather by Hofstede?s cultural dimensions: individualism, power distance, and uncertainty avoidance?as shown by mixed models (N=28,494). Specifically, higher power distance, individualism, and uncertainty avoidance were associated with negative societal sentiments toward Asians. Conclusions: Racism, in the form of Anti-Asian sentiments, are deep-seated, and predicated on structural undercurrents of culture. The COVID-19 pandemic may have indirectly and inadvertently exacerbated societal tendencies for racism. Our study lays the important groundwork to design interventions and policy communications to ameliorate Anti-Asian racism, which are culturally nuanced and contextually appropriate. UR - https://www.jmir.org/2021/12/e28305 UR - http://dx.doi.org/10.2196/28305 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678754 ID - info:doi/10.2196/28305 ER - TY - JOUR AU - Syed Abdul, Shabbir AU - Ramaswamy, Meghna AU - Fernandez-Luque, Luis AU - John, Oommen AU - Pitti, Thejkiran AU - Parashar, Babita PY - 2021/12/8 TI - The Pandemic, Infodemic, and People?s Resilience in India: Viewpoint JO - JMIR Public Health Surveill SP - e31645 VL - 7 IS - 12 KW - pandemic KW - COVID-19 KW - India KW - digital health KW - infodemics KW - Sustainable Development Goals KW - SDGs UR - https://publichealth.jmir.org/2021/12/e31645 UR - http://dx.doi.org/10.2196/31645 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787574 ID - info:doi/10.2196/31645 ER - TY - JOUR AU - Brauer, Eden AU - Choi, Kristen AU - Chang, John AU - Luo, Yi AU - Lewin, Bruno AU - Munoz-Plaza, Corrine AU - Bronstein, David AU - Bruxvoort, Katia PY - 2021/12/8 TI - Health Care Providers? Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study JO - JMIR Infodemiology SP - e33330 VL - 1 IS - 1 KW - health information KW - trust KW - health care provider KW - COVID-19 KW - vaccine KW - mixed method KW - communication N2 - 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. UR - https://infodemiology.jmir.org/2021/1/e33330 UR - http://dx.doi.org/10.2196/33330 UR - http://www.ncbi.nlm.nih.gov/pubmed/34926995 ID - info:doi/10.2196/33330 ER - TY - JOUR AU - Stewart, Callum AU - Ranjan, Yatharth AU - Conde, Pauline AU - Rashid, Zulqarnain AU - Sankesara, Heet AU - Bai, Xi AU - Dobson, B. Richard J. AU - Folarin, A. Amos PY - 2021/12/8 TI - Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) JO - JMIR Res Protoc SP - e32587 VL - 10 IS - 12 KW - mobile health KW - COVID-19 KW - digital health KW - smartphone KW - wearable devices KW - mental health KW - wearable KW - data KW - crowdsourced KW - monitoring KW - surveillance KW - observational KW - feasibility KW - infectious disease KW - recovery KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2021/12/e32587 UR - http://dx.doi.org/10.2196/32587 UR - http://www.ncbi.nlm.nih.gov/pubmed/34784292 ID - info:doi/10.2196/32587 ER - TY - JOUR AU - Mukka, Milla AU - Pesälä, Samuli AU - Hammer, Charlotte AU - Mustonen, Pekka AU - Jormanainen, Vesa AU - Pelttari, Hanna AU - Kaila, Minna AU - Helve, Otto PY - 2021/12/7 TI - 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 JO - JMIR Public Health Surveill SP - e31961 VL - 7 IS - 12 KW - COVID-19 KW - SARS-CoV-2 KW - smell disorders KW - taste disorders KW - information-seeking behavior KW - health personnel KW - statistical models KW - medical informatics N2 - 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. UR - https://publichealth.jmir.org/2021/12/e31961 UR - http://dx.doi.org/10.2196/31961 UR - http://www.ncbi.nlm.nih.gov/pubmed/34727525 ID - info:doi/10.2196/31961 ER - TY - JOUR AU - Bohnhoff, James AU - Davis, Alexander AU - Bruine de Bruin, Wändi AU - Krishnamurti, Tamar PY - 2021/12/7 TI - COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey JO - JMIR Infodemiology SP - e31774 VL - 1 IS - 1 KW - COVID-19 KW - health behavior KW - health behaviour KW - pregnancy KW - obstetrics KW - perinatal KW - preventive KW - preventative KW - mHealth KW - risk KW - information source KW - medical literacy KW - media literacy KW - information literacy KW - protection KW - protective KW - harm KW - women KW - engagement KW - online health information KW - behavior KW - information-seeking KW - critical appraisal KW - communication N2 - Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals? choice of specific protective health behaviors during pregnancy may be affected by information sources. Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system. Methods: Pregnant patients completed an app-based questionnaire about their sources of COVID-19 information and engagement in protective health behaviors. The voluntary questionnaire was made available to patients using a pregnancy app as part of their routine prenatal care between April 21 and November 27, 2020. Results: In total, 637 pregnant responders routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79%) was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective actions was relatively common, although 14% self-reported potentially harmful behaviors to avoid COVID-19 infection. The CDC and other sources were positively associated with engaging in protective behaviors while others (eg, US president Donald Trump) were negatively associated with protective behaviors. Participation in protective behaviors was not associated with refraining from potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased (P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the pandemic. Conclusions: Pregnant patients were highly engaged in COVID-19?related information-seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed health organizations about which actions may be harmful, in addition to which actions offer protection, may offer needed support to the pregnant population. UR - https://infodemiology.jmir.org/2021/1/e31774 UR - http://dx.doi.org/10.2196/31774 UR - http://www.ncbi.nlm.nih.gov/pubmed/34926994 ID - info:doi/10.2196/31774 ER - TY - JOUR AU - Abdel-Razig, Sawsan AU - Anglade, Pascale AU - Ibrahim, Halah PY - 2021/12/7 TI - Impact of the COVID-19 Pandemic on a Physician Group?s WhatsApp Chat: Qualitative Content Analysis JO - JMIR Form Res SP - e31791 VL - 5 IS - 12 KW - WhatsApp KW - social media KW - physician KW - pandemic KW - COVID-19 KW - qualitative KW - communication KW - misinformation KW - information-seeking behavior KW - information seeking KW - information sharing KW - content analysis KW - community N2 - 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. UR - https://formative.jmir.org/2021/12/e31791 UR - http://dx.doi.org/10.2196/31791 UR - http://www.ncbi.nlm.nih.gov/pubmed/34784291 ID - info:doi/10.2196/31791 ER - TY - JOUR AU - Daniore, Paola AU - Nittas, Vasileios AU - Moser, André AU - Höglinger, Marc AU - von Wyl, Viktor PY - 2021/12/6 TI - Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis JO - JMIR Public Health Surveill SP - e30004 VL - 7 IS - 12 KW - digital contact tracing KW - exposure notification KW - COVID-19 KW - SARS-CoV-2 KW - contact tracing KW - digital health KW - tracing apps KW - mHealth KW - mobile apps KW - key performance indicators KW - Venn diagram approach N2 - 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. UR - https://publichealth.jmir.org/2021/12/e30004 UR - http://dx.doi.org/10.2196/30004 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874890 ID - info:doi/10.2196/30004 ER - TY - JOUR AU - Fung, Kenneth AU - Liu, JW Jenny AU - Vahabi, Mandana AU - Li, Tai-Wai Alan AU - Zurowski, Mateusz AU - Wong, Pui-Hing Josephine PY - 2021/12/6 TI - Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment JO - JMIR Res Protoc SP - e33495 VL - 10 IS - 12 KW - COVID KW - COVID-19 KW - coronavirus KW - pandemic KW - resilience KW - acceptance commitment therapy KW - group empowerment N2 - 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 UR - https://www.researchprotocols.org/2021/12/e33495 UR - http://dx.doi.org/10.2196/33495 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726602 ID - info:doi/10.2196/33495 ER - TY - JOUR AU - Janvrin, Lynn Miranda AU - Korona-Bailey, Jessica AU - Koehlmoos, Pérez Tracey PY - 2021/12/6 TI - Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis JO - JMIR Form Res SP - e31271 VL - 5 IS - 12 KW - COVID-19 KW - coronavirus KW - framework analysis KW - information resources KW - monitoring KW - patient-reported outcome measures KW - self-reported KW - surveillance KW - symptom tracking KW - synthesis KW - digital health N2 - 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. UR - https://formative.jmir.org/2021/12/e31271 UR - http://dx.doi.org/10.2196/31271 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792469 ID - info:doi/10.2196/31271 ER - TY - JOUR AU - Cruickshank, Iain AU - Ginossar, Tamar AU - Sulskis, Jason AU - Zheleva, Elena AU - Berger-Wolf, Tanya PY - 2021/12/3 TI - Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis JO - J Med Internet Res SP - e29127 VL - 23 IS - 12 KW - COVID-19 KW - agenda setting KW - antivaccination KW - cross-platform KW - data mining of social media KW - misinformation KW - social media KW - Twitter KW - vaccinations KW - vaccine hesitancy N2 - 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. UR - https://www.jmir.org/2021/12/e29127 UR - http://dx.doi.org/10.2196/29127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665760 ID - info:doi/10.2196/29127 ER - TY - JOUR AU - Goldin, Shoshanna AU - Kong, Joyce So Yeon AU - Tokar, Anna AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Bahl, Jhilmil AU - Appuhamy, Ranil AU - Moen, Ann PY - 2021/12/3 TI - Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study JO - JMIR Public Health Surveill SP - e33455 VL - 7 IS - 12 KW - COVID-19 KW - vaccination KW - training KW - massive open online course KW - pandemic KW - vaccine KW - education KW - online education KW - preparation KW - evaluation KW - user experience KW - challenge KW - impact KW - knowledge KW - interest N2 - 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. UR - https://publichealth.jmir.org/2021/12/e33455 UR - http://dx.doi.org/10.2196/33455 UR - http://www.ncbi.nlm.nih.gov/pubmed/34794116 ID - info:doi/10.2196/33455 ER - TY - JOUR AU - Zhang, Jueman AU - Wang, Yi AU - Shi, Molu AU - Wang, Xiuli PY - 2021/12/3 TI - Factors Driving the Popularity and Virality of COVID-19 Vaccine Discourse on Twitter: Text Mining and Data Visualization Study JO - JMIR Public Health Surveill SP - e32814 VL - 7 IS - 12 KW - COVID-19 KW - vaccine KW - topic modeling KW - LDA KW - valence KW - share KW - viral KW - Twitter KW - social media N2 - 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. UR - https://publichealth.jmir.org/2021/12/e32814 UR - http://dx.doi.org/10.2196/32814 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665761 ID - info:doi/10.2196/32814 ER - TY - JOUR AU - Amundsen, Myklebust Ole AU - Hoffart, Asle AU - Johnson, Urnes Sverre AU - Ebrahimi, V. Omid PY - 2021/12/3 TI - Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e28239 VL - 5 IS - 12 KW - information sources KW - COVID-19 KW - avoidance KW - psychopathology N2 - 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 UR - https://formative.jmir.org/2021/12/e28239 UR - http://dx.doi.org/10.2196/28239 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678750 ID - info:doi/10.2196/28239 ER - TY - JOUR AU - Edwards, J. Laura AU - Fowlkes, L. Ashley AU - Wesley, G. Meredith AU - Kuntz, L. Jennifer AU - Odean, J. Marilyn AU - Caban-Martinez, J. Alberto AU - Dunnigan, Kayan AU - Phillips, L. Andrew AU - Grant, Lauren AU - Herring, K. Meghan AU - Groom, C. Holly AU - Respet, Karley AU - Beitel, Shawn AU - Zunie, Tnelda AU - Hegmann, T. Kurt AU - Kumar, Archana AU - Joseph, Gregory AU - Poe, Brandon AU - Louzado-Feliciano, Paola AU - Smith, E. Michael AU - Thiese, S. Matthew AU - Schaefer-Solle, Natasha AU - Yoo, M. Young AU - Silvera, A. Carlos AU - Mayo Lamberte, Julie AU - Mak, Josephine AU - McDonald, Clifford L. AU - Stuckey, J. Matthew AU - Kutty, Preeta AU - Arvay, L. Melissa AU - Yoon, K. Sarang AU - Tyner, L. Harmony AU - Burgess, L. Jefferey AU - Hunt, Rentz Danielle AU - Meece, Jennifer AU - Gaglani, Manjusha AU - Naleway, L. Allison AU - Thompson, G. Mark PY - 2021/12/3 TI - Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study JO - JMIR Res Protoc SP - e31574 VL - 10 IS - 12 KW - COVID-19 KW - SARS-CoV-2 KW - incidence KW - vaccine effectiveness KW - cohort study KW - health care personnel KW - first responder KW - essential and frontline workers N2 - 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 UR - https://www.researchprotocols.org/2021/12/e31574 UR - http://dx.doi.org/10.2196/31574 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662287 ID - info:doi/10.2196/31574 ER - TY - JOUR AU - Jolliff, Anna AU - Zhao, Qianqian AU - Eickhoff, Jens AU - Moreno, Megan PY - 2021/12/2 TI - Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Form Res SP - e30702 VL - 5 IS - 12 KW - COVID-19 KW - pandemic KW - adolescent KW - depression KW - anxiety KW - socioeconomic status KW - survey KW - mental health N2 - 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. UR - https://formative.jmir.org/2021/12/e30702 UR - http://dx.doi.org/10.2196/30702 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609316 ID - info:doi/10.2196/30702 ER - TY - JOUR AU - Donnat, Claire AU - Bunbury, Freddy AU - Kreindler, Jack AU - Liu, David AU - Filippidis, T. Filippos AU - Esko, Tonu AU - El-Osta, Austen AU - Harris, Matthew PY - 2021/12/1 TI - Predicting COVID-19 Transmission to Inform the Management of Mass Events: Model-Based Approach JO - JMIR Public Health Surveill SP - e30648 VL - 7 IS - 12 KW - COVID-19 KW - transmission dynamics KW - live event management KW - Monte Carlo simulation N2 - 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. UR - https://publichealth.jmir.org/2021/12/e30648 UR - http://dx.doi.org/10.2196/30648 UR - http://www.ncbi.nlm.nih.gov/pubmed/34583317 ID - info:doi/10.2196/30648 ER - TY - JOUR AU - Fisher, B. Lauren AU - Tuchman, Sylvie AU - Curreri, J. Andrew AU - Markgraf, Maggie AU - Nyer, B. Maren AU - Cassano, Paolo AU - Iverson, L. Grant AU - Fava, Maurizio AU - Zafonte, D. Ross AU - Pedrelli, Paola PY - 2021/12/1 TI - 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 JO - JMIR Form Res SP - e28734 VL - 5 IS - 12 KW - COVID-19 KW - telemental health KW - clinical trial KW - traumatic brain injury KW - depression KW - cognitive behavioral therapy N2 - 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 UR - https://formative.jmir.org/2021/12/e28734 UR - http://dx.doi.org/10.2196/28734 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662285 ID - info:doi/10.2196/28734 ER - TY - JOUR AU - Warin, Thierry PY - 2021/11/30 TI - Global Research on Coronaviruses: Metadata-Based Analysis for Public Health Policies JO - JMIR Med Inform SP - e31510 VL - 9 IS - 11 KW - COVID-19 KW - SARS-CoV-2 KW - natural language processing KW - coronavirus KW - unstructured data KW - data science KW - health 4.0 N2 - 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. UR - https://medinform.jmir.org/2021/11/e31510 UR - http://dx.doi.org/10.2196/31510 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596570 ID - info:doi/10.2196/31510 ER - TY - JOUR AU - Schulz, Johannes Peter AU - Andersson, M. Elin AU - Bizzotto, Nicole AU - Norberg, Margareta PY - 2021/11/29 TI - Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study JO - J Med Internet Res SP - e26743 VL - 23 IS - 11 KW - COVID-19 KW - coronavirus KW - longitudinal studies KW - EMA KW - worry KW - fear KW - pandemics N2 - Background: The foray of COVID-19 around the globe has certainly instigated worries in many people, and lockdown measures may well have triggered more specific worries. Sweden, more than other countries, relied on voluntary measures to fight the pandemic. This provides a particularly interesting context to assess people?s reactions to the threat of the pandemic. Objective: The general aim of this study was to better understand the worried reactions to the virus and the associated lockdown measures. As there have been very few longitudinal studies in this area published to date, development of feelings of worry over time was analyzed over a longer range than in previous research. Affective variables, worry in particular, were included because most of the research in this field has focused on cognitive variables. To employ new methodology, ecological momentary assessment was used for data collection and a multilevel modeling approach was adopted for data analysis. Methods: Results were based on an unbalanced panel sample of 260 Swedish participants filling in 3226 interview questionnaires by smartphone over a 7-week period in 2020 during the rapid rise of cases in the early phase of the pandemic. Causal factors considered in this study included the perceived severity of an infection, susceptibility of a person to the threat posed by the virus, perceived efficacy of safeguarding measures, and assessment of government action against the spread of COVID-19. The effect of these factors on worries was traced in two analytical steps: the effects at the beginning of the study and the effect on the trend during the study. Results: The level of general worry related to COVID-19 was modest (mean 6.67, SD 2.54 on an 11-point Likert scale); the increase during the study period was small, but the interindividual variation of both the worry level and its increase over time was large. Findings confirmed that the hypothesized causal factors (severity of infection, susceptibility to the threat of the virus, efficacy of safeguarding, and assessment of government preventive action) did indeed affect the level of worry. Conclusions: The results confirmed earlier research in a very special case and demonstrated the usefulness of a different study design, which takes a longitudinal perspective, and a new type of data analysis borrowed from multilevel study design. UR - https://www.jmir.org/2021/11/e26743 UR - http://dx.doi.org/10.2196/26743 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847065 ID - info:doi/10.2196/26743 ER - TY - JOUR AU - Jarynowski, Andrzej AU - Semenov, Alexander AU - Kami?ski, Miko?aj AU - Belik, Vitaly PY - 2021/11/29 TI - Mild Adverse Events of Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning JO - J Med Internet Res SP - e30529 VL - 23 IS - 11 KW - adverse events KW - Sputnik V KW - Gam-COVID-Vac KW - social media KW - Telegram KW - COVID-19 KW - Sars-CoV-2 KW - deep learning KW - vaccine safety N2 - 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 (?=.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. UR - https://www.jmir.org/2021/11/e30529 UR - http://dx.doi.org/10.2196/30529 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662291 ID - info:doi/10.2196/30529 ER - TY - JOUR AU - Kang, EunKyo AU - Lee, Hyejin AU - Sohn, Hoon Jee AU - Yun, Jieun AU - Lee, Yong Jin AU - Hong, Yun-Chul PY - 2021/11/26 TI - Impact of the COVID-19 Pandemic on the Health Status and Behaviors of Adults in Korea: National Cross-sectional Web-Based Self-report Survey JO - JMIR Public Health Surveill SP - e31635 VL - 7 IS - 11 KW - COVID-19 KW - health status KW - health behavior KW - self-reported online survey KW - pandemic KW - epidemiology KW - public health KW - sociodemographic factors KW - health interventions KW - lockdown N2 - Background: The COVID-19 pandemic has radically shifted living practices, thereby influencing changes in the health status and behaviors of every person. Objective: The aim of this study was to investigate the impact of COVID-19 on the self-reported health status and health behaviors along with any associated factors in adults in the Republic of Korea wherein no stringent lockdown measures were implemented during the pandemic. Methods: We conducted a web-based self-reported survey from November 2020 to December 2020. The study participants (N=2097) were identified through quota sampling by age, sex, and geographical regions among residents aged 19 years or older in Korea. The survey collected information on basic demographics, changes in self-reported health status, and health behaviors during the COVID-19 pandemic. Self-reported health status and health behaviors were categorized into 3 groups: unchanged, improved, or worsened. A chi-square test and logistic regression analyses were conducted. Results: With regard to changes in the self-reported health status, the majority (1478/2097, 70.5%) of the participants reported that their health was unchanged, while 20% (420/2097) of the participants reported having worser health after the COVID-19 outbreak. With regard to changes in health behaviors, the proportion of participants who increased tobacco consumption was similar to that of those who decreased tobacco consumption (110/545, 20.2% vs 106/545, 19.5%, respectively), while the proportion of those who decreased their drinking frequency was more than twice as many as those who increased their drinking frequency (578/1603, 36.1% vs 270/1603, 16.8%, respectively). Further, those who decreased their exercising frequency were more than those who increased their exercising frequency (333/823, 15.9% vs 211/823, 10%, respectively). The factor that had the greatest influence on lifestyle was age. In the subgroup analysis, the group aged 20-29 years had the highest number of individuals with both a worsened (100/377, 26.5%) and an improved (218/377, 15.7%) health status. Further, individuals aged 20-29 years had greater odds of increased smoking (6.44, 95% CI 2.15-19.32), increased alcohol use (4.64, 95% CI 2.60-8.28), and decreased moderate or higher intensity aerobic exercise (3.39, 95% CI 1.82-6.33) compared to individuals aged 60 years and older. Younger adults showed deteriorated health behaviors, while older adults showed improved health behaviors. Conclusions: The health status and the behavior of the majority of the Koreans were not found to be heavily affected by the COVID-19 outbreak. However, in some cases, changes in health status or health behavior were identified. This study highlighted that some groups were overwhelmingly affected by COVID-19 compared to others. Certain groups reported experiencing both worsening and improving health, while other groups reported unchanged health status. Age was the most influential factor for behavior change; in particular, the younger generation?s negative health behaviors need more attention in terms of public health. As COVID-19 prolongs, public health interventions for vulnerable groups may be needed. UR - https://publichealth.jmir.org/2021/11/e31635 UR - http://dx.doi.org/10.2196/31635 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653017 ID - info:doi/10.2196/31635 ER - TY - JOUR AU - Shilton, Sonjelle AU - Ivanova Reipold, Elena AU - Roca Álvarez, Albert AU - Martínez-Pérez, Z. Guillermo PY - 2021/11/26 TI - 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 JO - JMIR Res Protoc SP - e33088 VL - 10 IS - 11 KW - COVID-19 KW - SARS-CoV-2 KW - diagnostic KW - self-testing KW - mixed methods KW - testing KW - protocol KW - preference KW - population KW - health care worker KW - decision-making KW - accessibility KW - transmission KW - screening N2 - 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 UR - https://www.researchprotocols.org/2021/11/e33088 UR - http://dx.doi.org/10.2196/33088 UR - http://www.ncbi.nlm.nih.gov/pubmed/34726608 ID - info:doi/10.2196/33088 ER - TY - JOUR AU - Cheong, Queena AU - Au-yeung, Martin AU - Quon, Stephanie AU - Concepcion, Katsy AU - Kong, Dzevela Jude PY - 2021/11/25 TI - Predictive Modeling of Vaccination Uptake in US Counties: A Machine Learning?Based Approach JO - J Med Internet Res SP - e33231 VL - 23 IS - 11 KW - COVID-19 KW - vaccine KW - public health KW - machine learning KW - XGBoost KW - SARS-CoV-2 KW - sociodemographic factors KW - United States KW - sociodemographic KW - prediction KW - model KW - uptake N2 - 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. UR - https://www.jmir.org/2021/11/e33231 UR - http://dx.doi.org/10.2196/33231 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751650 ID - info:doi/10.2196/33231 ER - TY - JOUR AU - Suppan, Melanie AU - Stuby, Loric AU - Harbarth, Stephan AU - Fehlmann, A. Christophe AU - Achab, Sophia AU - Abbas, Mohamed AU - Suppan, Laurent PY - 2021/11/25 TI - Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study JO - JMIR Serious Games SP - e33003 VL - 9 IS - 4 KW - COVID-19 KW - serious game KW - infection prevention KW - SARS-CoV-2 KW - prospective KW - web-based KW - deployment KW - prevention KW - gaming KW - public health KW - dissemination KW - health information KW - behavior KW - survey N2 - 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. UR - https://games.jmir.org/2021/4/e33003 UR - http://dx.doi.org/10.2196/33003 UR - http://www.ncbi.nlm.nih.gov/pubmed/34635472 ID - info:doi/10.2196/33003 ER - TY - JOUR AU - Lawhun Costello, Victoria AU - Chevance, Guillaume AU - Wing, David AU - Mansour-Assi, J. Shadia AU - Sharp, Sydney AU - Golaszewski, M. Natalie AU - Young, A. Elizabeth AU - Higgins, Michael AU - Ibarra, Anahi AU - Larsen, Britta AU - Godino, G. Job PY - 2021/11/24 TI - Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis JO - JMIR Public Health Surveill SP - e28317 VL - 7 IS - 11 KW - COVID-19 KW - young adults KW - physical activity KW - sedentary behavior KW - activity monitor KW - public health KW - wearable KW - activity monitors KW - wrist worn KW - sedentary KW - lifestyle KW - pandemic N2 - Background: The COVID-19 pandemic has impacted multiple aspects of daily living, including behaviors associated with occupation, transportation, and health. It is unclear how these changes to daily living have impacted physical activity and sedentary behavior. Objective: In this study, we add to the growing body of research on the health impact of the COVID-19 pandemic by examining longitudinal changes in objectively measured daily physical activity and sedentary behavior among overweight or obese young adults participating in an ongoing weight loss trial in San Diego, California. Methods: Data were collected from 315 overweight or obese (BMI: range 25.0-39.9 kg/m2) participants aged from 18 to 35 years between November 1, 2019, and October 30, 2020, by using the Fitbit Charge 3 (Fitbit LLC). After conducting strict filtering to find valid data on consistent wear (>10 hours per day for ?250 days), data from 97 participants were analyzed to detect multiple structural changes in time series of physical activity and sedentary behavior. An algorithm was designed to detect multiple structural changes. This allowed for the automatic identification and dating of these changes in linear regression models with CIs. The number of breakpoints in regression models was estimated by using the Bayesian information criterion and residual sum of squares; the optimal segmentation corresponded to the lowest Bayesian information criterion and residual sum of squares. To quantify the changes in each outcome during the periods identified, linear mixed effects analyses were conducted. In terms of key demographic characteristics, the 97 participants included in our analyses did not differ from the 210 participants who were excluded. Results: After the initiation of the shelter-in-place order in California on March 19, 2021, there were significant decreases in step counts (?2872 steps per day; 95% CI ?2734 to ?3010), light physical activity times (?41.9 minutes; 95% CI ?39.5 to ?44.3), and moderate-to-vigorous physical activity times (?12.2 minutes; 95% CI ?10.6 to ?13.8), as well as significant increases in sedentary behavior times (+52.8 minutes; 95% CI 47.0-58.5). The decreases were greater than the expected declines observed during winter holidays, and as of October 30, 2020, they have not returned to the levels observed prior to the initiation of shelter-in-place orders. Conclusions: Among overweight or obese young adults, physical activity times decreased and sedentary behavior times increased concurrently with the implementation of COVID-19 mitigation strategies. The health conditions associated with a sedentary lifestyle may be additional, unintended results of the COVID-19 pandemic. UR - https://publichealth.jmir.org/2021/11/e28317 UR - http://dx.doi.org/10.2196/28317 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665759 ID - info:doi/10.2196/28317 ER - TY - JOUR AU - Scholl, Annika AU - Sassenberg, Kai PY - 2021/11/24 TI - 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 JO - JMIR Mhealth Uhealth SP - e28146 VL - 9 IS - 11 KW - COVID-19 KW - SARS-CoV-2 KW - contact tracing app KW - social identification KW - technology acceptance KW - pandemic KW - outbreak KW - health technology N2 - 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. UR - https://mhealth.jmir.org/2021/11/e28146 UR - http://dx.doi.org/10.2196/28146 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662289 ID - info:doi/10.2196/28146 ER - TY - JOUR AU - Wang, W. Andrea AU - Lan, Jo-Yu AU - Wang, Ming-Hung AU - Yu, Chihhao PY - 2021/11/23 TI - The Evolution of Rumors on a Closed Social Networking Platform During COVID-19: Algorithm Development and Content Study JO - JMIR Med Inform SP - e30467 VL - 9 IS - 11 KW - COVID-19 KW - rumors KW - rumor diffusion KW - rumor propagation KW - social listening KW - infodemic KW - social media KW - closed platform KW - natural language processing KW - machine learning KW - unsupervised learning KW - computers and society N2 - Background: In 2020, the COVID-19 pandemic put the world in a crisis regarding both physical and psychological health. Simultaneously, a myriad of unverified information flowed on social media and online outlets. The situation was so severe that the World Health Organization identified it as an infodemic in February 2020. Objective: The aim of this study was to examine the propagation patterns and textual transformation of COVID-19?related rumors on a closed social media platform. Methods: We obtained a data set of suspicious text messages collected on Taiwan?s most popular instant messaging platform, LINE, between January and July 2020. We proposed a classification-based clustering algorithm that could efficiently cluster messages into groups, with each group representing a rumor. For ease of understanding, a group is referred to as a ?rumor group.? Messages in a rumor group could be identical or could have limited textual differences between them. Therefore, each message in a rumor group is a form of the rumor. Results: A total of 936 rumor groups with at least 10 messages each were discovered among 114,124 text messages collected from LINE. Among 936 rumors, 396 (42.3%) were related to COVID-19. Of the 396 COVID-19?related rumors, 134 (33.8%) had been fact-checked by the International Fact-Checking Network?certified agencies in Taiwan and determined to be false or misleading. By studying the prevalence of simplified Chinese characters or phrases in the messages that originated in China, we found that COVID-19?related messages, compared to non?COVID-19?related messages, were more likely to have been written by non-Taiwanese users. The association was statistically significant, with P<.001, as determined by the chi-square independence test. The qualitative investigations of the three most popular COVID-19 rumors revealed that key authoritative figures, mostly medical personnel, were often misquoted in the messages. In addition, these rumors resurfaced multiple times after being fact-checked, usually preceded by major societal events or textual transformations. Conclusions: To fight the infodemic, it is crucial that we first understand why and how a rumor becomes popular. While social media has given rise to an unprecedented number of unverified rumors, it also provides a unique opportunity for us to study the propagation of rumors and their interactions with society. Therefore, we must put more effort into these areas. UR - https://medinform.jmir.org/2021/11/e30467 UR - http://dx.doi.org/10.2196/30467 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623954 ID - info:doi/10.2196/30467 ER - TY - JOUR AU - Midorikawa, Haruhiko AU - Tachikawa, Hirokazu AU - Taguchi, Takaya AU - Shiratori, Yuki AU - Takahashi, Asumi AU - Takahashi, Sho AU - Nemoto, Kiyotaka AU - Arai, Tetsuaki PY - 2021/11/22 TI - Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e29970 VL - 7 IS - 11 KW - COVID-19 KW - mental health KW - stress KW - depression KW - anxiety KW - occupation KW - public health KW - demographic factors KW - epidemiology KW - occupational health N2 - 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. UR - https://publichealth.jmir.org/2021/11/e29970 UR - http://dx.doi.org/10.2196/29970 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653018 ID - info:doi/10.2196/29970 ER - TY - JOUR AU - Jones, Kerina AU - Thompson, Rachel PY - 2021/11/22 TI - To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales JO - JMIR Mhealth Uhealth SP - e29181 VL - 9 IS - 11 KW - COVID-19 KW - survey KW - Wales KW - contact tracing KW - app KW - mHealth KW - mobile apps KW - digital health KW - public health N2 - 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. UR - https://mhealth.jmir.org/2021/11/e29181 UR - http://dx.doi.org/10.2196/29181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698645 ID - info:doi/10.2196/29181 ER - TY - JOUR AU - De Santis, Karolina Karina AU - Jahnel, Tina AU - Sina, Elida AU - Wienert, Julian AU - Zeeb, Hajo PY - 2021/11/22 TI - Digitization and Health in Germany: Cross-sectional Nationwide Survey JO - JMIR Public Health Surveill SP - e32951 VL - 7 IS - 11 KW - digital health KW - literacy KW - survey KW - attitude KW - usage KW - eHEALS KW - COVID-19 KW - physical activity KW - general population KW - misinformation N2 - Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (?=?.22, P<.001), higher household income (?=.21, P<.001), and more education (?=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. UR - https://publichealth.jmir.org/2021/11/e32951 UR - http://dx.doi.org/10.2196/32951 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813493 ID - info:doi/10.2196/32951 ER - TY - JOUR AU - Leal-Neto, Onicio AU - Egger, Thomas AU - Schlegel, Matthias AU - Flury, Domenica AU - Sumer, Johannes AU - Albrich, Werner AU - Babouee Flury, Baharak AU - Kuster, Stefan AU - Vernazza, Pietro AU - Kahlert, Christian AU - Kohler, Philipp PY - 2021/11/22 TI - Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study JO - JMIR Public Health Surveill SP - e33576 VL - 7 IS - 11 KW - digital epidemiology KW - SARS-CoV-2 KW - COVID-19 KW - health care workers N2 - 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. UR - https://publichealth.jmir.org/2021/11/e33576 UR - http://dx.doi.org/10.2196/33576 UR - http://www.ncbi.nlm.nih.gov/pubmed/34727046 ID - info:doi/10.2196/33576 ER - TY - JOUR AU - Polosa, Riccardo AU - Tomaselli, Venera AU - Ferrara, Pietro AU - Romeo, Corina Alba AU - Rust, Sonja AU - Saitta, Daniela AU - Caraci, Filippo AU - Romano, Corrado AU - Thangaraju, Murugesan AU - Zuccarello, Pietro AU - Rose, Jed AU - Cantone, Giacomo Giulio AU - Ferrante, Margherita AU - Belsey, Jonathan AU - Cibella, Fabio AU - Interlandi, Elisa AU - Ferri, Raffaele PY - 2021/11/22 TI - Seroepidemiological Survey on the Impact of Smoking on SARS-CoV-2 Infection and COVID-19 Outcomes: Protocol for the Troina Study JO - JMIR Res Protoc SP - e32285 VL - 10 IS - 11 KW - antibody persistence KW - cotinine KW - COVID-19 KW - SARS-CoV-2 KW - seroprevalence KW - smoking impact KW - smoking status N2 - 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 UR - https://www.researchprotocols.org/2021/11/e32285 UR - http://dx.doi.org/10.2196/32285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678752 ID - info:doi/10.2196/32285 ER - TY - JOUR AU - Schopow, Nikolas AU - Osterhoff, Georg AU - von Dercks, Nikolaus AU - Girrbach, Felix AU - Josten, Christoph AU - Stehr, Sebastian AU - Hepp, Pierre PY - 2021/11/18 TI - Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review JO - JMIR Public Health Surveill SP - e33509 VL - 7 IS - 11 KW - telemedical consultation KW - patient allocation KW - algorithm-based treatment KW - telemedicine KW - telehealth KW - consultation KW - allocation KW - algorithm KW - treatment KW - COVID-19 KW - coordination KW - Germany KW - economic KW - review KW - establishment KW - management N2 - 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. UR - https://publichealth.jmir.org/2021/11/e33509 UR - http://dx.doi.org/10.2196/33509 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623955 ID - info:doi/10.2196/33509 ER - TY - JOUR AU - Shah, Surbhi AU - Switzer, Sean AU - Shippee, D. Nathan AU - Wogensen, Pamela AU - Kosednar, Kathryn AU - Jones, Emma AU - Pestka, L. Deborah AU - Badlani, Sameer AU - Butler, Mary AU - Wagner, Brittin AU - White, Katie AU - Rhein, Joshua AU - Benson, Bradley AU - Reding, Mark AU - Usher, Michael AU - Melton, B. Genevieve AU - Tignanelli, James Christopher PY - 2021/11/18 TI - 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 JO - JMIR Med Inform SP - e30743 VL - 9 IS - 11 KW - COVID-19 KW - anticoagulation KW - clinical practice guideline KW - evidence-based practice KW - clinical decision support KW - implementation science KW - RE-AIM N2 - 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. UR - https://medinform.jmir.org/2021/11/e30743 UR - http://dx.doi.org/10.2196/30743 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550900 ID - info:doi/10.2196/30743 ER - TY - JOUR AU - Hueniken, Katrina AU - Somé, Habib Nibene AU - Abdelhack, Mohamed AU - Taylor, Graham AU - Elton Marshall, Tara AU - Wickens, M. Christine AU - Hamilton, A. Hayley AU - Wells, Samantha AU - Felsky, Daniel PY - 2021/11/17 TI - Machine Learning?Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study JO - JMIR Ment Health SP - e32876 VL - 8 IS - 11 KW - mental health KW - machine learning KW - COVID-19 KW - emotional distress KW - emotion KW - distress KW - prediction KW - model KW - anxiety KW - depression KW - symptom KW - cross-sectional KW - survey N2 - 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. UR - https://mental.jmir.org/2021/11/e32876 UR - http://dx.doi.org/10.2196/32876 UR - http://www.ncbi.nlm.nih.gov/pubmed/34705663 ID - info:doi/10.2196/32876 ER - TY - JOUR AU - Muric, Goran AU - Wu, Yusong AU - Ferrara, Emilio PY - 2021/11/17 TI - COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies JO - JMIR Public Health Surveill SP - e30642 VL - 7 IS - 11 KW - vaccine hesitancy KW - COVID-19 vaccines KW - dataset KW - COVID-19 KW - SARS-CoV-2 KW - social media KW - network analysis KW - hesitancy KW - vaccine KW - Twitter KW - misinformation KW - conspiracy KW - trust KW - public health KW - utilization N2 - 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. UR - https://publichealth.jmir.org/2021/11/e30642 UR - http://dx.doi.org/10.2196/30642 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653016 ID - info:doi/10.2196/30642 ER - TY - JOUR AU - Oyibo, Kiemute AU - Morita, Pelegrini Plinio PY - 2021/11/16 TI - Designing Better Exposure Notification Apps: The Role of Persuasive Design JO - JMIR Public Health Surveill SP - e28956 VL - 7 IS - 11 KW - contact tracing app KW - exposure notification app KW - COVID Alert KW - COVID-19 KW - persuasive technology KW - behavior change N2 - 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. UR - https://publichealth.jmir.org/2021/11/e28956 UR - http://dx.doi.org/10.2196/28956 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783673 ID - info:doi/10.2196/28956 ER - TY - JOUR AU - Chong, Chun Ka AU - Jia, Katherine AU - Lee, Shan Shui AU - Hung, Tim Chi AU - Wong, Sze Ngai AU - Lai, Tsun Francisco Tsz AU - Chau, Nancy AU - Yam, Kwan Carrie Ho AU - Chow, Yu Tsz AU - Wei, Yuchen AU - Guo, Zihao AU - Yeoh, Kiong Eng PY - 2021/11/16 TI - Characterization of Unlinked Cases of COVID-19 and Implications for Contact Tracing Measures: Retrospective Analysis of Surveillance Data JO - JMIR Public Health Surveill SP - e30968 VL - 7 IS - 11 KW - COVID-19 KW - contact tracing KW - unlinked KW - superspreading KW - dispersion KW - surveillance KW - monitoring KW - digital health KW - testing KW - transmission KW - epidemiology KW - outbreak KW - spread N2 - 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. UR - https://publichealth.jmir.org/2021/11/e30968 UR - http://dx.doi.org/10.2196/30968 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591778 ID - info:doi/10.2196/30968 ER - TY - JOUR AU - Kasturi, N. Suranga AU - Park, Jeremy AU - Wild, David AU - Khan, Babar AU - Haggstrom, A. David AU - Grannis, Shaun PY - 2021/11/15 TI - Predicting COVID-19?Related Health Care Resource Utilization Across a Statewide Patient Population: Model Development Study JO - J Med Internet Res SP - e31337 VL - 23 IS - 11 KW - COVID-19 KW - machine learning KW - population health KW - health care utilization KW - health disparities KW - health information KW - epidemiology KW - public health KW - digital health KW - health data KW - pandemic KW - decision models KW - health informatics KW - healthcare resources N2 - 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. UR - https://www.jmir.org/2021/11/e31337 UR - http://dx.doi.org/10.2196/31337 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581671 ID - info:doi/10.2196/31337 ER - TY - JOUR AU - Wood, M. Sarah AU - Pickel, Julia AU - Phillips, W. Alexis AU - Baber, Kari AU - Chuo, John AU - Maleki, Pegah AU - Faust, L. Haley AU - Petsis, Danielle AU - Apple, E. Danielle AU - Dowshen, Nadia AU - Schwartz, A. Lisa PY - 2021/11/15 TI - Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences JO - JMIR Pediatr Parent SP - e32708 VL - 4 IS - 4 KW - telehealth KW - telemedicine KW - adolescent KW - COVID-19 KW - acceptability KW - feasibility KW - young adult KW - teenager KW - cross-sectional KW - patient experience KW - experience KW - efficiency KW - equity KW - survey N2 - Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents? concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. UR - https://pediatrics.jmir.org/2021/4/e32708 UR - http://dx.doi.org/10.2196/32708 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779782 ID - info:doi/10.2196/32708 ER - TY - JOUR AU - Murtas, Rossella AU - Morici, Nuccia AU - Cogliati, Chiara AU - Puoti, Massimo AU - Omazzi, Barbara AU - Bergamaschi, Walter AU - Voza, Antonio AU - Rovere Querini, Patrizia AU - Stefanini, Giulio AU - Manfredi, Grazia Maria AU - Zocchi, Teresa Maria AU - Mangiagalli, Andrea AU - Brambilla, Vittoria Carla AU - Bosio, Marco AU - Corradin, Matteo AU - Cortellaro, Francesca AU - Trivelli, Marco AU - Savonitto, Stefano AU - Russo, Giampiero Antonio PY - 2021/11/15 TI - Algorithm for Individual Prediction of COVID-19?Related Hospitalization Based on Symptoms: Development and Implementation Study JO - JMIR Public Health Surveill SP - e29504 VL - 7 IS - 11 KW - COVID-19 KW - severe outcome KW - prediction KW - monitoring system KW - symptoms KW - risk prediction KW - risk KW - algorithms KW - prediction models KW - pandemic KW - digital data KW - health records N2 - 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. UR - https://publichealth.jmir.org/2021/11/e29504 UR - http://dx.doi.org/10.2196/29504 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543227 ID - info:doi/10.2196/29504 ER - TY - JOUR AU - An, Lawrence AU - Russell, M. Daniel AU - Mihalcea, Rada AU - Bacon, Elizabeth AU - Huffman, Scott AU - Resnicow, Ken PY - 2021/11/12 TI - Online Search Behavior Related to COVID-19 Vaccines: Infodemiology Study JO - JMIR Infodemiology SP - e32127 VL - 1 IS - 1 KW - online health information KW - behavior KW - search KW - COVID-19 KW - vaccine KW - infodemiology KW - internet KW - trend KW - public health KW - awareness KW - concern KW - interest KW - public KW - misinformation KW - safety KW - side effect KW - availability N2 - Background: Vaccination against COVID-19 is an important public health strategy to address the ongoing pandemic. Examination of online search behavior related to COVID-19 vaccines can provide insights into the public's awareness, concerns, and interest regarding COVID-19 vaccination. Objective: The aim of this study is to describe online search behavior related to COVID-19 vaccines during the start of public vaccination efforts in the United States. Methods: We examined Google Trends data from January 1, 2021, through March 16, 2021, to determine the relative search volume for vaccine-related searches on the internet. We also examined search query log data for COVID-19 vaccine-related searches and identified 5 categories of searches: (1) general or other information, (2) vaccine availability, (3) vaccine manufacturer, (4) vaccine side-effects and safety, and (5) vaccine myths and conspiracy beliefs. In this paper, we report on the proportion and trends for these different categories of vaccine-related searches. Results: In the first quarter of 2021, the proportion of all web-based search queries related to COVID-19 vaccines increased from approximately 10% to nearly 50% of all COVID-19?related queries (P<.001). A majority of COVID-19 vaccine queries addressed vaccine availability, and there was a particularly notable increase in the proportion of queries that included the name of a specific pharmacy (from 6% to 27%; P=.01). Queries related to vaccine safety and side-effects (<5% of total queries) or specific vaccine-related myths (<1% of total queries) were uncommon, and the relative frequency of both types of searches decreased during the study period. Conclusions: This study demonstrates an increase in online search behavior related to COVID-19 vaccination in early 2021 along with an increase in the proportion of searches related to vaccine availability at pharmacies. These findings are consistent with an increase in public interest and intention to get vaccinated during the initial phase of public COVID-19 vaccination efforts. UR - https://infodemiology.jmir.org/2021/1/e32127 UR - http://dx.doi.org/10.2196/32127 UR - http://www.ncbi.nlm.nih.gov/pubmed/34841200 ID - info:doi/10.2196/32127 ER - TY - JOUR AU - Lee, Kyu Jeong AU - Lin, Lavinia AU - Kang, Hyunjin PY - 2021/11/12 TI - The Influence of Normative Perceptions on the Uptake of the COVID-19 TraceTogether Digital Contact Tracing System: Cross-sectional Study JO - JMIR Public Health Surveill SP - e30462 VL - 7 IS - 11 KW - COVID-19 KW - social norms KW - TraceTogether KW - Singapore KW - contact tracing KW - mobile app KW - token N2 - 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 ?=0.31, SE=0.05; P<.001) and injunctive norms (unstandardized regression coefficient ?=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. UR - https://publichealth.jmir.org/2021/11/e30462 UR - http://dx.doi.org/10.2196/30462 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623956 ID - info:doi/10.2196/30462 ER - TY - JOUR AU - Lee, Bohee AU - Ibrahim, Aishah Siti AU - Zhang, Tiying PY - 2021/11/11 TI - Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis JO - JMIR Mhealth Uhealth SP - e32093 VL - 9 IS - 11 KW - mobile apps KW - applications KW - eHealth KW - mHealth KW - mobile health KW - digital health KW - telemedicine KW - telehealth KW - COVID-19 KW - coronavirus KW - pandemic KW - public health KW - health policy N2 - 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. UR - https://mhealth.jmir.org/2021/11/e32093 UR - http://dx.doi.org/10.2196/32093 UR - http://www.ncbi.nlm.nih.gov/pubmed/34748515 ID - info:doi/10.2196/32093 ER - TY - JOUR AU - Widmann, N. Catherine AU - Wieberneit, Michelle AU - Bieler, Luzie AU - Bernsen, Sarah AU - Gräfenkämper, Robin AU - Brosseron, Frederic AU - Schmeel, Carsten AU - Tacik, Pawel AU - Skowasch, Dirk AU - Radbruch, Alexander AU - Heneka, T. Michael PY - 2021/11/11 TI - Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study JO - JMIR Res Protoc SP - e30259 VL - 10 IS - 11 KW - SARS-CoV-2 KW - COVID-19 KW - postacute COVID-19 syndrome KW - cognition KW - neuropsychology KW - lung KW - magnetic resonance imaging N2 - 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 UR - https://www.researchprotocols.org/2021/11/e30259 UR - http://dx.doi.org/10.2196/30259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559059 ID - info:doi/10.2196/30259 ER - TY - JOUR AU - Valera, Pamela AU - Carmona, David AU - Malarkey, Sarah AU - Sinangil, Noah AU - Owens, Madelyn AU - Lefebre, Asia PY - 2021/11/10 TI - Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example JO - JMIR Form Res SP - e32591 VL - 5 IS - 11 KW - Alabama KW - correctional facilities KW - COVID-19 KW - online health reviews KW - review KW - monitoring KW - public health KW - policy KW - response KW - prison KW - United States KW - case study KW - formative KW - feasibility KW - acceptability KW - survey N2 - 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. UR - https://formative.jmir.org/2021/11/e32591 UR - http://dx.doi.org/10.2196/32591 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609313 ID - info:doi/10.2196/32591 ER - TY - JOUR AU - Zhang, Zizheng AU - Feng, Guanrui AU - Xu, Jiahong AU - Zhang, Yimin AU - Li, Jinhui AU - Huang, Jian AU - Akinwunmi, Babatunde AU - Zhang, P. Casper J. AU - Ming, Wai-kit PY - 2021/11/9 TI - The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study JO - JMIR Public Health Surveill SP - e32936 VL - 7 IS - 11 KW - COVID-19 KW - vaccine KW - hesitancy KW - social media KW - China KW - sentiment analysis KW - infoveillance KW - public health KW - surveillance KW - Weibo KW - data mining KW - sentiment KW - attitude N2 - 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. UR - https://publichealth.jmir.org/2021/11/e32936 UR - http://dx.doi.org/10.2196/32936 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591782 ID - info:doi/10.2196/32936 ER - TY - JOUR AU - Singh, Akansha AU - Lai, Yan Angel Hor AU - Wang, Jingxuan AU - Asim, Saba AU - Chan, Shing-Fong Paul AU - Wang, Zixin AU - Yeoh, Kiong Eng PY - 2021/11/9 TI - Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e31707 VL - 7 IS - 11 KW - COVID-19 KW - South Asian ethnic minorities KW - COVID-19 vaccination KW - uptake KW - cultural and religious reasons for vaccine hesitancy KW - perceptions KW - information exposure on social media KW - influence of peers KW - socioecological model KW - Hong Kong N2 - 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. UR - https://publichealth.jmir.org/2021/11/e31707 UR - http://dx.doi.org/10.2196/31707 UR - http://www.ncbi.nlm.nih.gov/pubmed/34653014 ID - info:doi/10.2196/31707 ER - TY - JOUR AU - Monnig, A. Mollie AU - Treloar Padovano, Hayley AU - Sokolovsky, W. Alexander AU - DeCost, Grace AU - Aston, R. Elizabeth AU - Haass-Koffler, L. Carolina AU - Szapary, Claire AU - Moyo, Patience AU - Avila, C. Jaqueline AU - Tidey, W. Jennifer AU - Monti, M. Peter AU - Ahluwalia, S. Jasjit PY - 2021/11/9 TI - Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey JO - JMIR Public Health Surveill SP - e29319 VL - 7 IS - 11 KW - SARS-CoV-2 KW - novel coronavirus KW - COVID-19 KW - alcohol use KW - alcohol drinking KW - opioid use KW - stimulant use KW - nicotine KW - smoking KW - survey KW - substance abuse KW - addiction KW - mental health KW - pandemic N2 - 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. UR - https://publichealth.jmir.org/2021/11/e29319 UR - http://dx.doi.org/10.2196/29319 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591780 ID - info:doi/10.2196/29319 ER - TY - JOUR AU - Loveys, Kate AU - Sagar, Mark AU - Pickering, Isabella AU - Broadbent, Elizabeth PY - 2021/11/8 TI - 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 JO - JMIR Ment Health SP - e31586 VL - 8 IS - 11 KW - COVID-19 KW - loneliness KW - stress KW - well-being KW - eHealth KW - digital human KW - conversational agent KW - older adults KW - chronic illness N2 - 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 UR - https://mental.jmir.org/2021/11/e31586 UR - http://dx.doi.org/10.2196/31586 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596572 ID - info:doi/10.2196/31586 ER - TY - JOUR AU - Bhalla, Sameer AU - Sharma, Brihat AU - Smith, Dale AU - Boley, Randy AU - McCluskey, Connor AU - Ilyas, Yousaf AU - Afshar, Majid AU - Balk, Robert AU - Karnik, Niranjan AU - Keshavarzian, Ali PY - 2021/11/5 TI - Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study JO - JMIR Public Health Surveill SP - e33022 VL - 7 IS - 11 KW - unhealthy alcohol use KW - COVID-19 KW - SARS-CoV-2 KW - acute respiratory distress syndrome KW - substance misuse KW - mechanical ventilation KW - substance use N2 - 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. UR - https://publichealth.jmir.org/2021/11/e33022 UR - http://dx.doi.org/10.2196/33022 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665758 ID - info:doi/10.2196/33022 ER - TY - JOUR AU - Ennab, Farah AU - ElSaban, Mariam AU - Khalaf, Eman AU - Tabatabaei, Hanieh AU - Khamis, Hassan Amar AU - Devi, Radha Bindu AU - Hanif, Kashif AU - Elhassan, Hiba AU - Saravanan, Ketharanathan AU - Cremonesini, David AU - Popatia, Rizwana AU - Malik, Zainab AU - Ho, B. Samuel AU - Abusamra, Rania PY - 2021/11/5 TI - Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study JO - JMIR Pediatr Parent SP - e29049 VL - 4 IS - 4 KW - pediatrics KW - children KW - COVID-19 KW - SARS-CoV-2 KW - United Arab Emirates KW - viral shedding KW - pandemic KW - treatment KW - outcomes KW - clinical KW - public heath N2 - 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. UR - https://pediatrics.jmir.org/2021/4/e29049 UR - http://dx.doi.org/10.2196/29049 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643535 ID - info:doi/10.2196/29049 ER - TY - JOUR AU - Joshi, Megha AU - Shah, Aangi AU - Trivedi, Bhavi AU - Trivedi, Jaahnavee AU - Patel, Viral AU - Parghi, Devam AU - Thakkar, Manini AU - Barot, Kanan AU - Jadawala, Vivek PY - 2021/11/5 TI - Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study JO - JMIR Res Protoc SP - e29896 VL - 10 IS - 11 KW - COVID-19 KW - mental health KW - India KW - lockdown KW - isolation KW - social isolation KW - behavior KW - psychology KW - psychosocial effects N2 - 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 UR - https://www.researchprotocols.org/2021/11/e29896 UR - http://dx.doi.org/10.2196/29896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519652 ID - info:doi/10.2196/29896 ER - TY - JOUR AU - Rabbani, Golam Md AU - Akter, Orin AU - Hasan, Zahid Md AU - Samad, Nandeeta AU - Mahmood, Shaila Shehrin AU - Joarder, Taufique PY - 2021/11/5 TI - COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey JO - JMIR Form Res SP - e28344 VL - 5 IS - 11 KW - COVID-19 KW - knowledge KW - attitude KW - practice KW - risk communication and community engagement KW - social and behavior change communication KW - Bangladesh KW - risk KW - pandemic KW - risk communication N2 - 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. UR - https://formative.jmir.org/2021/11/e28344 UR - http://dx.doi.org/10.2196/28344 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519660 ID - info:doi/10.2196/28344 ER - TY - JOUR AU - Claesdotter-Knutsson, Emma AU - Håkansson, Anders PY - 2021/11/3 TI - Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Serious Games SP - e30747 VL - 9 IS - 4 KW - COVID-19 KW - pandemic KW - web-based gambling KW - psychological distress KW - gender N2 - 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. UR - https://games.jmir.org/2021/4/e30747 UR - http://dx.doi.org/10.2196/30747 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730540 ID - info:doi/10.2196/30747 ER - TY - JOUR AU - Liew, Ming Tau AU - Lee, Sin Cia PY - 2021/11/3 TI - Examining the Utility of Social Media in COVID-19 Vaccination: Unsupervised Learning of 672,133 Twitter Posts JO - JMIR Public Health Surveill SP - e29789 VL - 7 IS - 11 KW - social media KW - COVID-19 KW - vaccine hesitancy KW - natural language processing KW - machine learning KW - infodemiology N2 - 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. UR - https://publichealth.jmir.org/2021/11/e29789 UR - http://dx.doi.org/10.2196/29789 UR - http://www.ncbi.nlm.nih.gov/pubmed/34583316 ID - info:doi/10.2196/29789 ER - TY - JOUR AU - Calvo-Valderrama, Gabriela Maria AU - Marroquín-Rivera, Arturo AU - Burn, Erin AU - Ospina-Pinillos, Laura AU - Bird, Victoria AU - Gómez-Restrepo, Carlos PY - 2021/11/3 TI - Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study JO - JMIR Form Res SP - e30293 VL - 5 IS - 11 KW - pandemic KW - COVID-19 KW - online focus groups KW - qualitative research KW - technology KW - adolescents KW - public health N2 - 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. UR - https://formative.jmir.org/2021/11/e30293 UR - http://dx.doi.org/10.2196/30293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34637395 ID - info:doi/10.2196/30293 ER - TY - JOUR AU - Chan, Lilian AU - El-Haddad, Nouhad AU - Freeman, Becky AU - O'Hara, J. Blythe AU - Woodland, Lisa AU - Harris-Roxas, Ben PY - 2021/11/3 TI - A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic JO - JMIR Form Res SP - e28929 VL - 5 IS - 11 KW - data collection KW - mobile phone KW - short message service KW - tobacco KW - COVID-19 KW - survey UR - https://formative.jmir.org/2021/11/e28929 UR - http://dx.doi.org/10.2196/28929 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612824 ID - info:doi/10.2196/28929 ER - TY - JOUR AU - Blanco, Ivan AU - Boemo, Teresa AU - Sanchez-Lopez, Alvaro PY - 2021/11/2 TI - An Online Assessment to Evaluate the Role of Cognitive Biases and Emotion Regulation Strategies for Mental Health During the COVID-19 Lockdown of 2020: Structural Equation Modeling Study JO - JMIR Ment Health SP - e30961 VL - 8 IS - 11 KW - COVID-19 KW - emotion regulation KW - cognitive biases KW - psychological adjustment KW - resilience N2 - Background: Extant research supports causal roles of cognitive biases in stress regulation under experimental conditions. However, their contribution to psychological adjustment in the face of ecological major stressors has been largely unstudied. Objective: We developed a novel online method for the ecological examination of attention and interpretation biases during major stress (ie, the COVID-19 lockdown in March/April 2020) and tested their relations with the use of emotion regulation strategies (ie, reappraisal and rumination) to account for individual differences in psychological adjustment to major COVID-19?related stressors (ie, low depression and anxiety, and high well-being and resilience). Methods: Participants completed an online protocol evaluating the psychological impact of COVID-19?related stressors and the use of emotion regulation strategies in response to them, during the initial weeks of the lockdown of March/April 2020. They also completed a new online cognitive task designed to remotely assess attention and interpretation biases for negative information. The psychometric properties of the online cognitive bias assessments were very good, supporting their feasibility for ecological evaluation. Results: Structural equation models showed that negative interpretation bias was a direct predictor of worst psychological adjustment (higher depression and anxiety, and lower well-being and resilience; ?29=7.57; root mean square error of approximation=0.000). Further, rumination mediated the influence of interpretation bias in anxiety (P=.045; 95% CI 0.03-3.25) and resilience (P=.001; 95% CI ?6.34 to ?1.65), whereas reappraisal acted as a mediator of the influence of both attention (P=.047; 95% CI ?38.71 to ?0.16) and interpretation biases (P=.04; 95% CI ?5.25 to ?0.12) in well-being. Conclusions: This research highlights the relevance of individual processes of attention and interpretation during periods of adversity and identifies modifiable protective factors that can be targeted through online interventions. UR - https://mental.jmir.org/2021/11/e30961 UR - http://dx.doi.org/10.2196/30961 UR - http://www.ncbi.nlm.nih.gov/pubmed/34517337 ID - info:doi/10.2196/30961 ER - TY - JOUR AU - Kim, Jeongmin AU - Lim, Hakyung AU - Ahn, Jae-Hyeon AU - Lee, Hwa Kyoung AU - Lee, Suk Kwang AU - Koo, Chul Kyo PY - 2021/11/2 TI - 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 JO - JMIR Med Inform SP - e32726 VL - 9 IS - 11 KW - COVID-19 KW - decision support techniques KW - machine learning KW - prediction KW - triage N2 - 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. UR - https://medinform.jmir.org/2021/11/e32726 UR - http://dx.doi.org/10.2196/32726 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609319 ID - info:doi/10.2196/32726 ER - TY - JOUR AU - Perrins, Genevieve AU - Ferdous, Tabassum AU - Hay, Dawn AU - Harreveld, Bobby AU - Reid-Searl, Kerry PY - 2021/11/2 TI - 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 JO - JMIR Form Res SP - e26136 VL - 5 IS - 11 KW - health literacy KW - cultural and linguistic diversity KW - COVID-19 KW - health care barriers KW - hard-to-reach research participants KW - regional Australia KW - health literacy profiles KW - literacy N2 - 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. UR - https://formative.jmir.org/2021/11/e26136 UR - http://dx.doi.org/10.2196/26136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581673 ID - info:doi/10.2196/26136 ER - TY - JOUR AU - Cher, Y. Benjamin A. AU - Wilson, A. Eric AU - Pinsky, M. Alexa AU - Townshend, F. Ryan AU - Wolski, V. Ann AU - Broderick, Michael AU - Milen, M. Allison AU - Lau, Audrey AU - Singh, Amrit AU - Cinti, K. Sandro AU - Engelke, G. Carl AU - Saha, K. Anjan PY - 2021/11/1 TI - Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study JO - J Med Internet Res SP - e28105 VL - 23 IS - 11 KW - triage KW - telephone KW - COVID-19 KW - utility KW - telemedicine KW - telehealth KW - patient information KW - concern KW - implementation KW - innovation KW - hospital N2 - 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. UR - https://www.jmir.org/2021/11/e28105 UR - http://dx.doi.org/10.2196/28105 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559669 ID - info:doi/10.2196/28105 ER - TY - JOUR AU - Aguilera, Adrian AU - Hernandez-Ramos, Rosa AU - Haro-Ramos, Y. Alein AU - Boone, Elizabeth Claire AU - Luo, Christina Tiffany AU - Xu, Jing AU - Chakraborty, Bibhas AU - Karr, Chris AU - Darrow, Sabrina AU - Figueroa, Astrid Caroline PY - 2021/11/1 TI - A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study JO - JMIR Ment Health SP - e25298 VL - 8 IS - 11 KW - mobile health KW - COVID-19 KW - text messaging KW - cognitive behavioral therapy KW - anxiety KW - depression KW - microrandomized trials KW - mHealth KW - intervention KW - mental health KW - SMS N2 - Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19?related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants? anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of ?1.72 (95% CI ?2.35 to ?1.09) in PHQ-8 scores and ?0.48 (95% CI ?0.71 to ?0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 UR - https://mental.jmir.org/2021/11/e25298 UR - http://dx.doi.org/10.2196/25298 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543230 ID - info:doi/10.2196/25298 ER - TY - JOUR AU - Spitale, Giovanni AU - Merten, Sonja AU - Jafflin, Kristen AU - Schwind, Bettina AU - Kaiser-Grolimund, Andrea AU - Biller-Andorno, Nikola PY - 2021/11/1 TI - 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 JO - JMIR Res Protoc SP - e33653 VL - 10 IS - 11 KW - disease outbreaks KW - coronavirus KW - COVID-19 surveys KW - COVID-19 questionnaires KW - qualitative methods KW - health literacy KW - policy making KW - risk and crisis communication KW - COVID-19 N2 - 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 UR - https://www.researchprotocols.org/2021/11/e33653 UR - http://dx.doi.org/10.2196/33653 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612823 ID - info:doi/10.2196/33653 ER - TY - JOUR AU - Baker, Venetia AU - Arnold, Georgia AU - Piot, Sara AU - Thwala, Lesedi AU - Glynn, Judith AU - Hargreaves, James AU - Birdthistle, Isolde PY - 2021/10/29 TI - Young Adults? Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement JO - JMIR Form Res SP - e30449 VL - 5 IS - 10 KW - COVID-19 KW - adolescents KW - young people KW - social media KW - edutainment N2 - 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. UR - https://formative.jmir.org/2021/10/e30449 UR - http://dx.doi.org/10.2196/30449 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596568 ID - info:doi/10.2196/30449 ER - TY - JOUR AU - Shelby, Tyler AU - Caruthers, Tyler AU - Kanner, Y. Oren AU - Schneider, Rebecca AU - Lipnickas, Dana AU - Grau, E. Lauretta AU - Manohar, Rajit AU - Niccolai, Linda PY - 2021/10/28 TI - Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study JO - JMIR Form Res SP - e31086 VL - 5 IS - 10 KW - mHealth KW - digital contact tracing KW - Bluetooth KW - COVID-19 KW - mixed methods N2 - 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. UR - https://formative.jmir.org/2021/10/e31086 UR - http://dx.doi.org/10.2196/31086 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586078 ID - info:doi/10.2196/31086 ER - TY - JOUR AU - Xiao, Jin AU - Meyerowitz, Cyril AU - Ragusa, Patricia AU - Funkhouser, Kimberly AU - Lischka, R. Tamara AU - Mendez Chagoya, Alberto Luis AU - Al Jallad, Nisreen AU - Wu, Tong Tong AU - Fiscella, Kevin AU - Ivie, Eden AU - Strange, Michelle AU - Collins, Jamie AU - Kopycka-Kedzierawski, T. Dorota AU - PY - 2021/10/26 TI - 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 JO - JMIR Res Protoc SP - e32345 VL - 10 IS - 10 KW - teledentistry KW - mDentistry KW - oral diseases KW - virtual visit KW - intraoral camera KW - pandemic response KW - COVID-19 KW - mHealth N2 - 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 UR - https://www.researchprotocols.org/2021/10/e32345 UR - http://dx.doi.org/10.2196/32345 UR - http://www.ncbi.nlm.nih.gov/pubmed/34597259 ID - info:doi/10.2196/32345 ER - TY - JOUR AU - Ainley, Esther AU - Witwicki, Cara AU - Tallett, Amy AU - Graham, Chris PY - 2021/10/25 TI - Using Twitter Comments to Understand People?s Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis JO - J Med Internet Res SP - e31101 VL - 23 IS - 10 KW - patient experience KW - COVID-19 KW - remote health care KW - phone consultation KW - video consultation KW - Twitter KW - sentiment analysis KW - social media KW - digital health KW - public health KW - public opinion N2 - 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. UR - https://www.jmir.org/2021/10/e31101 UR - http://dx.doi.org/10.2196/31101 UR - http://www.ncbi.nlm.nih.gov/pubmed/34469327 ID - info:doi/10.2196/31101 ER - TY - JOUR AU - Jeyakumar, Tharshini AU - Ambata-Villanueva, Sharon AU - McClure, Sarah AU - Henderson, Carolyn AU - Wiljer, David PY - 2021/10/22 TI - Best Practices for the Implementation and Sustainment of Virtual Health Information System Training: Qualitative Study JO - JMIR Med Educ SP - e30613 VL - 7 IS - 4 KW - training KW - health care providers KW - educational technology KW - patient care KW - COVID-19 KW - development KW - practice KW - best practice KW - pedagogy KW - teaching KW - implementation KW - medical education KW - online education KW - care delivery KW - perception KW - effectiveness N2 - 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. UR - https://mededu.jmir.org/2021/4/e30613 UR - http://dx.doi.org/10.2196/30613 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449402 ID - info:doi/10.2196/30613 ER - TY - JOUR AU - Ahn, Hee Myung AU - Shin, Yong-Wook AU - Suh, Sooyeon AU - Kim, Hye Jeong AU - Kim, Jung Hwa AU - Lee, Kyoung-Uk AU - Chung, Seockhoon PY - 2021/10/22 TI - High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study JO - JMIR Public Health Surveill SP - e25489 VL - 7 IS - 10 KW - COVID-19 KW - health personnel KW - occupational stress KW - anxiety KW - depression KW - stress KW - mental health KW - South Korea KW - health care worker KW - assessment KW - intervention N2 - 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. UR - https://publichealth.jmir.org/2021/10/e25489 UR - http://dx.doi.org/10.2196/25489 UR - http://www.ncbi.nlm.nih.gov/pubmed/34478401 ID - info:doi/10.2196/25489 ER - TY - JOUR AU - Corrêa, Pires Roberta AU - Castro, Carla Helena AU - Quaresma, Salomão Bruna Maria Castro AU - Stephens, Soares Paulo Roberto AU - Araujo-Jorge, Cremonini Tania AU - Ferreira, Rodrigues Roberto PY - 2021/10/22 TI - Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey JO - JMIR Form Res SP - e28088 VL - 5 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - health professionals KW - Brazil KW - pandemic KW - mental health KW - health planning N2 - 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. UR - https://formative.jmir.org/2021/10/e28088 UR - http://dx.doi.org/10.2196/28088 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519656 ID - info:doi/10.2196/28088 ER - TY - JOUR AU - Monselise, Michal AU - Chang, Chia-Hsuan AU - Ferreira, Gustavo AU - Yang, Rita AU - Yang, C. Christopher PY - 2021/10/21 TI - Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis JO - J Med Internet Res SP - e30765 VL - 23 IS - 10 KW - health care informatics KW - topic detection KW - unsupervised sentiment analysis KW - COVID-19 KW - vaccine hesitancy KW - sentiment KW - concern KW - vaccine KW - social media KW - trend KW - trust KW - health information KW - Twitter KW - discussion KW - communication KW - hesitancy KW - emotion KW - fear N2 - Background: As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter. Objective: The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media. Methods: To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity. Results: After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy. Conclusions: This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust. UR - https://www.jmir.org/2021/10/e30765 UR - http://dx.doi.org/10.2196/30765 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581682 ID - info:doi/10.2196/30765 ER - TY - JOUR AU - Sahoo, Prasad Durgesh AU - Singh, Kumar Arvind AU - Sahu, Prasad Dinesh AU - Pradhan, Kumar Somen AU - Patro, Kumar Binod AU - Batmanabane, Gitanjali AU - Mishra, Baijayantimala AU - Behera, Bijayini AU - Das, Ambarish AU - Dora, Susmita G. AU - Anand, L. AU - Azhar, M. S. AU - Nair, Jyolsna AU - Panigrahi, Sasmita AU - Akshaya, R. AU - Sahoo, Kumar Bimal AU - Sahu, Subhakanta AU - Sahoo, Suchismita PY - 2021/10/21 TI - Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study JO - JMIR Form Res SP - e28519 VL - 5 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - risk categorization KW - health care personnel KW - virus transmission KW - contact tracing KW - pandemic KW - risk stratification N2 - 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. UR - https://formative.jmir.org/2021/10/e28519 UR - http://dx.doi.org/10.2196/28519 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596569 ID - info:doi/10.2196/28519 ER - TY - JOUR AU - Aguiar, A. AU - Pinto, M. AU - Duarte, R. PY - 2021/10/19 TI - Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study JO - JMIR Res Protoc SP - e28071 VL - 10 IS - 10 KW - COVID-19 KW - public health KW - mental health KW - study protocol KW - psychological impact KW - anxiety KW - depression KW - grief KW - behavior change N2 - 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 UR - https://www.researchprotocols.org/2021/10/e28071 UR - http://dx.doi.org/10.2196/28071 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516387 ID - info:doi/10.2196/28071 ER - TY - JOUR AU - Luu, S. Hung AU - Filkins, M. Laura AU - Park, Y. Jason AU - Rakheja, Dinesh AU - Tweed, Jefferson AU - Menzies, Christopher AU - Wang, J. Vincent AU - Mittal, Vineeta AU - Lehmann, U. Christoph AU - Sebert, E. Michael PY - 2021/10/18 TI - Harnessing the Electronic Health Record and Computerized Provider Order Entry Data for Resource Management During the COVID-19 Pandemic: Development of a Decision Tree JO - JMIR Med Inform SP - e32303 VL - 9 IS - 10 KW - COVID-19 KW - computerized provider order entry KW - electronic health record KW - resource utilization KW - personal protective equipment KW - SARS-CoV-2 testing KW - clinical decision support N2 - 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. UR - https://medinform.jmir.org/2021/10/e32303 UR - http://dx.doi.org/10.2196/32303 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546942 ID - info:doi/10.2196/32303 ER - TY - JOUR AU - Benis, Arriel AU - Chatsubi, Anat AU - Levner, Eugene AU - Ashkenazi, Shai PY - 2021/10/14 TI - Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence?Based Infodemiology Study JO - JMIR Infodemiology SP - e31983 VL - 1 IS - 1 KW - influenza KW - vaccines KW - vaccination KW - social media KW - social networks KW - health communication KW - artificial intelligence KW - machine learning KW - text mining KW - infodemiology KW - COVID-19 KW - SARS-CoV-2 N2 - 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. UR - https://infodemiology.jmir.org/2021/1/e31983 UR - http://dx.doi.org/10.2196/31983 UR - http://www.ncbi.nlm.nih.gov/pubmed/34693212 ID - info:doi/10.2196/31983 ER - TY - JOUR AU - Marshall, Gard Emily AU - Breton, Mylaine AU - Cossette, Benoit AU - Isenor, Jennifer AU - Mathews, Maria AU - Ayn, Caitlyn AU - Smithman, Ann Mélanie AU - Stock, David AU - Frymire, Eliot AU - Edwards, Lynn AU - Green, Michael PY - 2021/10/13 TI - 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 JO - JMIR Res Protoc SP - e29984 VL - 10 IS - 10 KW - primary care KW - health services research KW - health policy KW - mixed methods research KW - COVID-19 KW - protocol KW - policy KW - longitudinal KW - coordination KW - access KW - impact KW - virtual care KW - virtual health KW - Canada N2 - 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 UR - https://www.researchprotocols.org/2021/10/e29984 UR - http://dx.doi.org/10.2196/29984 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559672 ID - info:doi/10.2196/29984 ER - TY - JOUR AU - Nakanishi, Miharu AU - Yamasaki, Syudo AU - Endo, Kaori AU - Niimura, Junko AU - Ziylan, Canan AU - Bakker, M. Ton J. E. AU - Granvik, Eva AU - Nägga, Katarina AU - Nishida, Atsushi PY - 2021/10/12 TI - 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 JO - JMIR Med Educ SP - e30652 VL - 7 IS - 4 KW - dementia KW - home care services KW - implementation science KW - nursing homes KW - web-based tool N2 - 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 (?21=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. UR - https://mededu.jmir.org/2021/4/e30652 UR - http://dx.doi.org/10.2196/30652 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543224 ID - info:doi/10.2196/30652 ER - TY - JOUR AU - Bos, C. Véronique L. L. AU - Jansen, Tessa AU - Klazinga, S. Niek AU - Kringos, S. Dionne PY - 2021/10/12 TI - Development and Actionability of the Dutch COVID-19 Dashboard: Descriptive Assessment and Expert Appraisal Study JO - JMIR Public Health Surveill SP - e31161 VL - 7 IS - 10 KW - COVID-19 KW - dashboard KW - performance intelligence KW - Netherlands KW - actionability KW - communication KW - government KW - pandemic KW - public health N2 - 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. UR - https://publichealth.jmir.org/2021/10/e31161 UR - http://dx.doi.org/10.2196/31161 UR - http://www.ncbi.nlm.nih.gov/pubmed/34543229 ID - info:doi/10.2196/31161 ER - TY - JOUR AU - Weber, M. Griffin AU - Zhang, G. Harrison AU - L'Yi, Sehi AU - Bonzel, Clara-Lea AU - Hong, Chuan AU - Avillach, Paul AU - Gutiérrez-Sacristán, Alba AU - Palmer, P. Nathan AU - Tan, Min Amelia Li AU - Wang, Xuan AU - Yuan, William AU - Gehlenborg, Nils AU - Alloni, Anna AU - Amendola, F. Danilo AU - Bellasi, Antonio AU - Bellazzi, Riccardo AU - Beraghi, Michele AU - Bucalo, Mauro AU - Chiovato, Luca AU - Cho, Kelly AU - Dagliati, Arianna AU - Estiri, Hossein AU - Follett, W. Robert AU - García Barrio, Noelia AU - Hanauer, A. David AU - Henderson, W. Darren AU - Ho, Yuk-Lam AU - Holmes, H. John AU - Hutch, R. Meghan AU - Kavuluru, Ramakanth AU - Kirchoff, Katie AU - Klann, G. Jeffrey AU - Krishnamurthy, K. Ashok AU - Le, T. Trang AU - Liu, Molei AU - Loh, Will Ne Hooi AU - Lozano-Zahonero, Sara AU - Luo, Yuan AU - Maidlow, Sarah AU - Makoudjou, Adeline AU - Malovini, Alberto AU - Martins, Roberto Marcelo AU - Moal, Bertrand AU - Morris, Michele AU - Mowery, L. Danielle AU - Murphy, N. Shawn AU - Neuraz, Antoine AU - Ngiam, Yuan Kee AU - Okoshi, P. Marina AU - Omenn, S. Gilbert AU - Patel, P. Lav AU - Pedrera Jiménez, Miguel AU - Prudente, A. Robson AU - Samayamuthu, Jebathilagam Malarkodi AU - Sanz Vidorreta, J. Fernando AU - Schriver, R. Emily AU - Schubert, Petra AU - Serrano Balazote, Pablo AU - Tan, WL Byorn AU - Tanni, E. Suzana AU - Tibollo, Valentina AU - Visweswaran, Shyam AU - Wagholikar, B. Kavishwar AU - Xia, Zongqi AU - Zöller, Daniela AU - AU - Kohane, S. Isaac AU - Cai, Tianxi AU - South, M. Andrew AU - Brat, A. Gabriel PY - 2021/10/11 TI - International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study JO - J Med Internet Res SP - e31400 VL - 23 IS - 10 KW - SARS-CoV-2 KW - electronic health records KW - federated study KW - retrospective cohort study KW - meta-analysis KW - COVID-19 KW - severe COVID-19 KW - laboratory trajectory N2 - 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. UR - https://www.jmir.org/2021/10/e31400 UR - http://dx.doi.org/10.2196/31400 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533459 ID - info:doi/10.2196/31400 ER - TY - JOUR AU - Lee, Won Seung AU - Kim, Young So AU - Moon, Yong Sung AU - Yoo, Kyung In AU - Yoo, Eun-Gyong AU - Eom, Hyeon Gwang AU - Kim, Jae-Min AU - Shin, Il Jae AU - Jeong, Ho Myung AU - Yang, Myung Jee AU - Yon, Keon Dong PY - 2021/10/8 TI - Statin Use and COVID-19 Infectivity and Severity in South Korea: Two Population-Based Nationwide Cohort Studies JO - JMIR Public Health Surveill SP - e29379 VL - 7 IS - 10 KW - COVID-19 KW - statin KW - susceptibility KW - severe clinical outcomes KW - length of hospital stay N2 - 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. UR - https://publichealth.jmir.org/2021/10/e29379 UR - http://dx.doi.org/10.2196/29379 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623311 ID - info:doi/10.2196/29379 ER - TY - JOUR AU - Pinilla, T. Yudi AU - Friessinger, Evelyn AU - Griesbaum, Marie Johanna AU - Berner, Lilith AU - Heinzel, Constanze AU - Elsner, Käthe AU - Fendel, Rolf AU - Held, Jana AU - Kreidenweiss, Andrea PY - 2021/10/8 TI - Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy) JO - JMIR Res Protoc SP - e27739 VL - 10 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - antibody KW - saliva KW - children KW - epidemiology N2 - 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 UR - https://www.researchprotocols.org/2021/10/e27739 UR - http://dx.doi.org/10.2196/27739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533472 ID - info:doi/10.2196/27739 ER - TY - JOUR AU - Khader, Yousef AU - Al Nsour, Mohannad PY - 2021/10/7 TI - Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis JO - JMIR Public Health Surveill SP - e32559 VL - 7 IS - 10 KW - COVID-19 KW - excess mortality KW - pandemic N2 - 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. UR - https://publichealth.jmir.org/2021/10/e32559 UR - http://dx.doi.org/10.2196/32559 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617910 ID - info:doi/10.2196/32559 ER - TY - JOUR AU - Hood, M. Anna AU - Stotesbury, Hanne AU - Murphy, Jennifer AU - Kölbel, Melanie AU - Slee, April AU - Springall, Charlie AU - Paradis, Matthew AU - Corral-Frías, Saraí Nadia AU - Reyes-Aguilar, Azalea AU - Cuellar Barboza, B. Alfredo AU - Noser, E. Amy AU - Gomes, Stacey AU - Mitchell, Monica AU - Watkins, M. Sharon AU - Butsch Kovacic, Melinda AU - Kirkham, J. Fenella AU - Crosby, E. Lori PY - 2021/10/7 TI - Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study JO - JMIR Ment Health SP - e29963 VL - 8 IS - 10 KW - COVID-19 KW - mental health KW - international KW - mitigation strategies KW - deprivation N2 - 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. UR - https://mental.jmir.org/2021/10/e29963 UR - http://dx.doi.org/10.2196/29963 UR - http://www.ncbi.nlm.nih.gov/pubmed/34357877 ID - info:doi/10.2196/29963 ER - TY - JOUR AU - Ranjan, Yatharth AU - Althobiani, Malik AU - Jacob, Joseph AU - Orini, Michele AU - Dobson, JB Richard AU - Porter, Joanna AU - Hurst, John AU - Folarin, A. Amos PY - 2021/10/7 TI - Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e28873 VL - 10 IS - 10 KW - mHealth KW - COVID-19 KW - mobile health KW - remote monitoring KW - wearables KW - internet of things KW - lung diseases KW - respiratory health KW - mental health KW - cardiopulmonary diseases N2 - 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 UR - https://www.researchprotocols.org/2021/10/e28873 UR - http://dx.doi.org/10.2196/28873 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319235 ID - info:doi/10.2196/28873 ER - TY - JOUR AU - Albouy-Llaty, Marion AU - Martin, Caroline AU - Benamouzig, Daniel AU - Bothorel, Eric AU - Munier, Gilles AU - Simonin, Catherine AU - Guéant, Jean-Louis AU - Rusch, Emmanuel PY - 2021/10/7 TI - Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France JO - J Med Internet Res SP - e27301 VL - 23 IS - 10 KW - COVID-19 pandemic KW - digital contact tracing applications KW - health inequalities KW - Europe KW - health promotion UR - https://www.jmir.org/2021/10/e27301 UR - http://dx.doi.org/10.2196/27301 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313588 ID - info:doi/10.2196/27301 ER - TY - JOUR AU - Lau, Joseph AU - Yu, Yanqiu AU - Xin, Meiqi AU - She, Rui AU - Luo, Sitong AU - Li, Lijuan AU - Wang, Suhua AU - Ma, Le AU - Tao, Fangbiao AU - Zhang, Jianxin AU - Zhao, Junfeng AU - Hu, Dongsheng AU - Li, Liping AU - Zhang, Guohua AU - Gu, Jing AU - Lin, Danhua AU - Wang, Hongmei AU - Cai, Yong AU - Wang, Zhaofen AU - You, Hua AU - Hu, Guoqing AU - PY - 2021/10/7 TI - Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e26840 VL - 7 IS - 10 KW - COVID-19 KW - health behavior KW - prevention KW - control KW - cognition KW - face mask KW - hand hygiene KW - interpersonal contacts KW - China KW - protection KW - public health KW - behavior KW - infectious disease KW - cross-sectional KW - survey N2 - 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. UR - https://publichealth.jmir.org/2021/10/e26840 UR - http://dx.doi.org/10.2196/26840 UR - http://www.ncbi.nlm.nih.gov/pubmed/34479184 ID - info:doi/10.2196/26840 ER - TY - JOUR AU - Kvale, Gerd AU - Frisk, Bente AU - Jürgensen, Marte AU - Børtveit, Tore AU - Ødegaard-Olsen, Theodor Øystein AU - Wilhelmsen-Langeland, Ane AU - Aarli, Bøgvald Bernt AU - Sandnes, Kristina AU - Rykken, Sidsel AU - Haugstvedt, Anne AU - Hystad, William Sigurd AU - Søfteland, Eirik PY - 2021/10/7 TI - Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study JO - JMIR Res Protoc SP - e32216 VL - 10 IS - 10 KW - COVID-19 KW - chronic illnesses KW - concentrated rehabilitation KW - low back pain KW - post?COVID-19 symptoms KW - post?COVID-19 syndrome KW - long COVID KW - fatigue KW - type 2 diabetes KW - anxiety KW - depression N2 - 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 UR - https://www.researchprotocols.org/2021/10/e32216 UR - http://dx.doi.org/10.2196/32216 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505838 ID - info:doi/10.2196/32216 ER - TY - JOUR AU - Kaufmann, G. Peter AU - Havens, S. Donna AU - Mensinger, L. Janell AU - Bradley, K. Patricia AU - Brom, M. Heather AU - Copel, C. Linda AU - Costello, Alexander AU - D'Annunzio, Christine AU - Dean Durning, Jennifer AU - Maldonado, Linda AU - Barrow McKenzie, Ann AU - Smeltzer, C. Suzanne AU - Yost, Jennifer AU - PY - 2021/10/7 TI - The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study JO - JMIR Res Protoc SP - e30757 VL - 10 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - stress KW - depression KW - anxiety KW - sleep KW - social support KW - resilience KW - mental health KW - physical health N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30757 UR - http://dx.doi.org/10.2196/30757 UR - http://www.ncbi.nlm.nih.gov/pubmed/34582354 ID - info:doi/10.2196/30757 ER - TY - JOUR AU - Thomas Craig, Jean Kelly AU - Rizvi, Rubina AU - Willis, C. Van AU - Kassler, J. William AU - Jackson, Purcell Gretchen PY - 2021/10/6 TI - Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review JO - JMIR Public Health Surveill SP - e32468 VL - 7 IS - 10 KW - contact tracing KW - non-pharmaceutical interventions KW - pandemic KW - epidemic KW - viral disease KW - COVID-19 KW - isolation KW - testing KW - surveillance KW - monitoring KW - review KW - intervention KW - effectiveness KW - mitigation KW - transmission KW - spread KW - protection KW - outcome N2 - 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. UR - https://publichealth.jmir.org/2021/10/e32468 UR - http://dx.doi.org/10.2196/32468 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612841 ID - info:doi/10.2196/32468 ER - TY - JOUR AU - Heyerdahl, W. Leonardo AU - Lana, Benedetta AU - Giles-Vernick, Tamara PY - 2021/10/6 TI - The Impact of the Online COVID-19 Infodemic on French Red Cross Actors? Field Engagement and Protective Behaviors: Mixed Methods Study JO - JMIR Infodemiology SP - e27472 VL - 1 IS - 1 KW - COVID-19 KW - infodemics KW - social listening KW - epidemics KW - medical anthropology KW - nongovernmental organizations N2 - 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. UR - https://infodemiology.jmir.org/2021/1/e27472 UR - http://dx.doi.org/10.2196/27472 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661065 ID - info:doi/10.2196/27472 ER - TY - JOUR AU - Summers, Charlotte AU - Wu, Philip AU - Taylor, G. Alisdair J. PY - 2021/10/6 TI - Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study JO - JMIR Form Res SP - e31273 VL - 5 IS - 10 KW - stress KW - mental health KW - COVID-19 KW - digital therapy KW - mHealth KW - support KW - behavior KW - intervention KW - online intervention KW - outcome KW - wellbeing KW - sleep KW - activity KW - nutrition N2 - 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. UR - https://formative.jmir.org/2021/10/e31273 UR - http://dx.doi.org/10.2196/31273 UR - http://www.ncbi.nlm.nih.gov/pubmed/34459740 ID - info:doi/10.2196/31273 ER - TY - JOUR AU - Chan, Siang Kai AU - Wang, Bei AU - Tan, Pin Yen AU - Chow, Ling Jaclyn Jie AU - Ong, Ling Ee AU - Junnarkar, P. Sameer AU - Low, Keem Jee AU - Huey, Terence Cheong Wei AU - Shelat, G. Vishal PY - 2021/10/6 TI - Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study JO - JMIR Perioper Med SP - e30473 VL - 4 IS - 2 KW - enhanced recovery after surgery KW - early mobilization KW - liver resection KW - pancreas surgery KW - quality improvement project KW - pancreaticoduodenectomy N2 - 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. UR - https://periop.jmir.org/2021/2/e30473 UR - http://dx.doi.org/10.2196/30473 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559668 ID - info:doi/10.2196/30473 ER - TY - JOUR AU - De Ridder, David AU - Loizeau, Jutta Andrea AU - Sandoval, Luis José AU - Ehrler, Frédéric AU - Perrier, Myriam AU - Ritch, Albert AU - Violot, Guillemette AU - Santolini, Marc AU - Greshake Tzovaras, Bastian AU - Stringhini, Silvia AU - Kaiser, Laurent AU - Pradeau, Jean-François AU - Joost, Stéphane AU - Guessous, Idris PY - 2021/10/6 TI - Detection of Spatiotemporal Clusters of COVID-19?Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study JO - JMIR Res Protoc SP - e30444 VL - 10 IS - 10 KW - participatory surveillance KW - infectious disease KW - COVID-19 KW - SARS-CoV-2 KW - space-time clustering KW - digital health KW - mobile app KW - mHealth KW - epidemiology KW - surveillance KW - digital surveillance KW - public health N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30444 UR - http://dx.doi.org/10.2196/30444 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449403 ID - info:doi/10.2196/30444 ER - TY - JOUR AU - Gonsalves, P. Pattie AU - Sharma, Rhea AU - Hodgson, Eleanor AU - Bhat, Bhargav AU - Jambhale, Abhijeet AU - Weiss, A. Helen AU - Fairburn, G. Christopher AU - Cavanagh, Kate AU - Cuijpers, Pim AU - Michelson, Daniel AU - Patel, Vikram PY - 2021/10/6 TI - 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 JO - JMIR Res Protoc SP - e30339 VL - 10 IS - 10 KW - randomized controlled trial KW - internet-based intervention KW - smartphone KW - adolescent KW - schools KW - mental health KW - COVID-19 KW - app KW - protocol KW - problem-solving KW - intervention KW - teenager KW - young adult KW - India KW - feasibility KW - effective N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30339 UR - http://dx.doi.org/10.2196/30339 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586075 ID - info:doi/10.2196/30339 ER - TY - JOUR AU - Naaseh, Ariana AU - Thompson, Sean AU - Tohmasi, Steven AU - Wiechmann, Warren AU - Toohey, Shannon AU - Wray, Alisa AU - Boysen-Osborn, Megan PY - 2021/10/5 TI - Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study JO - JMIR Med Educ SP - e29486 VL - 7 IS - 4 KW - residency application KW - social media KW - medical education KW - resident KW - medical student KW - perspective KW - residency recruitment KW - virtual application KW - virtual residency N2 - Background: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media?based communication and dissemination of information. Objective: We sought to determine social media?s impact on residency applicants during an entirely virtual application cycle. Methods: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. Results: A total of 72 participants (15.5% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53% (n=38) reported following prospective residency accounts on social media, and 89% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74%) increasing the number of programs to which they applied. Survey respondents ranked social media?s effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86%) felt that programs should use social media in future application cycles even if they are nonvirtual. Conclusions: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match. UR - https://mededu.jmir.org/2021/4/e29486 UR - http://dx.doi.org/10.2196/29486 UR - http://www.ncbi.nlm.nih.gov/pubmed/34591779 ID - info:doi/10.2196/29486 ER - TY - JOUR AU - Luo, Yan PY - 2021/10/5 TI - The Association of Delayed Care With Depression Among US Middle-Aged and Older Adults During the COVID-19 Pandemic: Cross-sectional Analysis JO - JMIR Aging SP - e29953 VL - 4 IS - 4 KW - depression KW - COVID-19 KW - delayed care KW - middle-aged adults KW - older adults N2 - Background: During the COVID-19 pandemic, the depression level among US adults has significantly increased. Age disparity in depression during the pandemic has been reported in recent studies. Delay or avoidance of medical care is one of the collateral damages associated with the COVID-19 pandemic, and it can lead to increased morbidity and mortality. Objective: This study aimed to assess the prevalence of depression and delayed care among US middle-aged adults and older adults during the pandemic, as well as investigate the association of delayed care with depression among those 2 age groups. Methods: This cross-sectional study used data from the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0). Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years were included. Depression was measured by the Composite International Diagnostic Interview-Short Form (CIDI-SF). Delayed care was measured by the following 4 items: delayed surgery, delayed seeing a doctor, delayed dental care, and other delayed care. Results: A total of 3246 participants were identified. More than half of the participants were older than 65 years (n=1890, 58.2%), and 274 (8.8%) participants had depression during the pandemic. Delayed dental care was positively associated with depression among both middle-aged adults (OR 2.05, 95% CI 1.04-4.03; P=.04) and older adults (OR 3.08, 95% CI 1.07-8.87; P=.04). Delayed surgery was positively associated with depression among older adults (OR 3.69, 95% CI 1.06-12.90; P=.04). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education levels (some college or above) or worse self-reported health had a higher likelihood of having depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults. Conclusions: This study found that depression was prevalent among middle-aged and older adults during the pandemic. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the association of delayed surgery and dental care with depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients? concerns on delayed surgery and dental care. Moreover, the implementation of telemental health services is needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive measurements for delayed care is needed to decipher the path through which delayed care is associated with depression. UR - https://aging.jmir.org/2021/4/e29953 UR - http://dx.doi.org/10.2196/29953 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524964 ID - info:doi/10.2196/29953 ER - TY - JOUR AU - Fiorentino, Francesca AU - Prociuk, Denys AU - Espinosa Gonzalez, Belen Ana AU - Neves, Luisa Ana AU - Husain, Laiba AU - Ramtale, Christian Sonny AU - Mi, Emma AU - Mi, Ella AU - Macartney, Jack AU - Anand, N. Sneha AU - Sherlock, Julian AU - Saravanakumar, Kavitha AU - Mayer, Erik AU - de Lusignan, Simon AU - Greenhalgh, Trisha AU - Delaney, C. Brendan PY - 2021/10/5 TI - An Early Warning Risk Prediction Tool (RECAP-V1) for Patients Diagnosed With COVID-19: Protocol for a Statistical Analysis Plan JO - JMIR Res Protoc SP - e30083 VL - 10 IS - 10 KW - COVID-19 KW - modeling KW - remote assessment KW - risk score KW - early warning N2 - 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 UR - https://www.researchprotocols.org/2021/10/e30083 UR - http://dx.doi.org/10.2196/30083 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468322 ID - info:doi/10.2196/30083 ER - TY - JOUR AU - Noddin, Katie AU - Bradley, Dani AU - Wolfberg, Adam PY - 2021/10/4 TI - Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study JO - JMIR Pediatr Parent SP - e27769 VL - 4 IS - 4 KW - digital health KW - COVID-19 KW - maternal health KW - obstetrics KW - COVID KW - pandemic KW - pregnant women KW - birth KW - hospital KW - delivery KW - women's health KW - Cesarean sections N2 - 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. UR - https://pediatrics.jmir.org/2021/4/e27769 UR - http://dx.doi.org/10.2196/27769 UR - http://www.ncbi.nlm.nih.gov/pubmed/34509975 ID - info:doi/10.2196/27769 ER - TY - JOUR AU - Gordon, S. Judith AU - Sbarra, David AU - Armin, Julie AU - Pace, W. Thaddeus W. AU - Gniady, Chris AU - Barraza, Yessenya PY - 2021/10/4 TI - Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19?Related Stress: Pilot Feasibility Study JO - JMIR Form Res SP - e32353 VL - 5 IS - 10 KW - COVID-19 KW - stress KW - anxiety KW - isolation KW - intervention KW - guided imagery KW - mobile app N2 - 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. UR - https://formative.jmir.org/2021/10/e32353 UR - http://dx.doi.org/10.2196/32353 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546941 ID - info:doi/10.2196/32353 ER - TY - JOUR AU - Hentati, Amira AU - Forsell, Erik AU - Ljótsson, Brjánn AU - Kraepelien, Martin PY - 2021/10/4 TI - Practical and Emotional Problems Reported by Users of a Self-guided Digital Problem-solving Intervention During the COVID-19 Pandemic: Content Analysis JO - JMIR Form Res SP - e31722 VL - 5 IS - 10 KW - digital intervention KW - COVID-19 KW - problem-solving KW - self-guided intervention KW - content analysis KW - public health KW - mental health KW - depression KW - anxiety KW - pandemic N2 - 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 UR - https://formative.jmir.org/2021/10/e31722 UR - http://dx.doi.org/10.2196/31722 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559670 ID - info:doi/10.2196/31722 ER - TY - JOUR AU - Pan, Myat AU - San, Myat PY - 2021/10/4 TI - Innovation and Inequality: A Medical Student Perspective. Comment on "The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic" JO - JMIR Med Educ SP - e26790 VL - 7 IS - 4 KW - medical education KW - technology KW - coronavirus KW - medical students KW - COVID-19 KW - pandemic KW - online lecture KW - virtual reality KW - education UR - https://mededu.jmir.org/2021/4/e26790 UR - http://dx.doi.org/10.2196/26790 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081609 ID - info:doi/10.2196/26790 ER - TY - JOUR AU - Egan, J. Kieren AU - Hodgson, William AU - Dunlop, D. Mark AU - Imperatore, Gennaro AU - Kirk, Alison AU - Maguire, Roma PY - 2021/10/1 TI - 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 JO - JMIR Form Res SP - e27358 VL - 5 IS - 10 KW - physical activity KW - Android KW - COVID-19 KW - intervention KW - co-design KW - exercise KW - app KW - development KW - support KW - caregiver N2 - 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. UR - https://formative.jmir.org/2021/10/e27358 UR - http://dx.doi.org/10.2196/27358 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406969 ID - info:doi/10.2196/27358 ER - TY - JOUR AU - Farah, Mohamed Alinoor AU - Nour, Yousuf Tahir AU - Obsiye, Muse AU - Aden, Akil Mowlid AU - Ali, Moeline Omar AU - Hussein, Arab Muktar AU - Budul, Bedel Abdullahi AU - Omer, Muktar AU - Getnet, Fentabil PY - 2021/10/1 TI - Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study JO - JMIR Form Res SP - e26980 VL - 5 IS - 10 KW - COVID-19 KW - knowledge KW - attitude KW - practice KW - health care workers KW - Eastern Ethiopia N2 - 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. UR - https://formative.jmir.org/2021/10/e26980 UR - http://dx.doi.org/10.2196/26980 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477559 ID - info:doi/10.2196/26980 ER - TY - JOUR AU - Withiel, Toni AU - Barson, Elizabeth AU - Ng, Irene AU - Segal, Reny AU - Williams, Goulding Daryl Lindsay AU - Krieser, Benjamin Roni AU - Lee, Keat AU - Mezzavia, Mario Paul AU - Sindoni, Teresa AU - Chen, Yinwei AU - Fisher, Anne Caroline PY - 2021/9/29 TI - The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study JO - JMIR Perioper Med SP - e27166 VL - 4 IS - 2 KW - COVID-19 KW - perioperative KW - mental health KW - qualitative KW - grief KW - psychology KW - health care worker KW - experience KW - hospital KW - trauma KW - thematic analysis KW - interview N2 - 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. UR - https://periop.jmir.org/2021/2/e27166 UR - http://dx.doi.org/10.2196/27166 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346887 ID - info:doi/10.2196/27166 ER - TY - JOUR AU - Geronikolou, Styliani AU - Drosatos, George AU - Chrousos, George PY - 2021/9/29 TI - Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study JO - JMIR Form Res SP - e27741 VL - 5 IS - 9 KW - emotional analysis KW - COVID-19 KW - Twitter KW - Greece KW - infodemics KW - emotional contagion KW - epidemiology KW - pandemic KW - mental health N2 - 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. UR - https://formative.jmir.org/2021/9/e27741 UR - http://dx.doi.org/10.2196/27741 UR - http://www.ncbi.nlm.nih.gov/pubmed/34469328 ID - info:doi/10.2196/27741 ER - TY - JOUR AU - McKinstry, Brian AU - Alexander, Helen AU - Maxwell, Gabriela AU - Blaikie, Lesley AU - Patel, Sameer AU - Guthrie, Bruce AU - PY - 2021/9/27 TI - The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study JO - JMIR Form Res SP - e20131 VL - 5 IS - 9 KW - telemonitoring KW - eHealth KW - COVID-19 KW - primary care N2 - 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. UR - https://formative.jmir.org/2021/9/e20131 UR - http://dx.doi.org/10.2196/20131 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449404 ID - info:doi/10.2196/20131 ER - TY - JOUR AU - Liu, W. Jenny J. AU - Nazarov, Anthony AU - Plouffe, A. Rachel AU - Forchuk, A. Callista AU - Deda, Erisa AU - Gargala, Dominic AU - Le, Tri AU - Bourret-Gheysen, Jesse AU - Soares, Vanessa AU - Nouri, S. Maede AU - Hosseiny, Fardous AU - Smith, Patrick AU - Roth, Maya AU - MacDougall, G. Arlene AU - Marlborough, Michelle AU - Jetly, Rakesh AU - Heber, Alexandra AU - Albuquerque, Joy AU - Lanius, Ruth AU - Balderson, Ken AU - Dupuis, Gabrielle AU - Mehta, Viraj AU - Richardson, Don J. PY - 2021/9/27 TI - Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study JO - JMIR Res Protoc SP - e32663 VL - 10 IS - 9 KW - COVID-19 KW - health care worker KW - pandemic KW - mental health KW - wellbeing KW - survey KW - design KW - longitudinal KW - prospective KW - protocol KW - challenge KW - impact KW - distress KW - perception N2 - 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 UR - https://www.researchprotocols.org/2021/9/e32663 UR - http://dx.doi.org/10.2196/32663 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477557 ID - info:doi/10.2196/32663 ER - TY - JOUR AU - Greenleaf, R. Abigail AU - Mwima, Gerald AU - Lethoko, Molibeli AU - Conkling, Martha AU - Keefer, George AU - Chang, Christiana AU - McLeod, Natasha AU - Maruyama, Haruka AU - Chen, Qixuan AU - Farley, M. Shannon AU - Low, Andrea PY - 2021/9/27 TI - Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection JO - JMIR Res Protoc SP - e31236 VL - 10 IS - 9 KW - COVID-19 KW - cell phones KW - mHealth KW - Africa south of the Sahara KW - surveillance N2 - 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 UR - https://www.researchprotocols.org/2021/9/e31236 UR - http://dx.doi.org/10.2196/31236 UR - http://www.ncbi.nlm.nih.gov/pubmed/34351866 ID - info:doi/10.2196/31236 ER - TY - JOUR AU - Hart, Joanna AU - Summer, Amy AU - Yadav, N. Kuldeep AU - Peace, Summer AU - Hong, David AU - Konu, Michael AU - Clapp, T. Justin PY - 2021/9/24 TI - Content and Communication of Inpatient Family Visitation Policies During the COVID-19 Pandemic: Sequential Mixed Methods Study JO - J Med Internet Res SP - e28897 VL - 23 IS - 9 KW - family-centered care KW - hospital policy KW - public health KW - health communication KW - ethics KW - health systems KW - public perceptions KW - COVID-19 KW - pandemic N2 - Background: Inpatient health care facilities restricted inpatient visitation due to the COVID-19 pandemic. There is no existing evidence of how they communicated these policies to the public nor the impact of their communication choices on public perception. Objective: This study aims to describe patterns of inpatient visitation policies during the initial peak of the COVID-19 pandemic in the United States and the communication of these policies to the general public, as well as to identify communication strategies that maximize positive impressions of the facility despite visitation restrictions. Methods: We conducted a sequential, exploratory, mixed methods study including a qualitative analysis of COVID-19 era visitation policies published on Pennsylvania-based facility websites, as captured between April 30 and May 20, 2020 (ie, during the first peak of the COVID-19 pandemic in the United States). We also conducted a factorial survey-based experiment to test how key elements of hospitals? visitation policy communication are associated with individuals? willingness to seek care in October 2020. For analysis of the policies, we included all inpatient facilities in Pennsylvania. For the factorial experiment, US adults were drawn from internet research panels. The factorial survey-based experiment presented composite policies that varied in their justification for restricted visitation, the degree to which the facility expressed ownership of the policy, and the inclusion of family-centered care support plans. Our primary outcome was participants? willingness to recommend the hypothetical facility using a 5-point Likert scale. Results: We identified 104 unique policies on inpatient visitation from 363 facilities? websites. The mean Flesch-Kincaid Grade Level for the policies was 14.2. Most policies prohibited family presence (99/104, 95.2%). Facilities justified the restricted visitation policies on the basis of community protection (59/104, 56.7%), authorities? guidance or regulations (34/104, 32.7%), or scientific rationale (23/104, 22.1%). A minority (38/104, 36.5%) addressed how restrictive visitation may impair family-centered care. Most of the policies analyzed used passive voice to communicate restrictions. A total of 1321 participants completed the web-based survey. Visitation policy elements significantly associated with willingness to recommend the facility included justifications based on community protection (OR 1.44, 95% CI 1.24-1.68) or scientific rationale (OR 1.30, 95% CI 1.12-1.51), rather than those based on a governing authority. The facility expressed a high degree of ownership over the decision (OR 1.16, 95% CI 1.04-1.29), rather than a low degree of ownership; and inclusion of family-centered care support plans (OR 2.80, 95% CI 2.51-3.12), rather than no such support. Conclusions: Health systems can immediately improve public receptiveness of restrictive visitation policies by emphasizing community protection, ownership over the facility?s policy, and promoting family-centered care. UR - https://www.jmir.org/2021/9/e28897 UR - http://dx.doi.org/10.2196/28897 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406968 ID - info:doi/10.2196/28897 ER - TY - JOUR AU - Cross, J. Troy AU - Isautier, J. Jennifer M. AU - Morris, J. Sarah AU - Johnson, D. Bruce AU - Wheatley-Guy, M. Courtney AU - Taylor, J. Bryan PY - 2021/9/24 TI - The Influence of Social Distancing Behaviors and Psychosocial Factors on Physical Activity During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e31278 VL - 7 IS - 9 KW - physical activity KW - COVID-19 KW - mental health KW - social distancing KW - public health KW - pandemic KW - physical health KW - exercise N2 - 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. UR - https://publichealth.jmir.org/2021/9/e31278 UR - http://dx.doi.org/10.2196/31278 UR - http://www.ncbi.nlm.nih.gov/pubmed/34509976 ID - info:doi/10.2196/31278 ER - TY - JOUR AU - Mote, Jasmine AU - Gill, Kathryn AU - Fulford, Daniel PY - 2021/9/23 TI - ?Skip the Small Talk? Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study JO - JMIR Form Res SP - e28002 VL - 5 IS - 9 KW - COVID-19 KW - depression KW - digital group KW - loneliness KW - social connection KW - virtual social interaction KW - community KW - mental health KW - connection KW - virtual health N2 - 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. UR - https://formative.jmir.org/2021/9/e28002 UR - http://dx.doi.org/10.2196/28002 UR - http://www.ncbi.nlm.nih.gov/pubmed/34468326 ID - info:doi/10.2196/28002 ER - TY - JOUR AU - Wati, Laras Risa AU - Ulfa, Sayyidatul Annisa AU - Kevaladandra, Zulfa AU - Shalihat, Shelly AU - Syahadatina, Bella AU - Pratomo, Hadi PY - 2021/9/23 TI - Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study JO - JMIR Form Res SP - e25615 VL - 5 IS - 9 KW - pretesting KW - media KW - stress KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2021/9/e25615 UR - http://dx.doi.org/10.2196/25615 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254944 ID - info:doi/10.2196/25615 ER - TY - JOUR AU - Der-Martirosian, Claudia AU - Wyte-Lake, Tamar AU - Balut, Michelle AU - Chu, Karen AU - Heyworth, Leonie AU - Leung, Lucinda AU - Ziaeian, Boback AU - Tubbesing, Sarah AU - Mullur, Rashmi AU - Dobalian, Aram PY - 2021/9/23 TI - Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e29429 VL - 5 IS - 9 KW - telehealth KW - telemedicine KW - veterans KW - US Department of Veterans Affairs KW - primary care KW - cardiology KW - home-based primary care KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2021/9/e29429 UR - http://dx.doi.org/10.2196/29429 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477554 ID - info:doi/10.2196/29429 ER - TY - JOUR AU - Van Herck, Maarten AU - Goërtz, J. Yvonne M. AU - Houben-Wilke, Sarah AU - Machado, C. Felipe V. AU - Meys, Roy AU - Delbressine, M. Jeannet AU - Vaes, W. Anouk AU - Burtin, Chris AU - Posthuma, Rein AU - Franssen, E. Frits M. AU - Hajian, Bita AU - Vijlbrief, Herman AU - Spies, Yvonne AU - van 't Hul, J. Alex AU - Janssen, A. Daisy J. AU - Spruit, A. Martijn PY - 2021/9/21 TI - Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups JO - J Med Internet Res SP - e30274 VL - 23 IS - 9 KW - COVID-19 KW - SARS-CoV-2 KW - long COVID KW - post-COVID-19 syndrome KW - post-acute sequelae of COVID-19 KW - fatigue KW - post-viral fatigue KW - pandemic KW - online health KW - mental health KW - online support N2 - 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. UR - https://www.jmir.org/2021/9/e30274 UR - http://dx.doi.org/10.2196/30274 UR - http://www.ncbi.nlm.nih.gov/pubmed/34494964 ID - info:doi/10.2196/30274 ER - TY - JOUR AU - Siedlikowski, Sophia AU - Noël, Louis-Philippe AU - Moynihan, Anne Stephanie AU - Robin, Marc PY - 2021/9/21 TI - Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic JO - J Med Internet Res SP - e27283 VL - 23 IS - 9 KW - chatbot KW - COVID-19 KW - conversational agents KW - public health KW - artificial intelligence KW - infodemic KW - infodemiology KW - misinformation KW - digital health KW - virtual care UR - https://www.jmir.org/2021/9/e27283 UR - http://dx.doi.org/10.2196/27283 UR - http://www.ncbi.nlm.nih.gov/pubmed/34375299 ID - info:doi/10.2196/27283 ER - TY - JOUR AU - Budhwani, Suman AU - Fujioka, Keiko Jamie AU - Chu, Cherry AU - Baranek, Hayley AU - Pus, Laura AU - Wasserman, Lori AU - Vigod, Simone AU - Martin, Danielle AU - Agarwal, Payal AU - Mukerji, Geetha PY - 2021/9/21 TI - Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context JO - JMIR Form Res SP - e30280 VL - 5 IS - 9 KW - virtual care KW - mental health KW - quality of care KW - implementation KW - COVID-19 KW - digital health KW - pandemic KW - ambulatory care N2 - 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. UR - https://formative.jmir.org/2021/9/e30280 UR - http://dx.doi.org/10.2196/30280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406967 ID - info:doi/10.2196/30280 ER - TY - JOUR AU - Bachtiger, Patrik AU - Adamson, Alexander AU - Maclean, A. William AU - Kelshiker, A. Mihir AU - Quint, K. Jennifer AU - Peters, S. Nicholas PY - 2021/9/20 TI - Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study JO - JMIR Public Health Surveill SP - e30460 VL - 7 IS - 9 KW - COVID-19 KW - shielding KW - well-being KW - personal health record KW - determinant KW - behavior KW - protection KW - longitudinal KW - observational KW - health policy KW - mental health KW - epidemiology KW - public health N2 - 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. UR - https://publichealth.jmir.org/2021/9/e30460 UR - http://dx.doi.org/10.2196/30460 UR - http://www.ncbi.nlm.nih.gov/pubmed/34298499 ID - info:doi/10.2196/30460 ER - TY - JOUR AU - Alsudias, Lama AU - Rayson, Paul PY - 2021/9/17 TI - Social Media Monitoring of the COVID-19 Pandemic and Influenza Epidemic With Adaptation for Informal Language in Arabic Twitter Data: Qualitative Study JO - JMIR Med Inform SP - e27670 VL - 9 IS - 9 KW - Arabic KW - COVID-19 KW - infectious disease KW - influenza KW - infodemiology KW - infoveillance KW - social listening KW - informal language KW - multilabel classification KW - natural language processing KW - named entity recognition KW - Twitter N2 - 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. UR - https://medinform.jmir.org/2021/9/e27670 UR - http://dx.doi.org/10.2196/27670 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346892 ID - info:doi/10.2196/27670 ER - TY - JOUR AU - Brogly, Chris AU - Bauer, A. Michael AU - Lizotte, J. Daniel AU - Press, L. MacLean AU - MacDougall, Arlene AU - Speechley, Mark AU - Huner, Erin AU - Mitchell, Marc AU - Anderson, K. Kelly AU - Pila, Eva PY - 2021/9/17 TI - An App-Based Surveillance System for Undergraduate Students? Mental Health During the COVID-19 Pandemic: Protocol for a Prospective Cohort Study JO - JMIR Res Protoc SP - e30504 VL - 10 IS - 9 KW - undergraduate KW - mental health KW - smartphone KW - app KW - COVID-19 KW - postsecondary institutions KW - mobile apps KW - mHealth KW - mobile health N2 - 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 UR - https://www.researchprotocols.org/2021/9/e30504 UR - http://dx.doi.org/10.2196/30504 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516391 ID - info:doi/10.2196/30504 ER - TY - JOUR AU - Han, Lei AU - Zhan, Yanru AU - Li, Weizi AU - Xu, Yuqing AU - Xu, Yan AU - Zhao, Jinzhe PY - 2021/9/16 TI - Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e31052 VL - 7 IS - 9 KW - COVID-19 KW - cyberchondria KW - depression KW - anxiety KW - stress KW - ABC theory of emotions KW - lockdown experience KW - perceived severity KW - cross-sectional KW - online health information N2 - 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 (?=0.36, t=8.51, P<.001), anxiety (?=0.41, t=9.84, P<.001), and stress (?=0.46, t=11.45, P<.001), which were mediated by cyberchondria (?=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (?=0.07, t=2.01, P=.045) and stress (?=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (?=0.10, t=2.59, P=.009) and anxiety (?=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. UR - https://publichealth.jmir.org/2021/9/e31052 UR - http://dx.doi.org/10.2196/31052 UR - http://www.ncbi.nlm.nih.gov/pubmed/34478402 ID - info:doi/10.2196/31052 ER - TY - JOUR AU - Yamagami, Kan AU - Nomura, Akihiro AU - Kometani, Mitsuhiro AU - Shimojima, Masaya AU - Sakata, Kenji AU - Usui, Soichiro AU - Furukawa, Kenji AU - Takamura, Masayuki AU - Okajima, Masaki AU - Watanabe, Kazuyoshi AU - Yoneda, Takashi PY - 2021/9/16 TI - Early Detection of Symptom Exacerbation in Patients With SARS-CoV-2 Infection Using the Fitbit Charge 3 (DEXTERITY): Pilot Evaluation JO - JMIR Form Res SP - e30819 VL - 5 IS - 9 KW - COVID-19 KW - silent hypoxia KW - wearable device KW - Fitbit KW - estimated oxygen variation KW - detection KW - infectious disease KW - pilot study KW - symptom KW - outpatient KW - oxygen KW - sleep KW - wearable N2 - 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 UR - https://formative.jmir.org/2021/9/e30819 UR - http://dx.doi.org/10.2196/30819 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516390 ID - info:doi/10.2196/30819 ER - TY - JOUR AU - Beogo, Idrissa AU - Ramdé, Jean AU - Nguemeleu Tchouaket, Eric AU - Sia, Drissa AU - Bationo, Jean-Claude Nebila AU - Collin, Stephanie AU - Anne, Abdoulaye AU - Gagnon, Marie-Pierre PY - 2021/9/15 TI - Co-Development of a Web-Based Hub (eSocial-hub) to Combat Social Isolation and Loneliness in Francophone and Anglophone Older People in the Linguistic Minority Context (Quebec, Manitoba, and New Brunswick): Protocol for a Mixed Methods Interventional Study JO - JMIR Res Protoc SP - e30802 VL - 10 IS - 9 KW - older people KW - nursing facility KW - nursing home KW - long-term care home KW - linguistic minority KW - digital health KW - COVID-19 KW - social isolation KW - loneliness KW - older adults KW - development KW - isolation KW - minority KW - community N2 - Background: The first wave of the COVID-19 pandemic has severely hit Canadian nursing facilities (81% of deaths). To this toll, public health measures (eg, visitation restriction) have subsequently deepened the social isolation and loneliness of residents in nursing facilities (NFs), especially those in linguistic minority settings: Anglophone institutions in Quebec and Francophone institutions outside Quebec. However, very few COVID-19 initiatives targeting these populations specifically have been documented. Given the limited number of NFs serving linguistic minorities in Canadian populations, families and loved ones often live far from these facilities, sometimes even in other provinces. This context places the digital solutions as particularly relevant for the present COVID-19 pandemic as well as in the post?COVID-19 era. Objective: This project aims to co-develop a virtual community of practice through a web-based platform (eSocial-hub) to combat social isolation and loneliness among the older people in linguistic minority settings in Canada. Methods: An interventional study using a sequential mixed methods design will be conducted. Four purposely selected NFs will be included, 2 among facilities in Manitoba and 2 in New Brunswick; and 2 Anglophone NFs in Quebec will serve as knowledge users. The development of eSocial-hub will include an experimental 4-month phase involving the following end users: (1) older people (n=3 per NF), (2) families of the participating older people (n=3 per NF), and (3) frontline staff (nurse and health care aid; n=2 per NF). Results: Activities and solutions aiming at reducing social isolation and loneliness will be implemented and then evaluated with the project stakeholders, and the best practices generated. The assessment will be conducted using indicators derived from the 5 domains of the Consolidated Framework for Implementation Research. The project will be led by an interdisciplinary team and will involve a multisectoral partnership. Conclusions: The project will develop a promising and generalizable solution that uses virtual technology to help reduce social isolation and loneliness among the older people. International Registered Report Identifier (IRRID): PRR1-10.2196/30802 UR - https://www.researchprotocols.org/2021/9/e30802 UR - http://dx.doi.org/10.2196/30802 UR - http://www.ncbi.nlm.nih.gov/pubmed/34464326 ID - info:doi/10.2196/30802 ER - TY - JOUR AU - Lopez Segui, Francesc AU - Hernandez Guillamet, Guillem AU - Pifarré Arolas, Héctor AU - Marin-Gomez, X. Francesc AU - Ruiz Comellas, Anna AU - Ramirez Morros, Maria Anna AU - Adroher Mas, Cristina AU - Vidal-Alaball, Josep PY - 2021/9/14 TI - Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study JO - J Med Internet Res SP - e29622 VL - 23 IS - 9 KW - COVID-19 KW - primary care KW - diagnose variations KW - big data KW - ICD10 KW - health system KW - healthcare system N2 - 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. UR - https://www.jmir.org/2021/9/e29622 UR - http://dx.doi.org/10.2196/29622 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313600 ID - info:doi/10.2196/29622 ER - TY - JOUR AU - Abd-Alrazaq, Alaa AU - Hassan, Asmaa AU - Abuelezz, Israa AU - Ahmed, Arfan AU - Alzubaidi, Saleh Mahmood AU - Shah, Uzair AU - Alhuwail, Dari AU - Giannicchi, Anna AU - Househ, Mowafa PY - 2021/9/14 TI - Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review JO - J Med Internet Res SP - e29136 VL - 23 IS - 9 KW - technologies KW - digital tools KW - COVID-19 KW - novel coronavirus KW - scoping review KW - digital health KW - telemedicine N2 - 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. UR - https://www.jmir.org/2021/9/e29136 UR - http://dx.doi.org/10.2196/29136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406962 ID - info:doi/10.2196/29136 ER - TY - JOUR AU - Al Tamime, Reham AU - Weber, Ingmar PY - 2021/9/14 TI - Tracking Exposure to Ads Amid the COVID-19 Pandemic: Development of a Public Google Ads Data Set JO - JMIR Data SP - e22446 VL - 2 IS - 1 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - panic buying KW - Google Ads KW - data KW - database KW - tracking KW - research KW - public availability KW - online behaviors N2 - Background: The COVID-19 pandemic has had a substantial impact on economies, governments, businesses, and most importantly, people?s health. To bring the spread of COVID-19 under control, strict lockdown measures have been implemented across the globe. These lockdown measures resulted in a spate of panic buying and increase in demand for hygiene products and other grocery items. Objective: In this paper, we describe a data set from Google Ads that looks at the presentation of ads to people while they browse the web during the COVID-19 pandemic. We are making the data set available to the research community. Methods: We started this ongoing data collection on March 28, 2020, leveraging Developer Tools? network requests to retrieve Google Ads data. We identified a list of items related and unrelated to panic buying. We then captured these items as targeting criteria under what people are actively researching or planning on Google Ads. Google Ads data has been filtered using additional targeting criteria such as country, gender, and parental status. Results: Since the inception of our collection, we have actively maintained and updated our repository on a monthly basis. In total, we have published over 4116 data points. This paper also presents basic statistics that reveal variations in Google Ads data across countries, gender, and parental status. Conclusions: We hope that this Google Ads data set can increase our understanding of ad exposure during the COVID-19 outbreak. In particular, this data set can lead to further studies that look at the relationship between exposure to ads, time spent web browsing, and health outcomes. UR - https://data.jmir.org/2021/1/e22446 UR - http://dx.doi.org/10.2196/22446 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/22446 ER - TY - JOUR AU - Vancini, L. Rodrigo AU - Camargo-Neto, Luiz AU - Andrade, S. Marilia AU - de Lira, A. Claudio AU - dos Santos, G. Rafaela AU - Nikolaidis, T. Pantelis AU - Knechtle, Beat AU - Piacezzi, HV Luiz AU - Teixeira-Lopes, CB Maria AU - Assayag-Batista, E. Ruth AU - Pinto-Okuno, F. Meiry AU - Vancini-Campanharo, R. Cássia PY - 2021/9/14 TI - A Sociodemographic Profile of Mask Use During the COVID-19 Outbreak Among Young and Elderly Individuals in Brazil: Online Survey Study JO - JMIR Aging SP - e28989 VL - 4 IS - 3 KW - aging KW - older adults KW - COVID-19 KW - pandemic KW - sociodemographic profile KW - face mask KW - social media KW - online media KW - adolescents N2 - 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. UR - https://aging.jmir.org/2021/3/e28989 UR - http://dx.doi.org/10.2196/28989 UR - http://www.ncbi.nlm.nih.gov/pubmed/34253508 ID - info:doi/10.2196/28989 ER - TY - JOUR AU - Lam, Carson AU - Tso, Foon Chak AU - Green-Saxena, Abigail AU - Pellegrini, Emily AU - Iqbal, Zohora AU - Evans, Daniel AU - Hoffman, Jana AU - Calvert, Jacob AU - Mao, Qingqing AU - Das, Ritankar PY - 2021/9/14 TI - Semisupervised Deep Learning Techniques for Predicting Acute Respiratory Distress Syndrome From Time-Series Clinical Data: Model Development and Validation Study JO - JMIR Form Res SP - e28028 VL - 5 IS - 9 KW - acute respiratory distress syndrome KW - COVID-19 KW - semisupervised learning KW - deep learning KW - machine learning KW - algorithm KW - prediction KW - decision support N2 - 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. UR - https://formative.jmir.org/2021/9/e28028 UR - http://dx.doi.org/10.2196/28028 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398784 ID - info:doi/10.2196/28028 ER - TY - JOUR AU - Rashid Soron, Tanjir AU - Ashiq, Rahman Md Ashiqur AU - Al-Hakeem, Marzia AU - Chowdhury, Farzan Zaid AU - Uddin Ahmed, Helal AU - Afrooz Chowdhury, Chaman PY - 2021/9/13 TI - Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh JO - JMIR Form Res SP - e24624 VL - 5 IS - 9 KW - domestic violence KW - COVID-19 KW - mental health KW - violence KW - Bangladesh KW - lockdown KW - isolation KW - anxiety KW - stress KW - telemental health KW - telepsychiatry KW - web-based survey N2 - 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. UR - https://formative.jmir.org/2021/9/e24624 UR - http://dx.doi.org/10.2196/24624 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346893 ID - info:doi/10.2196/24624 ER - TY - JOUR AU - Hu, Tao AU - Wang, Siqin AU - Luo, Wei AU - Zhang, Mengxi AU - Huang, Xiao AU - Yan, Yingwei AU - Liu, Regina AU - Ly, Kelly AU - Kacker, Viraj AU - She, Bing AU - Li, Zhenlong PY - 2021/9/10 TI - Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective JO - J Med Internet Res SP - e30854 VL - 23 IS - 9 KW - Twitter KW - public opinion KW - COVID-19 vaccines KW - sentiment analysis KW - emotion analysis KW - topic modeling KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/9/e30854 UR - http://dx.doi.org/10.2196/30854 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346888 ID - info:doi/10.2196/30854 ER - TY - JOUR AU - Liu, Songxiang AU - Xie, Mao AU - Zhang, Zhicai AU - Wu, Xinghuo AU - Gao, Fei AU - Lu, Lin AU - Zhang, Jiayao AU - Xie, Yi AU - Yang, Fan AU - Ye, Zhewei PY - 2021/9/10 TI - A 3D Hologram With Mixed Reality Techniques to Improve Understanding of Pulmonary Lesions Caused by COVID-19: Randomized Controlled Trial JO - J Med Internet Res SP - e24081 VL - 23 IS - 9 KW - COVID-19 KW - mixed reality KW - hologram KW - pulmonary KW - lesion KW - diagnostic KW - imaging N2 - 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 UR - https://www.jmir.org/2021/9/e24081 UR - http://dx.doi.org/10.2196/24081 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061760 ID - info:doi/10.2196/24081 ER - TY - JOUR AU - Gilkey, B. Melissa AU - Kong, Yi Wei AU - Huang, Qian AU - Grabert, K. Brigid AU - Thompson, Peyton AU - Brewer, T. Noel PY - 2021/9/10 TI - Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals JO - J Med Internet Res SP - e31240 VL - 23 IS - 9 KW - adolescent health KW - primary care KW - telemedicine KW - health communication KW - health services KW - telehealth KW - adolescent KW - young adult KW - teenager KW - COVID-19 KW - survey KW - policy KW - access N2 - 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. UR - https://www.jmir.org/2021/9/e31240 UR - http://dx.doi.org/10.2196/31240 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406974 ID - info:doi/10.2196/31240 ER - TY - JOUR AU - Tahamtan, Iman AU - Potnis, Devendra AU - Mohammadi, Ehsan AU - Miller, E. Laura AU - Singh, Vandana PY - 2021/9/10 TI - Framing of and Attention to COVID-19 on Twitter: Thematic Analysis of Hashtags JO - J Med Internet Res SP - e30800 VL - 23 IS - 9 KW - COVID-19 KW - framing KW - Twitter KW - social media KW - public opinion KW - engagement KW - public attention KW - thematic analysis KW - public health N2 - 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. UR - https://www.jmir.org/2021/9/e30800 UR - http://dx.doi.org/10.2196/30800 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406961 ID - info:doi/10.2196/30800 ER - TY - JOUR AU - Geva, A. Gil AU - Ketko, Itay AU - Nitecki, Maya AU - Simon, Shoham AU - Inbar, Barr AU - Toledo, Itay AU - Shapiro, Michael AU - Vaturi, Barak AU - Votta, Yoni AU - Filler, Daniel AU - Yosef, Roey AU - Shpitzer, A. Sagi AU - Hir, Nabil AU - Peri Markovich, Michal AU - Shapira, Shachar AU - Fink, Noam AU - Glasberg, Elon AU - Furer, Ariel PY - 2021/9/10 TI - Data Empowerment of Decision-Makers in an Era of a Pandemic: Intersection of ?Classic? and Artificial Intelligence in the Service of Medicine JO - J Med Internet Res SP - e24295 VL - 23 IS - 9 KW - COVID-19 KW - medical informatics KW - decision-making KW - pandemic KW - data KW - policy KW - validation KW - accuracy KW - data analysis N2 - 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. UR - https://www.jmir.org/2021/9/e24295 UR - http://dx.doi.org/10.2196/24295 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313589 ID - info:doi/10.2196/24295 ER - TY - JOUR AU - Tzilos Wernette, Golfo AU - Countryman, Kristina AU - Mmeje, Okeoma AU - Ngo, M. Quyen AU - Zlotnick, Caron PY - 2021/9/10 TI - Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes JO - JMIR Res Protoc SP - e30367 VL - 10 IS - 9 KW - COVID-19 KW - pregnancy KW - COVID-19 pandemic KW - alcohol use KW - drug use KW - sexually transmitted infections KW - technology-delivered interventions N2 - 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 UR - https://www.researchprotocols.org/2021/9/e30367 UR - http://dx.doi.org/10.2196/30367 UR - http://www.ncbi.nlm.nih.gov/pubmed/34351867 ID - info:doi/10.2196/30367 ER - TY - JOUR AU - Hamadeh, Abdullah AU - Feng, Zeny AU - Niergarth, Jessmyn AU - Wong, WL William PY - 2021/9/9 TI - Estimation of COVID-19 Period Prevalence and the Undiagnosed Population in Canadian Provinces: Model-Based Analysis JO - JMIR Public Health Surveill SP - e26409 VL - 7 IS - 9 KW - COVID-19 KW - prevalence KW - undiagnosed proportion KW - mathematical modeling KW - estimate KW - Canada KW - diagnosis KW - control KW - distribution KW - infectious disease KW - model KW - framework KW - progression KW - transmission N2 - 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. UR - https://publichealth.jmir.org/2021/9/e26409 UR - http://dx.doi.org/10.2196/26409 UR - http://www.ncbi.nlm.nih.gov/pubmed/34228626 ID - info:doi/10.2196/26409 ER - TY - JOUR AU - Ricadat, Élise AU - Béliard, Aude AU - Citrini, Marie AU - Craus, Yann AU - Gabarro, Céline AU - Mamzer, Marie-France AU - Marques, Ana AU - Sannié, Thomas AU - Teixeira, Maria AU - Tocilovac, Marko AU - Velpry, Livia AU - Villa, François AU - Virole, Louise AU - Lefève, Céline PY - 2021/9/9 TI - COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study JO - JMIR Res Protoc SP - e28728 VL - 10 IS - 9 KW - chronic illness KW - care KW - prevention KW - vulnerability KW - health democracy KW - COVID KW - qualitative study KW - COVID-19 KW - pandemic KW - risk N2 - 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 UR - https://www.researchprotocols.org/2021/9/e28728 UR - http://dx.doi.org/10.2196/28728 UR - http://www.ncbi.nlm.nih.gov/pubmed/34460413 ID - info:doi/10.2196/28728 ER - TY - JOUR AU - Klingelhöfer, Doris AU - Braun, Markus AU - Brüggmann, Dörthe AU - Groneberg, A. David PY - 2021/9/8 TI - The Pandemic Year 2020: World Map of Coronavirus Research JO - J Med Internet Res SP - e30692 VL - 23 IS - 9 KW - COVID-19 KW - SARS-CoV-2 KW - incidence, research funding KW - socioeconomic factors KW - bibliometrics KW - bibliometric analysis KW - global health KW - public health KW - health database KW - online research KW - research database N2 - 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. UR - https://www.jmir.org/2021/9/e30692 UR - http://dx.doi.org/10.2196/30692 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346891 ID - info:doi/10.2196/30692 ER - TY - JOUR AU - Tretiakov, Alexei AU - Hunter, Inga PY - 2021/9/8 TI - User Experiences of the NZ COVID Tracer App in New Zealand: Thematic Analysis of Interviews JO - JMIR Mhealth Uhealth SP - e26318 VL - 9 IS - 9 KW - COVID-19 KW - contact tracing KW - app KW - New Zealand KW - adoption KW - use KW - civic responsibility KW - privacy N2 - Background: For mobile app?based COVID-19 contact tracing to be fully effective, a large majority of the population needs to be using the app on an ongoing basis. However, there is a paucity of studies of users, as opposed to potential adopters, of mobile contact tracing apps and of their experiences. New Zealand, a high-income country with western political culture, was successful in managing the COVID-19 pandemic, and its experience is valuable for informing policy responses in similar contexts. Objective: This study asks the following research questions: (1) How do users experience the app in their everyday contexts? and (2) What drives the use of the app? Methods: Residents of New Zealand?s Auckland region, which encompasses the country?s largest city, were approached via Facebook, and 34 NZ COVID Tracer app users were interviewed. Interview transcripts were analyzed using thematic analysis. Results: Interviews ranged in duration from 15 to 50 minutes. Participants ranged in age from those in their late teens to those in their early sixties. Even though about half of the participants identified as White New Zealanders of European origin, different ethnicities were represented, including New Zealanders of South Pacific, Indian, Middle Eastern, South American, and Southeast Asian descent. Out of 34 participants, 2 (6%) identified as M?ori (Indigenous New Zealanders). A broad range of careers were represented, from top-middle management to health support work and charity work. Likewise, educational backgrounds ranged broadly, from high school completion to master?s degrees. Out of 34 participants, 2 (6%) were unemployed, having recently lost their jobs because of the pandemic. The thematic analysis resulted in five major themes: perceived benefits, patterns of use, privacy, social influence, and need for collective action. Benefits of using the app to society in general were more salient to the participants than immediate health benefits to the individual. Use, however, depended on the alert level and tended to decline for many participants at low alert levels. Privacy considerations played a small role in shaping adoption and use, even though the participants were highly aware of privacy discourse around the app. Participants were aware of the need for high levels of adoption and use of the app to control the pandemic. Attempts to encourage others to use the app were common, although not always successful. Conclusions: Appeals to civic responsibility are likely to drive the use of a mobile contact tracing app under the conditions of high threat. Under the likely scenario of COVID-19 remaining endemic and requiring ongoing vigilance over the long term, other mechanisms promoting the use of mobile contact tracing apps may be needed, such as offering incentives. As privacy is not an important concern for many users, flexible privacy settings in mobile contact tracing apps allowing users to set their optimal levels of privacy may be appropriate. UR - https://mhealth.jmir.org/2021/9/e26318 UR - http://dx.doi.org/10.2196/26318 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292868 ID - info:doi/10.2196/26318 ER - TY - JOUR AU - Stamenova, Vess AU - Chu, Cherry AU - Pang, Andrea AU - Tadrous, Mina AU - Bhatia, Sacha R. AU - Cram, Peter PY - 2021/9/7 TI - Using Administrative Data to Explore Potentially Aberrant Provision of Virtual Care During COVID-19: Retrospective Cohort Study of Ontario Provincial Data JO - J Med Internet Res SP - e29396 VL - 23 IS - 9 KW - telemedicine KW - virtual care KW - COVID-19 KW - pandemic KW - virtual health KW - telehealth KW - ambulatory visits KW - physicians KW - patients KW - digital health N2 - 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. UR - https://www.jmir.org/2021/9/e29396 UR - http://dx.doi.org/10.2196/29396 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313590 ID - info:doi/10.2196/29396 ER - TY - JOUR AU - Tuck, B. Alison AU - Thompson, J. Renee PY - 2021/9/7 TI - Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study JO - JMIR Form Res SP - e26513 VL - 5 IS - 9 KW - social media KW - social networking sites KW - COVID-19 KW - loneliness KW - well-being N2 - 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 (r64 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 UR - https://www.researchprotocols.org/2021/9/e28337 UR - http://dx.doi.org/10.2196/28337 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292163 ID - info:doi/10.2196/28337 ER - TY - JOUR AU - Quinn, Marie Lauren AU - Olajide, Oluwafumbi AU - Green, Marsha AU - Sayed, Hazem AU - Ansar, Humera PY - 2021/8/31 TI - Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study JO - J Med Internet Res SP - e25549 VL - 23 IS - 8 KW - antenatal KW - virtual clinic KW - technology KW - COVID-19 KW - United Kingdom KW - pandemic KW - feasibility KW - effective KW - telehealth KW - virtual health N2 - 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. UR - https://www.jmir.org/2021/8/e25549 UR - http://dx.doi.org/10.2196/25549 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254940 ID - info:doi/10.2196/25549 ER - TY - JOUR AU - Higashi, T. Robin AU - Sweetenham, W. John AU - Israel, D. Aimee AU - Tiro, A. Jasmin PY - 2021/8/31 TI - COVID-19 Communication From Seven Health Care Institutions in North Texas for English- and Spanish-Speaking Cancer Patients: Mixed Method Website Study JO - JMIR Cancer SP - e30492 VL - 7 IS - 3 KW - COVID-19 KW - coronavirus KW - safety net KW - internet KW - communication N2 - Background: The COVID-19 pandemic has created an urgent need to rapidly disseminate health information, especially to those with cancer, because they face higher morbidity and mortality rates. At the same time, the pandemic?s disproportionate impact on Latinx populations underscores the need for information to reach Spanish speakers. However, the equity of COVID-19 information communicated through institutions? online media to Spanish-speaking cancer patients is unknown. Objective: We conducted a multimodal, mixed method document review study to evaluate the equity of online information about COVID-19 and cancer available to English- and Spanish-speaking populations from seven health care institutions in North Texas, where one in five adults is Spanish-speaking. Our focus was less on the ?digital divide,? which conveys disparities in access to computers and the internet based on the race/ethnicity, education, and income of at-risk populations; rather, our study asks the following question: to what extent is online content useful and culturally appropriate in meeting Spanish speakers? information needs? Methods: We reviewed 50 websites (33 English and 17 Spanish) over a period of 1 week in the middle of May 2020. We sampled seven institutions? main oncology and COVID web pages, and both internal (institutional) and external (noninstitutional) linked content. We conducted several analyses for each sampled page, including (1) thematic content analysis, (2) literacy level analysis using Readability Studio software, (3) coding using the Patient Education and Materials Assessment Tool (PEMAT), and (4) descriptive analysis of video and diversity content. Results: The themes most frequently addressed on English and Spanish websites differed. While ?resources/FAQs? were frequently cited themes on both websites, English websites more frequently addressed ?news/updates? and ?cancer+COVID,? and Spanish websites addressed ?protection? and ?COVID data.? Spanish websites had on average a lower literacy level (11th grade) than English websites (13th grade), although still far above the recommended guideline of 6th to 8th grade. The PEMAT?s overall average accessibility score was the same for English (n=33 pages) and Spanish pages (n=17 pages) at 82%. Among the Dallas-Fort Worth organizations, the average accessibility of Spanish pages (n=7) was slightly lower than that of English pages (n=19) (77% vs 81%), due mostly to the discrepancy in English-only videos and visual aids. Of the 50 websites, 12 (24%) had embedded videos; however, 100% of videos were in English, including one on a Spanish website. Conclusions: We identified an uneven response among the seven health care institutions for providing equitable information to Spanish-speaking Dallas-Fort Worth residents concerned about COVID and cancer. Spanish speakers lack equal access in both diversity of content about COVID-19 and access to other websites, leaving an already vulnerable cancer patient population at greater risk. We recommend several specific actions to enhance content and navigability for Spanish speakers. UR - https://cancer.jmir.org/2021/3/e30492 UR - http://dx.doi.org/10.2196/30492 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346886 ID - info:doi/10.2196/30492 ER - TY - JOUR AU - Worrall, P. Amy AU - Kelly, Claire AU - O'Neill, Aine AU - O'Doherty, Murray AU - Kelleher, Eoin AU - Cushen, Marie Anne AU - McNally, Cora AU - McConkey, Samuel AU - Glavey, Siobhan AU - Lavin, Michelle AU - de Barra, Eoghan PY - 2021/8/31 TI - Online Search Trends Influencing Anticoagulation in Patients With COVID-19: Observational Study JO - JMIR Form Res SP - e21817 VL - 5 IS - 8 KW - COVID-19 KW - coronavirus KW - online search engines KW - anticoagulation KW - thrombosis KW - online influence KW - health information dissemination N2 - 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. UR - https://formative.jmir.org/2021/8/e21817 UR - http://dx.doi.org/10.2196/21817 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292865 ID - info:doi/10.2196/21817 ER - TY - JOUR AU - Kishore, Kamal AU - Jaswal, Vidushi AU - Verma, Madhur AU - Koushal, Vipin PY - 2021/8/30 TI - Exploring the Utility of Google Mobility Data During the COVID-19 Pandemic in India: Digital Epidemiological Analysis JO - JMIR Public Health Surveill SP - e29957 VL - 7 IS - 8 KW - COVID-19 KW - lockdown KW - nonpharmaceutical Interventions KW - social distancing KW - digital surveillance KW - Google Community Mobility Reports KW - community mobility N2 - 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. UR - https://publichealth.jmir.org/2021/8/e29957 UR - http://dx.doi.org/10.2196/29957 UR - http://www.ncbi.nlm.nih.gov/pubmed/34174780 ID - info:doi/10.2196/29957 ER - TY - JOUR AU - Ladapo, A. Joseph AU - Rothwell, T. Jonathan AU - Ramirez, M. Christina PY - 2021/8/30 TI - Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study JO - JMIR Form Res SP - e30164 VL - 5 IS - 8 KW - COVID-19 KW - pandemic KW - mental health KW - public health KW - isolation KW - loneliness KW - guideline KW - risk KW - perception KW - United States KW - health risk KW - well-being N2 - 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. UR - https://formative.jmir.org/2021/8/e30164 UR - http://dx.doi.org/10.2196/30164 UR - http://www.ncbi.nlm.nih.gov/pubmed/34253507 ID - info:doi/10.2196/30164 ER - TY - JOUR AU - Beatty, L. Alexis AU - Peyser, D. Noah AU - Butcher, E. Xochitl AU - Carton, W. Thomas AU - Olgin, E. Jeffrey AU - Pletcher, J. Mark AU - Marcus, M. Gregory PY - 2021/8/30 TI - The COVID-19 Citizen Science Study: Protocol for a Longitudinal Digital Health Cohort Study JO - JMIR Res Protoc SP - e28169 VL - 10 IS - 8 KW - COVID-19 KW - digital technology KW - participant engagement KW - electronic health records KW - mobile app KW - mHealth KW - digital health N2 - 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 UR - https://www.researchprotocols.org/2021/8/e28169 UR - http://dx.doi.org/10.2196/28169 UR - http://www.ncbi.nlm.nih.gov/pubmed/34310336 ID - info:doi/10.2196/28169 ER - TY - JOUR AU - Gmunder, Nicole Kristin AU - Ruiz, W. Jose AU - Franceschi, Dido AU - Suarez, M. Maritza PY - 2021/8/27 TI - Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study JO - JMIR Med Inform SP - e27977 VL - 9 IS - 8 KW - telemedicine KW - COVID-19 KW - patient portals KW - delivery of health care KW - telehealth KW - pandemic KW - digital health N2 - 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. UR - https://medinform.jmir.org/2021/8/e27977 UR - http://dx.doi.org/10.2196/27977 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254936 ID - info:doi/10.2196/27977 ER - TY - JOUR AU - Lapão, Velez Luís AU - Peyroteo, Mariana AU - Maia, Melanie AU - Seixas, Jorge AU - Gregório, João AU - Mira da Silva, Miguel AU - Heleno, Bruno AU - Correia, César Jorge PY - 2021/8/26 TI - Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach JO - J Med Internet Res SP - e24181 VL - 23 IS - 8 KW - primary healthcare KW - information systems KW - telemedicine KW - implementation KW - design science research KW - COVID-19 KW - monitoring KW - chronic disease KW - elderly KW - digital health N2 - 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. UR - https://www.jmir.org/2021/8/e24181 UR - http://dx.doi.org/10.2196/24181 UR - http://www.ncbi.nlm.nih.gov/pubmed/34313591 ID - info:doi/10.2196/24181 ER - TY - JOUR AU - Zhu, Peng Yu AU - Park, Woo Han PY - 2021/8/26 TI - Development of a COVID-19 Web Information Transmission Structure Based on a Quadruple Helix Model: Webometric Network Approach Using Bing JO - J Med Internet Res SP - e27681 VL - 23 IS - 8 KW - quadruple helix model KW - COVID-19 KW - structural analysis KW - content analysis KW - network analysis KW - public health KW - webometrics KW - infodemiology KW - infoveillance KW - development KW - internet KW - online health information KW - structure KW - communication KW - big data N2 - 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. UR - https://www.jmir.org/2021/8/e27681 UR - http://dx.doi.org/10.2196/27681 UR - http://www.ncbi.nlm.nih.gov/pubmed/34280119 ID - info:doi/10.2196/27681 ER - TY - JOUR AU - Deonarine, Andrew AU - Lyons, Genevieve AU - Lakhani, Chirag AU - De Brouwer, Walter PY - 2021/8/26 TI - 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 JO - JMIR Public Health Surveill SP - e26604 VL - 7 IS - 8 KW - COVID-19 KW - satellite imagery KW - built environment KW - social determinants of health KW - machine learning KW - artificial intelligence KW - community KW - risk KW - United States KW - indicator KW - comorbidity KW - environment KW - population KW - determinant KW - mortality KW - prediction N2 - 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. UR - https://publichealth.jmir.org/2021/8/e26604 UR - http://dx.doi.org/10.2196/26604 UR - http://www.ncbi.nlm.nih.gov/pubmed/34280122 ID - info:doi/10.2196/26604 ER - TY - JOUR AU - Bae, Seul Ye AU - Kim, Hwan Kyung AU - Choi, Won Sae AU - Ko, Taehoon AU - Lim, Seo Jun AU - Piao, Meihua PY - 2021/8/26 TI - 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 JO - JMIR Form Res SP - e26227 VL - 5 IS - 8 KW - COVID-19 KW - mobile app KW - telemedicine KW - wearable device KW - vital sign KW - satisfaction KW - usability N2 - 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. UR - https://formative.jmir.org/2021/8/e26227 UR - http://dx.doi.org/10.2196/26227 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254946 ID - info:doi/10.2196/26227 ER - TY - JOUR AU - Neves, Luísa Ana AU - Li, Edmond AU - Serafini, Alice AU - Jimenez, Geronimo AU - Lingner, Heidrun AU - Koskela, H. Tuomas AU - Hoffman, D. Robert AU - Collins, Claire AU - Petek, Davorina AU - Claveria, Ana AU - Tsopra, Rosy AU - Irving, Greg AU - Gusso, Gustavo AU - O?Neill, Gregory Braden AU - Hoedebecke, Kyle AU - Espitia, Milena Sandra AU - Ungan, Mehmet AU - Nessler, Katarzyna AU - Lazic, Vanja AU - Laranjo, Liliana AU - Memarian, Ensieh AU - Fernandez, Jose Maria AU - Ghafur, Saira AU - Fontana, Gianluca AU - Majeed, Azeem AU - Car, Josip AU - Darzi, Ara PY - 2021/8/26 TI - Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study JO - JMIR Res Protoc SP - e30099 VL - 10 IS - 8 KW - primary care KW - telemedicine KW - virtual care KW - digital-first models KW - quality of care KW - patient safety N2 - 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 UR - https://www.researchprotocols.org/2021/8/e30099 UR - http://dx.doi.org/10.2196/30099 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292867 ID - info:doi/10.2196/30099 ER - TY - JOUR AU - Chum, Antony AU - Nielsen, Andrew AU - Bellows, Zachary AU - Farrell, Eddie AU - Durette, Pierre-Nicolas AU - Banda, M. Juan AU - Cupchik, Gerald PY - 2021/8/25 TI - Changes in Public Response Associated With Various COVID-19 Restrictions in Ontario, Canada: Observational Infoveillance Study Using Social Media Time Series Data JO - J Med Internet Res SP - e28716 VL - 23 IS - 8 KW - COVID-19 KW - public opinion KW - social media KW - sentiment analysis KW - public health restrictions KW - infodemiology KW - infoveillance KW - coronavirus KW - evaluation N2 - 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. UR - https://www.jmir.org/2021/8/e28716 UR - http://dx.doi.org/10.2196/28716 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227996 ID - info:doi/10.2196/28716 ER - TY - JOUR AU - Witteveen, Dirk AU - de Pedraza, Pablo PY - 2021/8/18 TI - The Roles of General Health and COVID-19 Proximity in Contact Tracing App Usage: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e27892 VL - 7 IS - 8 KW - COVID-19 KW - contact tracing KW - socioeconomic factors KW - labor market status KW - privacy KW - data sharing KW - pandemic KW - mobile health KW - public health KW - smartphone KW - mobile phone N2 - 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. UR - https://publichealth.jmir.org/2021/8/e27892 UR - http://dx.doi.org/10.2196/27892 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081602 ID - info:doi/10.2196/27892 ER - TY - JOUR AU - Stevens, R. Hannah AU - Acic, Irena AU - Rhea, Sofia PY - 2021/8/17 TI - 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 JO - JMIR Public Health Surveill SP - e29029 VL - 7 IS - 8 KW - COVID-19 KW - natural language processing KW - LGBTQ+ KW - mental health KW - anxiety KW - emotion KW - coronavirus KW - outbreak N2 - 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. UR - https://publichealth.jmir.org/2021/8/e29029 UR - http://dx.doi.org/10.2196/29029 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402803 ID - info:doi/10.2196/29029 ER - TY - JOUR AU - Tozzi, Eugenio Alberto AU - Gesualdo, Francesco AU - Urbani, Emanuele AU - Sbenaglia, Alessandro AU - Ascione, Roberto AU - Procopio, Nicola AU - Croci, Ileana AU - Rizzo, Caterina PY - 2021/8/13 TI - Digital Surveillance Through an Online Decision Support Tool for COVID-19 Over One Year of the Pandemic in Italy: Observational Study JO - J Med Internet Res SP - e29556 VL - 23 IS - 8 KW - COVID-19 KW - public health KW - surveillance KW - digital surveillance KW - internet KW - online decision support system KW - decision support KW - support KW - online tool KW - Italy KW - observational N2 - 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. UR - https://www.jmir.org/2021/8/e29556 UR - http://dx.doi.org/10.2196/29556 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292866 ID - info:doi/10.2196/29556 ER - TY - JOUR AU - Nies, Sarah AU - Patel, Shae AU - Shafer, Melissa AU - Longman, Laura AU - Sharif, Iman AU - Pina, Paulo PY - 2021/8/13 TI - Understanding Physicians? Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e26565 VL - 5 IS - 8 KW - telemedicine KW - federally qualified health care center KW - primary care KW - COVID-19 KW - telehealth KW - physician KW - doctor KW - preference KW - perspective KW - dissemination KW - appropriate KW - cross-sectional KW - survey N2 - 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. UR - https://formative.jmir.org/2021/8/e26565 UR - http://dx.doi.org/10.2196/26565 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227993 ID - info:doi/10.2196/26565 ER - TY - JOUR AU - Beaudoin, E. Christopher AU - Hong, Traci PY - 2021/8/12 TI - Predictors of COVID-19 Preventive Perceptions and Behaviors Among Millennials: Two Cross-sectional Survey Studies JO - J Med Internet Res SP - e30612 VL - 23 IS - 8 KW - COVID-19 KW - coronavirus KW - pandemic KW - preventive perceptions KW - preventive behaviors KW - health information seeking KW - political party identification KW - COVID-19 testing N2 - 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 (?=.22, P<.001), self-efficacy (?=.15, P=.02), and response efficacy (?=.25, P<.001) as well as, at nearing significance, higher perceptions of susceptibility (?=.11, P=.07). In Study 2, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (?=.25, P<.001), susceptibility (?=.14, P<.001), and preventive behaviors (?=.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 (?=?.14, P=.02) and response efficacy (?=?.13, P=.03) and, at nearing significance, lower perceptions of severity (?=?.10, P=.08) and susceptibility (?=?.12, P=.06). In Study 2, respondents who identified as being more Republican had significantly lower perceptions of severity (?=?.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 (?=.17, P=.006) and significantly lower perceptions of severity in Study 2 (?=?.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. UR - https://www.jmir.org/2021/8/e30612 UR - http://dx.doi.org/10.2196/30612 UR - http://www.ncbi.nlm.nih.gov/pubmed/34182460 ID - info:doi/10.2196/30612 ER - TY - JOUR AU - Roghani, Ali PY - 2021/8/12 TI - The Influence of COVID-19 Vaccination on Daily Cases, Hospitalization, and Death Rate in Tennessee, United States: Case Study JO - JMIRx Med SP - e29324 VL - 2 IS - 3 KW - COVID-19 KW - pandemic KW - vaccination KW - vaccine KW - strategy KW - vaccination strategy KW - hospitalization KW - mortality rates KW - older adults KW - mortality N2 - 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. UR - https://med.jmirx.org/2021/3/e29324 UR - http://dx.doi.org/10.2196/29324 UR - http://www.ncbi.nlm.nih.gov/pubmed/34424255 ID - info:doi/10.2196/29324 ER - TY - JOUR AU - Tan, Hao AU - Peng, Sheng-Lan AU - Zhu, Chun-Peng AU - You, Zuo AU - Miao, Ming-Cheng AU - Kuai, Shu-Guang PY - 2021/8/12 TI - Long-term Effects of the COVID-19 Pandemic on Public Sentiments in Mainland China: Sentiment Analysis of Social Media Posts JO - J Med Internet Res SP - e29150 VL - 23 IS - 8 KW - COVID-19 KW - emotional trauma KW - public sentiment on social media KW - long-term effect N2 - 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. UR - https://www.jmir.org/2021/8/e29150 UR - http://dx.doi.org/10.2196/29150 UR - http://www.ncbi.nlm.nih.gov/pubmed/34280118 ID - info:doi/10.2196/29150 ER - TY - JOUR AU - Walia, Bhavneet AU - Shridhar, Anshu AU - Arasu, Pratap AU - Singh, Kaur Gursimar PY - 2021/8/12 TI - US Physicians? Perspective on the Sudden Shift to Telehealth: Survey Study JO - JMIR Hum Factors SP - e26336 VL - 8 IS - 3 KW - physician survey KW - US telehealth training KW - US telehealth care KW - COVID-19 KW - pandemic KW - snowball sampling KW - health care access KW - health care quality KW - telehealth KW - telemedicine KW - survey KW - physician KW - perspective KW - recommendation KW - policy KW - public health KW - implication KW - quality KW - access N2 - Background: Given the sudden shift to telemedicine during the early COVID-19 pandemic, we conducted a survey of practicing physicians? experience with telehealth during the prepandemic and early pandemic periods. Our survey estimates that most patient visits in the United States during the early COVID-19 pandemic period were conducted via telehealth. Given this magnitude and the potential benefits and challenges of telehealth for the US health care system, in this paper, we obtain, summarize, and analyze telehealth views and experiences of US-based practicing-physicians. Objective: The aim of this study was to examine the extent of shift toward telehealth training and care provision during the early pandemic from the US-based practicing physicians? perspective. We also sought to determine the short- and long-term implications of this shift on the quality, access, and mode of US health care delivery. Methods: We conducted a purposive, snowball-sampled survey of US practicing-physicians. A total of 148 physician completed the survey. Data were collected from July 17, 2020, through September 4, 2020. Results: Sample training intensity scaled 21-fold during the early pandemic period, and patient-care visits conducted via telehealth increased, on average, from 13.1% directly before the pandemic to 59.7% during the early pandemic period. Surveyed physician respondents reported that telehealth patient visits and face-to-face patient visits are comparable in quality. The difference was not statistically significant based on a nonparametric sign test (P=.11). Moreover, physicians feel that telehealth care should continue to play a larger role (44.9% of total visits) in postpandemic health care in the United States. Our survey findings suggest a high market concentration in telehealth software, which is a market structural characteristic that may have implications on the cost and access of telehealth. The results varied markedly by physician employer type. Conclusions: During the shift toward telehealth, there has been a considerable discovery among physicians regarding US telehealth physicians. Physicians are now better prepared to undertake telehealth care from a training perspective. They are favorable toward a permanently expanded telehealth role, with potential for enhanced health care access, and the realization of enhanced access may depend on market structural characteristics of telehealth software platforms. UR - https://humanfactors.jmir.org/2021/3/e26336 UR - http://dx.doi.org/10.2196/26336 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938813 ID - info:doi/10.2196/26336 ER - TY - JOUR AU - Liu, Siru AU - Li, Jili AU - Liu, Jialin PY - 2021/8/10 TI - Leveraging Transfer Learning to Analyze Opinions, Attitudes, and Behavioral Intentions Toward COVID-19 Vaccines: Social Media Content and Temporal Analysis JO - J Med Internet Res SP - e30251 VL - 23 IS - 8 KW - vaccine KW - COVID-19 KW - leveraging transfer learning KW - pandemic KW - infodemiology KW - infoveillance KW - public health KW - social media KW - content analysis KW - machine learning KW - online health N2 - 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. UR - https://www.jmir.org/2021/8/e30251 UR - http://dx.doi.org/10.2196/30251 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254942 ID - info:doi/10.2196/30251 ER - TY - JOUR AU - große Deters, Fenne AU - Meier, Tabea AU - Milek, Anne AU - Horn, B. Andrea PY - 2021/8/10 TI - Self-Focused and Other-Focused Health Concerns as Predictors of the Uptake of Corona Contact Tracing Apps: Empirical Study JO - J Med Internet Res SP - e29268 VL - 23 IS - 8 KW - COVID-19 KW - corona contact tracing app KW - digital proximity tracing KW - preventive behavior KW - health concern KW - prosocial motivation KW - public health KW - risk perception, eHealth, Corona-Warn-App KW - SwissCovid KW - contact tracing app KW - contact tracing N2 - 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. UR - https://www.jmir.org/2021/8/e29268 UR - http://dx.doi.org/10.2196/29268 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227995 ID - info:doi/10.2196/29268 ER - TY - JOUR AU - Bauer, Cici AU - Zhang, Kehe AU - Lee, Miryoung AU - Fisher-Hoch, Susan AU - Guajardo, Esmeralda AU - McCormick, Joseph AU - de la Cerda, Isela AU - Fernandez, E. Maria AU - Reininger, Belinda PY - 2021/8/5 TI - Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective JO - JMIR Public Health Surveill SP - e29205 VL - 7 IS - 8 KW - COVID-19 KW - spatial pattern KW - social determinants of health KW - Bayesian KW - underserved population KW - health inequity N2 - 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. UR - https://publichealth.jmir.org/2021/8/e29205 UR - http://dx.doi.org/10.2196/29205 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081608 ID - info:doi/10.2196/29205 ER - TY - JOUR AU - Sajjadi, B. Nicholas AU - Shepard, Samuel AU - Ottwell, Ryan AU - Murray, Kelly AU - Chronister, Justin AU - Hartwell, Micah AU - Vassar, Matt PY - 2021/8/4 TI - Examining the Public?s Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study JO - JMIR Infodemiology SP - e28740 VL - 1 IS - 1 KW - content KW - COVID-19 KW - frequently asked questions KW - internet KW - machine learning KW - natural language processing KW - quality KW - question KW - SARS-CoV-2 KW - search analytics KW - search engine KW - transparency KW - vaccine hesitancy KW - vaccine KW - web-based health information N2 - Background: The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19?related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective: Using Google?s RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods: We searched COVID-19 vaccine terms on Google and used the ?People also ask? box to obtain FAQs generated by Google?s machine learning algorithms. FAQs are assigned an ?answer? source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association?s (JAMA?s) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results: Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine?related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (?24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions: The most frequently asked COVID-19 vaccine?related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine?related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts. UR - https://infodemiology.jmir.org/2021/1/e28740 UR - http://dx.doi.org/10.2196/28740 UR - http://www.ncbi.nlm.nih.gov/pubmed/34458683 ID - info:doi/10.2196/28740 ER - TY - JOUR AU - Masngut, Nasaai AU - Mohamad, Emma PY - 2021/8/4 TI - Association Between Public Opinion and Malaysian Government Communication Strategies About the COVID-19 Crisis: Content Analysis of Image Repair Strategies in Social Media JO - J Med Internet Res SP - e28074 VL - 23 IS - 8 KW - COVID-19 KW - crisis KW - health communication KW - image repair KW - Malaysian government KW - sentiment KW - communication KW - content analysis KW - public opinion KW - social media KW - strategy N2 - 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. UR - https://www.jmir.org/2021/8/e28074 UR - http://dx.doi.org/10.2196/28074 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156967 ID - info:doi/10.2196/28074 ER - TY - JOUR AU - Su, Zhaohui AU - McDonnell, Dean AU - Cheshmehzangi, Ali AU - Li, Xiaoshan AU - Maestro, Daniel AU - ?egalo, Sabina AU - Ahmad, Junaid AU - Hao, Xiaoning PY - 2021/8/4 TI - With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines JO - JMIR Public Health Surveill SP - e26111 VL - 7 IS - 8 KW - COVID-19 KW - coronavirus KW - COVID-19 vaccine KW - made in China KW - vaccine efficacy KW - vaccine safety KW - vaccine KW - China KW - expectation KW - safety KW - efficacy KW - infectious disease KW - public health KW - consequence KW - standard UR - https://publichealth.jmir.org/2021/8/e26111 UR - http://dx.doi.org/10.2196/26111 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560997 ID - info:doi/10.2196/26111 ER - TY - JOUR AU - Hajduczok, G. Alexander AU - DiJoseph, M. Kara AU - Bent, Brinnae AU - Thorp, K. Audrey AU - Mullholand, B. Jon AU - MacKay, A. Stuart AU - Barik, Sabrina AU - Coleman, J. Jamie AU - Paules, I. Catharine AU - Tinsley, Andrew PY - 2021/8/4 TI - Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study JO - JMIR Form Res SP - e28568 VL - 5 IS - 8 KW - COVID-19 KW - wearable devices KW - remote physiologic monitoring KW - heart rate KW - heart rate variability KW - respiratory rate KW - sleep KW - REM sleep KW - deep sleep KW - wearable KW - vaccine KW - monitoring KW - respiratory KW - physiological KW - cohort N2 - 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 UR - https://formative.jmir.org/2021/8/e28568 UR - http://dx.doi.org/10.2196/28568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34236995 ID - info:doi/10.2196/28568 ER - TY - JOUR AU - Beauchamp, R. Mark AU - Hulteen, M. Ryan AU - Ruissen, R. Geralyn AU - Liu, Yan AU - Rhodes, E. Ryan AU - Wierts, M. Colin AU - Waldhauser, J. Katrina AU - Harden, H. Samantha AU - Puterman, Eli PY - 2021/7/30 TI - Online-Delivered Group and Personal Exercise Programs to Support Low Active Older Adults? Mental Health During the COVID-19 Pandemic: Randomized Controlled Trial JO - J Med Internet Res SP - e30709 VL - 23 IS - 7 KW - COVID-19 KW - randomized trial KW - mental health KW - physical activity N2 - Background: In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults. Objective: The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic. Methods: The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ?65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a WLC condition. A total of 241 older adults (n=187 women) provided baseline measures (via online questionnaires), were randomized (ngroup=80, npersonal=82, ncontrol=79), and completed measures every 2 weeks for the duration of the trial. The trial?s primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction, and depression symptoms. Results: The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (P>.05 for all). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (effect size [ES]=0.288-0.601), and although the week 12 effect (ES=0.375) was in the same direction the difference was not statistically significant (P=.089). Participants in the personal condition displayed improved mental health, when compared with WLC participants, in the same medium ES range (ES=0.293-0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES=0.455, P=.069) and 12 (ES=0.258, P=.353), they were not statistically significant. In addition, participants in the group condition displayed improvements in physical health when compared with the WLC (ES=0.079-0.496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (slope P=.271). Conclusions: There were no intervention effects for the trial?s primary outcome (ie, psychological flourishing). It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (ie, potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04412343; https://clinicaltrials.gov/ct2/show/NCT04412343 UR - https://www.jmir.org/2021/7/e30709 UR - http://dx.doi.org/10.2196/30709 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328433 ID - info:doi/10.2196/30709 ER - TY - JOUR AU - Al-Rayes, A. Saja AU - Alumran, Arwa AU - Aljabri, Duaa AU - Aljaffary, Afnan AU - Aldoukhi, Ethar AU - Alahmedalyousif, Zainab AU - Al Madani, Reem PY - 2021/7/30 TI - Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study JO - J Med Internet Res SP - e27618 VL - 23 IS - 7 KW - awareness KW - COVID-19 KW - Kingdom of Saudi Arabia KW - telehealth KW - telemedicine KW - utilization N2 - 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. UR - https://www.jmir.org/2021/7/e27618 UR - http://dx.doi.org/10.2196/27618 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156963 ID - info:doi/10.2196/27618 ER - TY - JOUR AU - Park, Jihwan AU - Han, Jinhyun AU - Kim, Yerin AU - Rho, Jung Mi PY - 2021/7/30 TI - Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study JO - JMIR Med Inform SP - e29315 VL - 9 IS - 7 KW - COVID-19 KW - app-based services KW - acceptance KW - concerns KW - epidemiological investigation, self-route management app, privacy N2 - 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. UR - https://medinform.jmir.org/2021/7/e29315 UR - http://dx.doi.org/10.2196/29315 UR - http://www.ncbi.nlm.nih.gov/pubmed/34137726 ID - info:doi/10.2196/29315 ER - TY - JOUR AU - Davidson, C. Jennifer AU - Karadzhov, Dimitar AU - Wilson, Graham PY - 2021/7/29 TI - Practitioners? and Policymakers? Successes, Challenges, Innovations, and Learning in Promoting Children?s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey JO - JMIR Res Protoc SP - e31013 VL - 10 IS - 7 KW - mobile phones KW - smartphone app KW - qualitative KW - mixed method KW - international KW - survey KW - service providers KW - policy KW - practice KW - children?s rights KW - well-being KW - COVID-19 KW - pandemic KW - app KW - mHealth KW - children N2 - Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children?s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children?s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children?s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners?, managers?, and policymakers? efforts to support children?s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies?the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents? sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 UR - https://www.researchprotocols.org/2021/7/e31013 UR - http://dx.doi.org/10.2196/31013 UR - http://www.ncbi.nlm.nih.gov/pubmed/34323850 ID - info:doi/10.2196/31013 ER - TY - JOUR AU - Shah, Anish AU - Darling, Michele AU - Arstein-Kerslake, Olivia AU - Morgan, Tiffany AU - Vance Tovrea, Aubreen AU - Young, James AU - Laines, Helen PY - 2021/7/29 TI - Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory: Survey Study JO - JMIR Form Res SP - e29952 VL - 5 IS - 7 KW - COVID-19 KW - coronavirus KW - pandemic KW - mental health KW - social isolation KW - wellness N2 - 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 UR - https://formative.jmir.org/2021/7/e29952 UR - http://dx.doi.org/10.2196/29952 UR - http://www.ncbi.nlm.nih.gov/pubmed/34323851 ID - info:doi/10.2196/29952 ER - TY - JOUR AU - Abdulaal, Ahmed AU - Patel, Aatish AU - Al-Hindawi, Ahmed AU - Charani, Esmita AU - Alqahtani, A. Saleh AU - Davies, W. Gary AU - Mughal, Nabeela AU - Moore, Prockter Luke Stephen PY - 2021/7/28 TI - Clinical Utility and Functionality of an Artificial Intelligence?Based App to Predict Mortality in COVID-19: Mixed Methods Analysis JO - JMIR Form Res SP - e27992 VL - 5 IS - 7 KW - app KW - artificial intelligence KW - coronavirus KW - COVID-19 KW - development KW - function KW - graphical user interface KW - machine learning KW - model KW - mortality KW - neural network KW - prediction KW - usability KW - utility N2 - 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. UR - https://formative.jmir.org/2021/7/e27992 UR - http://dx.doi.org/10.2196/27992 UR - http://www.ncbi.nlm.nih.gov/pubmed/34115603 ID - info:doi/10.2196/27992 ER - TY - JOUR AU - Kagawa, Nantamu Mike AU - Chipamaunga, Shalote AU - Prozesky, Detlef AU - Kafumukache, Elliot AU - Gwini, Rudo AU - Kandawasvika, Gwendoline AU - Katowa-Mukwato, Patricia AU - Masanganise, Rangarirai AU - Pretorius, Louise AU - Wessels, Quenton AU - Dithole, S. Kefalotse AU - Marimo, Clemence AU - Mubuuke, Gonzaga Aloysius AU - Mbalinda, Nalugo Scovia AU - van der Merwe, Lynette AU - Nyoni, N. Champion PY - 2021/7/28 TI - 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 JO - JMIR Res Protoc SP - e28905 VL - 10 IS - 7 KW - Africa KW - COVID-19 KW - emergency remote teaching KW - formal online learning KW - pandemic N2 - 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 UR - https://www.researchprotocols.org/2021/7/e28905 UR - http://dx.doi.org/10.2196/28905 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254943 ID - info:doi/10.2196/28905 ER - TY - JOUR AU - Lu, Ding-Heng AU - Hsu, Chia-An AU - Yuan, J. Eunice AU - Fen, Jun-Jeng AU - Lee, Chung-Yuan AU - Ming, Jin-Lain AU - Chen, Tzeng-Ji AU - Lee, Wui-Chiang AU - Chen, Shih-Ann PY - 2021/7/27 TI - Experiences With Internet Triaging of 9498 Outpatients Daily at the Largest Public Hospital in Taiwan During the COVID-19 Pandemic: Observational Study JO - JMIR Med Inform SP - e20994 VL - 9 IS - 7 KW - COVID-19 KW - hospital KW - information services KW - outpatients KW - patient KW - SARS-CoV-2 KW - triage KW - virus N2 - 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. UR - https://medinform.jmir.org/2021/7/e20994 UR - http://dx.doi.org/10.2196/20994 UR - http://www.ncbi.nlm.nih.gov/pubmed/34043524 ID - info:doi/10.2196/20994 ER - TY - JOUR AU - Ong, Triton AU - Wilczewski, Hattie AU - Paige, R. Samantha AU - Soni, Hiral AU - Welch, M. Brandon AU - Bunnell, E. Brian PY - 2021/7/26 TI - Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint JO - JMIR Serious Games SP - e26520 VL - 9 IS - 3 KW - extended reality KW - virtual reality KW - augmented reality KW - mixed reality KW - telehealth KW - telemedicine KW - COVID-19 KW - telepresence UR - https://games.jmir.org/2021/3/e26520 UR - http://dx.doi.org/10.2196/26520 UR - http://www.ncbi.nlm.nih.gov/pubmed/34227992 ID - info:doi/10.2196/26520 ER - TY - JOUR AU - Gupta, K. Agrayan AU - Grannis, J. Shaun AU - Kasthurirathne, N. Suranga PY - 2021/7/26 TI - Evaluation of a Parsimonious COVID-19 Outbreak Prediction Model: Heuristic Modeling Approach Using Publicly Available Data Sets JO - J Med Internet Res SP - e28812 VL - 23 IS - 7 KW - coronavirus KW - COVID-19 KW - emerging outbreak KW - modeling disease outbreak KW - precision public health KW - predictive modeling N2 - 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. UR - https://www.jmir.org/2021/7/e28812 UR - http://dx.doi.org/10.2196/28812 UR - http://www.ncbi.nlm.nih.gov/pubmed/34156964 ID - info:doi/10.2196/28812 ER - TY - JOUR AU - Miyawaki, Atsushi AU - Tabuchi, Takahiro AU - Ong, K. Michael AU - Tsugawa, Yusuke PY - 2021/7/23 TI - Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study JO - J Med Internet Res SP - e27982 VL - 23 IS - 7 KW - telemedicine KW - telehealth KW - disparity KW - access to care KW - COVID-19 KW - Japan N2 - 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. UR - https://www.jmir.org/2021/7/e27982 UR - http://dx.doi.org/10.2196/27982 UR - http://www.ncbi.nlm.nih.gov/pubmed/34259641 ID - info:doi/10.2196/27982 ER - TY - JOUR AU - Scholl, Julia AU - Kohls, Elisabeth AU - Görges, Frauke AU - Steinbrecher, Marc AU - Baldofski, Sabrina AU - Moessner, Markus AU - Rummel-Kluge, Christine PY - 2021/7/23 TI - 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 JO - JMIR Form Res SP - e27865 VL - 5 IS - 7 KW - online KW - group chats KW - COVID-19 pandemic KW - psychiatric outpatient setting KW - online interventions KW - e-mental health KW - COVID-19 KW - pandemic KW - mental health KW - psychoeducation KW - online chat N2 - 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 UR - https://formative.jmir.org/2021/7/e27865 UR - http://dx.doi.org/10.2196/27865 UR - http://www.ncbi.nlm.nih.gov/pubmed/34161252 ID - info:doi/10.2196/27865 ER - TY - JOUR AU - Mhende, Josephine AU - Bell, A. Sharrill AU - Cottrell-Daniels, Cherell AU - Luong, Jackie AU - Streiff, Micah AU - Dannenfelser, Mark AU - Hayat, J. Matthew AU - Spears, Adams Claire PY - 2021/7/23 TI - Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e25926 VL - 5 IS - 7 KW - acceptability KW - addiction KW - African American KW - cessation KW - COVID-19 KW - feasibility KW - income KW - low socioeconomic status KW - mHealth KW - mindfulness KW - minority KW - smoking KW - SMS KW - text messaging KW - treatment N2 - 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 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. UR - https://www.jmir.org/2021/6/e24285 UR - http://dx.doi.org/10.2196/24285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081607 ID - info:doi/10.2196/24285 ER - TY - JOUR AU - Beresford, Thomas AU - Ronan, J. Patrick AU - Hipp, Daniel PY - 2021/6/14 TI - A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series JO - JMIR Form Res SP - e26417 VL - 5 IS - 6 KW - cognition KW - COVID-19 KW - safety KW - remote use KW - delirium KW - brain injury, brain KW - diagnosis KW - assessment KW - test KW - telehealth KW - telemedicine N2 - 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. UR - https://formative.jmir.org/2021/6/e26417 UR - http://dx.doi.org/10.2196/26417 UR - http://www.ncbi.nlm.nih.gov/pubmed/34010137 ID - info:doi/10.2196/26417 ER - TY - JOUR AU - Miao, H. Julia PY - 2021/6/14 TI - Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic JO - JMIR Med Educ SP - e26797 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - medical student KW - community service KW - telemedicine KW - telehealth KW - community outreach KW - peer teaching KW - student-led initiative KW - clinical assessment KW - adaptability KW - team-based learning UR - https://mededu.jmir.org/2021/2/e26797 UR - http://dx.doi.org/10.2196/26797 UR - http://www.ncbi.nlm.nih.gov/pubmed/34061763 ID - info:doi/10.2196/26797 ER - TY - JOUR AU - Neely, Stephen AU - Eldredge, Christina AU - Sanders, Ron PY - 2021/6/11 TI - Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study JO - J Med Internet Res SP - e29802 VL - 23 IS - 6 KW - social media KW - internet KW - communication KW - public health KW - COVID-19 KW - usage KW - United States KW - information seeking KW - web-based health information KW - survey KW - mistrust N2 - 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 (?216=50.790; ?=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. UR - https://www.jmir.org/2021/6/e29802 UR - http://dx.doi.org/10.2196/29802 UR - http://www.ncbi.nlm.nih.gov/pubmed/34043526 ID - info:doi/10.2196/29802 ER - TY - JOUR AU - Willems, H. Sofie AU - Rao, Jyotsna AU - Bhambere, Sailee AU - Patel, Dipu AU - Biggins, Yvonne AU - Guite, W. Jessica PY - 2021/6/11 TI - Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity JO - JMIR Mhealth Uhealth SP - e25021 VL - 9 IS - 6 KW - coronavirus KW - digital health KW - multiplatform KW - chat KW - symptom tracking KW - well-being KW - COVID-19 KW - online platform KW - symptom KW - monitoring KW - follow-up UR - https://mhealth.jmir.org/2021/6/e25021 UR - http://dx.doi.org/10.2196/25021 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033575 ID - info:doi/10.2196/25021 ER - TY - JOUR AU - Quach, Thu AU - Ðoàn, N. Lan AU - Liou, Julia AU - Ponce, A. Ninez PY - 2021/6/11 TI - A Rapid Assessment of the Impact of COVID-19 on Asian Americans: Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e23976 VL - 7 IS - 6 KW - COVID-19 KW - Asian American KW - testing KW - mental health KW - barrier KW - behavior KW - impact KW - discrimination KW - inequality KW - disparity KW - experience KW - COVID KW - violence KW - culture KW - stress KW - anti-Asian violence N2 - 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. UR - https://publichealth.jmir.org/2021/6/e23976 UR - http://dx.doi.org/10.2196/23976 UR - http://www.ncbi.nlm.nih.gov/pubmed/34019478 ID - info:doi/10.2196/23976 ER - TY - JOUR AU - Basch, H. Corey AU - Mohlman, Jan AU - Fera, Joseph AU - Tang, Hao AU - Pellicane, Alessia AU - Basch, E. Charles PY - 2021/6/10 TI - Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study JO - JMIR Public Health Surveill SP - e29528 VL - 7 IS - 6 KW - TikTok KW - social media KW - COVID-19 KW - testing KW - disgust KW - anxiety KW - content analysis KW - communication KW - infodemiology KW - infoveillance KW - public health KW - digital public health KW - digital health KW - community mitigation N2 - 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 (?=.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. UR - https://publichealth.jmir.org/2021/6/e29528 UR - http://dx.doi.org/10.2196/29528 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081591 ID - info:doi/10.2196/29528 ER - TY - JOUR AU - Osmanlliu, Esli AU - Rafie, Edmond AU - Bédard, Sylvain AU - Paquette, Jesseca AU - Gore, Genevieve AU - Pomey, Marie-Pascale PY - 2021/6/9 TI - Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review JO - JMIR Mhealth Uhealth SP - e27102 VL - 9 IS - 6 KW - COVID-19 KW - contact tracing KW - exposure notification KW - app KW - design KW - implementation KW - participatory KW - eHealth KW - surveillance KW - monitoring KW - review N2 - 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. UR - https://mhealth.jmir.org/2021/6/e27102 UR - http://dx.doi.org/10.2196/27102 UR - http://www.ncbi.nlm.nih.gov/pubmed/34038376 ID - info:doi/10.2196/27102 ER - TY - JOUR AU - Moore, C. Ryan AU - Lee, Y. Angela AU - Hancock, T. Jeffrey AU - Halley, C. Meghan AU - Linos, Eleni PY - 2021/6/9 TI - 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 JO - JMIR Hum Factors SP - e26043 VL - 8 IS - 2 KW - COVID-19 KW - natural language processing KW - public health messaging KW - social distancing compliance KW - age differences KW - older adults KW - younger adults KW - age KW - NLP KW - public health KW - elderly KW - youth KW - adult KW - emotion KW - compliance KW - guideline N2 - 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. UR - https://humanfactors.jmir.org/2021/2/e26043 UR - http://dx.doi.org/10.2196/26043 UR - http://www.ncbi.nlm.nih.gov/pubmed/33914689 ID - info:doi/10.2196/26043 ER - TY - JOUR AU - Wu, Xue AU - Nazari, Nabi AU - Griffiths, D. Mark PY - 2021/6/9 TI - Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study JO - J Med Internet Res SP - e26285 VL - 23 IS - 6 KW - COVID-19 KW - cyberchondria KW - COVID-19 fear KW - COVID-19 anxiety KW - anxiety sensitivity KW - anxiety KW - intolerance of uncertainty KW - mental health KW - survey KW - SEM N2 - 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: ?=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: ?=.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 (?=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (?=.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. UR - https://www.jmir.org/2021/6/e26285 UR - http://dx.doi.org/10.2196/26285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34014833 ID - info:doi/10.2196/26285 ER - TY - JOUR AU - Ferreira, Sónia AU - Sousa, Machado Mafalda AU - Moreira, Silva Pedro AU - Sousa, Nuno AU - Picó-Pérez, Maria AU - Morgado, Pedro PY - 2021/6/9 TI - A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study JO - JMIR Public Health Surveill SP - e24312 VL - 7 IS - 6 KW - COVID-19 KW - anxiety KW - coronavirus KW - depression KW - frontline KW - health care professionals KW - health care staff KW - obsessive compulsive disorder KW - SARS-CoV-2 KW - stress N2 - 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 (?=1.1; t=2.5; P=.01) and working at the frontline (?=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 (?=?1.5; t=?2.5; P=.01) and anxiety (?=?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. UR - https://publichealth.jmir.org/2021/6/e24312 UR - http://dx.doi.org/10.2196/24312 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630744 ID - info:doi/10.2196/24312 ER - TY - JOUR AU - Nicolaidou, Iolie AU - Stavrou, Evi AU - Leonidou, Georgia PY - 2021/6/9 TI - Building Primary-School Children?s Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study JO - JMIR Pediatr Parent SP - e27958 VL - 4 IS - 2 KW - COVID-19 KW - interactive learning environment KW - internet-based cognitive behavioral therapy KW - parents KW - prevention intervention KW - primary school children KW - psychological resilience KW - teachers N2 - Background: Resilience is a person?s mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children?s resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program ?Friends,? to overcome accessibility issues associated with delivering cognitive behavioral therapy?based interventions in formal and informal education settings. Objective: This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment?s usability. Methods: A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children?s anxiety symptoms, namely the Greek translation of the original Spence Children?s Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. Results: In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students? reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=?6.99; P<.001), identification of somatic symptoms of stress (t19=?7.31; P<.001), and identification of stress management techniques (t19=?6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. Conclusions: This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access. UR - https://pediatrics.jmir.org/2021/2/e27958 UR - http://dx.doi.org/10.2196/27958 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106080 ID - info:doi/10.2196/27958 ER - TY - JOUR AU - Castro, A. Lauren AU - Shelley, D. Courtney AU - Osthus, Dave AU - Michaud, Isaac AU - Mitchell, Jason AU - Manore, A. Carrie AU - Del Valle, Y. Sara PY - 2021/6/9 TI - How New Mexico Leveraged a COVID-19 Case Forecasting Model to Preemptively Address the Health Care Needs of the State: Quantitative Analysis JO - JMIR Public Health Surveill SP - e27888 VL - 7 IS - 6 KW - COVID-19 KW - forecasting KW - health care KW - prediction KW - forecast KW - model KW - quantitative KW - hospital KW - ICU KW - ventilator KW - intensive care unit KW - probability KW - trend KW - plan N2 - 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. UR - https://publichealth.jmir.org/2021/6/e27888 UR - http://dx.doi.org/10.2196/27888 UR - http://www.ncbi.nlm.nih.gov/pubmed/34003763 ID - info:doi/10.2196/27888 ER - TY - JOUR AU - Ko, Po-Jen AU - Yu, Sheng-Yueh AU - Chang, Chien-Hwa John AU - Hsieh, Ming-Ju AU - Chu, Sung-Yu AU - Tan, Wei-Hwa Jimmy AU - Cheng, Wan-Ling AU - Ho, Pei PY - 2021/6/9 TI - Using a Web-Based Platform as an Alternative for Conducting International, Multidisciplinary Medical Conferences During the Novel COVID-19 Pandemic: Analysis of a Conference JO - JMIR Med Educ SP - e23980 VL - 7 IS - 2 KW - web-based conference KW - live broadcast KW - medical education KW - dialysis access KW - coronavirus KW - COVID-19 KW - conference KW - social media KW - web-based platform KW - internet KW - interaction KW - teleconference N2 - Background: The COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative. Objective: The unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic. Methods: The program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference. Results: We used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90%) were retained in the web-based conference via live broadcasting. The conference was attended by 71% (37/52) of the original international faculties and 71% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92%) were delivered. A special session??Dialysis access management under the impact of viral epidemics??was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively. Conclusions: Switching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic. UR - https://mededu.jmir.org/2021/2/e23980 UR - http://dx.doi.org/10.2196/23980 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970866 ID - info:doi/10.2196/23980 ER - TY - JOUR AU - Guelmami, Noomen AU - Ben Khalifa, Maher AU - Chalghaf, Nasr AU - Kong, Dzevela Jude AU - Amayra, Tannoubi AU - Wu, Jianhong AU - Azaiez, Fairouz AU - Bragazzi, Luigi Nicola PY - 2021/6/9 TI - 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 JO - JMIR Form Res SP - e27280 VL - 5 IS - 6 KW - COVID-19 pandemic KW - media disinformation KW - social media addiction KW - mental health KW - scale validation N2 - 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 ? 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. UR - https://formative.jmir.org/2021/6/e27280 UR - http://dx.doi.org/10.2196/27280 UR - http://www.ncbi.nlm.nih.gov/pubmed/34021742 ID - info:doi/10.2196/27280 ER - TY - JOUR AU - Emard, Nicholas AU - Lynch, A. Kathleen AU - Liou, T. Kevin AU - Atkinson, Thomas AU - Green, K. Angela AU - Daly, Bobby AU - Trevino, Kelly AU - Mao, J. Jun PY - 2021/6/8 TI - Virtual Mind-Body Programming for Patients With Cancer During the COVID-19 Pandemic: Qualitative Study JO - JMIR Cancer SP - e27384 VL - 7 IS - 2 KW - cancer KW - fitness KW - meditation KW - stress KW - COVID-19 KW - qualitative KW - coping KW - wellbeing KW - psychosocial KW - virtual health N2 - 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. UR - https://cancer.jmir.org/2021/2/e27384 UR - http://dx.doi.org/10.2196/27384 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882018 ID - info:doi/10.2196/27384 ER - TY - JOUR AU - Völkel, Gunnar AU - Fürstberger, Axel AU - Schwab, D. Julian AU - Werle, D. Silke AU - Ikonomi, Nensi AU - Gscheidmeier, Thomas AU - Kraus, M. Johann AU - Groß, Alexander AU - Holderried, Martin AU - Balig, Julien AU - Jobst, Franz AU - Kuhn, Peter AU - Kuhn, A. Klaus AU - Kohlbacher, Oliver AU - Kaisers, X. Udo AU - Seufferlein, Thomas AU - Kestler, A. Hans PY - 2021/6/7 TI - Patient Empowerment During the COVID-19 Pandemic by Ensuring Safe and Fast Communication of Test Results: Implementation and Performance of a Tracking System JO - J Med Internet Res SP - e27348 VL - 23 IS - 6 KW - process optimization KW - patient empowerment KW - data security KW - COVID-19 KW - clinical information system KW - platform independent KW - eHealth KW - telemedicine KW - quality management N2 - 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. UR - https://www.jmir.org/2021/6/e27348 UR - http://dx.doi.org/10.2196/27348 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999836 ID - info:doi/10.2196/27348 ER - TY - JOUR AU - O'Connell, James AU - Abbas, Manzar AU - Beecham, Sarah AU - Buckley, Jim AU - Chochlov, Muslim AU - Fitzgerald, Brian AU - Glynn, Liam AU - Johnson, Kevin AU - Laffey, John AU - McNicholas, Bairbre AU - Nuseibeh, Bashar AU - O'Callaghan, Michael AU - O'Keeffe, Ian AU - Razzaq, Abdul AU - Rekanar, Kaavya AU - Richardson, Ita AU - Simpkin, Andrew AU - Storni, Cristiano AU - Tsvyatkova, Damyanka AU - Walsh, Jane AU - Welsh, Thomas AU - O'Keeffe, Derek PY - 2021/6/7 TI - Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature JO - JMIR Mhealth Uhealth SP - e27753 VL - 9 IS - 6 KW - digital contact tracing KW - automated contact tracing KW - COVID-19 KW - SARS-CoV-2 KW - mHealth KW - mobile app KW - app KW - tracing KW - monitoring KW - surveillance KW - review KW - best practice KW - design N2 - 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. UR - https://mhealth.jmir.org/2021/6/e27753 UR - http://dx.doi.org/10.2196/27753 UR - http://www.ncbi.nlm.nih.gov/pubmed/34003764 ID - info:doi/10.2196/27753 ER - TY - JOUR AU - Zhao, Lina AU - Sznajder, Kristin AU - Cheng, Dan AU - Wang, Shimeng AU - Cui, Can AU - Yang, Xiaoshi PY - 2021/6/7 TI - Coping Styles for Mediating the Effect of Resilience on Depression Among Medical Students in Web-Based Classes During the COVID-19 Pandemic: Cross-sectional Questionnaire Study JO - J Med Internet Res SP - e25259 VL - 23 IS - 6 KW - resilience KW - coping styles KW - depression KW - medical students KW - COVID-19 KW - coping KW - mediation KW - web-based education KW - e-learning KW - smartphone KW - cross-sectional N2 - Background: Due to strict, nationwide, comprehensive COVID-19 protective measures, including home quarantine, all Chinese medical students began taking web-based classes beginning in the spring semester of 2020. Home quarantine, web-based classes, and the stress surrounding the COVID-19 pandemic may have triggered an increased incidence of mental health problems among medical students. Although there have been increasing amounts of literature on depression among medical students, studies focusing on positive psychological resources, such as resilience during the COVID-19 pandemic, still need to be expanded. Objective: This study aims to assess depression among medical students who are taking web-based classes during the COVID-19 pandemic and to investigate the role of coping styles as mediators between resilience and depression. Methods: A cross-sectional study of 666 medical students involving stratified sampling in Shenyang, Liaoning Province, China, was completed between March 20 and April 10, 2020. The participants responded to a self-administered, smartphone-based questionnaire, which included the Patient Health Questionnaire-9, Simplified Coping Style Questionnaire, and Ego Resilience 89 Scale. Hierarchical linear regression and structural equation modeling were used in this study. Results: The prevalence of depression among the participants was 9.6% (64/666) in this study. The regression analysis revealed that grade (the year in which the medical student was in training) (P=.013), how well students adapted to web-based classes (P<.001), their levels of resilience (P=.04), and their coping styles were independent predictors for depression (P<.001). Resilience and positive coping styles were negatively related to depression (resilience: P=.04; positive coping styles: P<.001), and negative coping styles were positively related to depression (P<.001). The structural equation modeling analysis showed that the effect of resilience on depression was partially mediated by coping styles (P=.007). Conclusions: In this study, it was found that the prevalence of depression was slightly low and coping styles mediated the association between resilience and depression among medical students during the COVID-19 pandemic. These findings have significant implications for future studies. Future studies and interventions should aim to improve resilience and promote positive coping styles. UR - https://www.jmir.org/2021/6/e25259 UR - http://dx.doi.org/10.2196/25259 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033579 ID - info:doi/10.2196/25259 ER - TY - JOUR AU - Heyen, Marie Janna AU - Weigl, Noé AU - Müller, Mario AU - Müller, Stefan AU - Eberle, Urs AU - Manoliu, Andrei AU - Vetter, Stefan AU - Brown, D. Adam AU - Berger, Thomas AU - Kleim, Birgit PY - 2021/6/7 TI - Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders JO - JMIR Form Res SP - e28055 VL - 5 IS - 6 KW - anxiety KW - COVID-19 KW - electronic mental health KW - feasibility KW - first responder KW - mental health KW - mindfulness KW - resilience KW - self-efficacy KW - sleep quality KW - stress KW - training N2 - 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. UR - https://formative.jmir.org/2021/6/e28055 UR - http://dx.doi.org/10.2196/28055 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999835 ID - info:doi/10.2196/28055 ER - TY - JOUR AU - Mack, L. Dante AU - DaSilva, W. Alex AU - Rogers, Courtney AU - Hedlund, Elin AU - Murphy, I. Eilis AU - Vojdanovski, Vlado AU - Plomp, Jane AU - Wang, Weichen AU - Nepal, K. Subigya AU - Holtzheimer, E. Paul AU - Wagner, D. Dylan AU - Jacobson, C. Nicholas AU - Meyer, L. Meghan AU - Campbell, T. Andrew AU - Huckins, F. Jeremy PY - 2021/6/4 TI - Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II JO - J Med Internet Res SP - e28892 VL - 23 IS - 6 KW - anxiety KW - college KW - COVID-19 KW - COVID fatigue KW - depression KW - George Floyd KW - mobile sensing KW - phone usage KW - sleep KW - digital phenotyping N2 - 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. UR - https://www.jmir.org/2021/6/e28892 UR - http://dx.doi.org/10.2196/28892 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900935 ID - info:doi/10.2196/28892 ER - TY - JOUR AU - Guntuku, Chandra Sharath AU - Purtle, Jonathan AU - Meisel, F. Zachary AU - Merchant, M. Raina AU - Agarwal, Anish PY - 2021/6/3 TI - Partisan Differences in Twitter Language Among US Legislators During the COVID-19 Pandemic: Cross-sectional Study JO - J Med Internet Res SP - e27300 VL - 23 IS - 6 KW - Twitter KW - COVID-19 KW - digital health KW - US legislators KW - natural language processing KW - policy makers KW - social media KW - policy KW - politics KW - language KW - cross-sectional KW - content KW - sentiment KW - infodemiology KW - infoveillance N2 - 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. UR - https://www.jmir.org/2021/6/e27300 UR - http://dx.doi.org/10.2196/27300 UR - http://www.ncbi.nlm.nih.gov/pubmed/33939620 ID - info:doi/10.2196/27300 ER - TY - JOUR AU - Tso, Foon Chak AU - Garikipati, Anurag AU - Green-Saxena, Abigail AU - Mao, Qingqing AU - Das, Ritankar PY - 2021/6/3 TI - Correlation of Population SARS-CoV-2 Cycle Threshold Values to Local Disease Dynamics: Exploratory Observational Study JO - JMIR Public Health Surveill SP - e28265 VL - 7 IS - 6 KW - reverse transcription polymerase chain reaction KW - testing KW - cycle threshold KW - COVID-19 KW - epidemiology KW - Rt KW - exploratory KW - correlation KW - population KW - threshold KW - disease dynamic KW - distribution KW - transmission N2 - 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. UR - https://publichealth.jmir.org/2021/6/e28265 UR - http://dx.doi.org/10.2196/28265 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999831 ID - info:doi/10.2196/28265 ER - TY - JOUR AU - Benoni, Roberto AU - Panunzi, Silvia AU - Campagna, Irene AU - Moretti, Francesca AU - Lo Cascio, Giuliana AU - Spiteri, Gianluca AU - Porru, Stefano AU - Tardivo, Stefano PY - 2021/6/3 TI - The Effect of Test Timing on the Probability of Positive SARS-CoV-2 Swab Test Results: Mixed Model Approach JO - JMIR Public Health Surveill SP - e27189 VL - 7 IS - 6 KW - close contact KW - COVID-19 KW - health care workers KW - health surveillance KW - swab test timing N2 - 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. UR - https://publichealth.jmir.org/2021/6/e27189 UR - http://dx.doi.org/10.2196/27189 UR - http://www.ncbi.nlm.nih.gov/pubmed/34003761 ID - info:doi/10.2196/27189 ER - TY - JOUR AU - Esmaeilzadeh, Pouyan AU - Mirzaei, Tala PY - 2021/6/3 TI - Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran JO - JMIR Med Inform SP - e28497 VL - 9 IS - 6 KW - COVID-19 KW - pandemic KW - clinician burnout KW - electronic health record KW - health information technologies KW - hospital intervention N2 - 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. UR - https://medinform.jmir.org/2021/6/e28497 UR - http://dx.doi.org/10.2196/28497 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033578 ID - info:doi/10.2196/28497 ER - TY - JOUR AU - Krawczyk, Konrad AU - Chelkowski, Tadeusz AU - Laydon, J. Daniel AU - Mishra, Swapnil AU - Xifara, Denise AU - Gibert, Benjamin AU - Flaxman, Seth AU - Mellan, Thomas AU - Schwämmle, Veit AU - Röttger, Richard AU - Hadsund, T. Johannes AU - Bhatt, Samir PY - 2021/6/2 TI - Quantifying Online News Media Coverage of the COVID-19 Pandemic: Text Mining Study and Resource JO - J Med Internet Res SP - e28253 VL - 23 IS - 6 KW - text mining KW - COVID-19 KW - infoveillance KW - sentiment analysis KW - public health N2 - 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. UR - https://www.jmir.org/2021/6/e28253 UR - http://dx.doi.org/10.2196/28253 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900934 ID - info:doi/10.2196/28253 ER - TY - JOUR AU - Kahnbach, Leonie AU - Lehr, Dirk AU - Brandenburger, Jessica AU - Mallwitz, Tim AU - Jent, Sophie AU - Hannibal, Sandy AU - Funk, Burkhardt AU - Janneck, Monique PY - 2021/6/2 TI - Quality and Adoption of COVID-19 Tracing Apps and Recommendations for Development: Systematic Interdisciplinary Review of European Apps JO - J Med Internet Res SP - e27989 VL - 23 IS - 6 KW - COVID-19 KW - contact tracing KW - app-based tracing KW - Mobile App Rating Scale KW - user engagement KW - human?computer interaction N2 - 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. UR - https://www.jmir.org/2021/6/e27989 UR - http://dx.doi.org/10.2196/27989 UR - http://www.ncbi.nlm.nih.gov/pubmed/33890867 ID - info:doi/10.2196/27989 ER - TY - JOUR AU - Zweig, Alison Sophia AU - Zapf, John Alexander AU - Xu, Hanmeng AU - Li, Qingfeng AU - Agarwal, Smisha AU - Labrique, Bernard Alain AU - Peters, H. David PY - 2021/6/2 TI - Impact of Public Health and Social Measures on the COVID-19 Pandemic in the United States and Other Countries: Descriptive Analysis JO - JMIR Public Health Surveill SP - e27917 VL - 7 IS - 6 KW - surveillance KW - COVID-19 KW - public health KW - health policy KW - global health KW - policy KW - epidemiology KW - descriptive epidemiology N2 - 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. UR - https://publichealth.jmir.org/2021/6/e27917 UR - http://dx.doi.org/10.2196/27917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33975277 ID - info:doi/10.2196/27917 ER - TY - JOUR AU - Ross, M. Kathryn AU - Hong, Young-Rock AU - Krukowski, A. Rebecca AU - Miller, R. Darci AU - Lemas, J. Dominick AU - Cardel, I. Michelle PY - 2021/6/2 TI - Acceptability of Research and Health Care Visits During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Form Res SP - e27185 VL - 5 IS - 6 KW - COVID-19 KW - health care access KW - telehealth KW - research recruitment KW - telemedicine KW - belief KW - access KW - willingness KW - cross-sectional KW - survey N2 - 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. UR - https://formative.jmir.org/2021/6/e27185 UR - http://dx.doi.org/10.2196/27185 UR - http://www.ncbi.nlm.nih.gov/pubmed/34033577 ID - info:doi/10.2196/27185 ER - TY - JOUR AU - Afzal, Muhammad AU - Hussain, Maqbool AU - Hussain, Jamil AU - Bang, Jaehun AU - Lee, Sungyoung PY - 2021/6/1 TI - COVID-19 Knowledge Resource Categorization and Tracking: Conceptual Framework Study JO - J Med Internet Res SP - e29730 VL - 23 IS - 6 KW - information organization KW - resource management KW - knowledge graphs KW - interactive dashboard KW - dependency tracking KW - COVID-19 KW - pandemic KW - information technology KW - tracing information KW - dashboards KW - digital health N2 - Background: Since the declaration of COVID-19 as a global pandemic by the World Health Organization, the disease has gained momentum with every passing day. Various private and government sectors of different countries allocated funding for research in multiple capacities. A significant portion of efforts has been devoted to information technology and service infrastructure development, including research on developing intelligent models and techniques for alerts, monitoring, early diagnosis, prevention, and other relevant services. As a result, many information resources have been created globally and are available for use. However, a defined structure to organize these resources into categories based on the nature and origin of the data is lacking. Objective: This study aims to organize COVID-19 information resources into a well-defined structure to facilitate the easy identification of a resource, tracking information workflows, and to provide a guide for a contextual dashboard design and development. Methods: A sequence of action research was performed that involved a review of COVID-19 efforts and initiatives on a global scale during the year 2020. Data were collected according to the defined structure of primary, secondary, and tertiary categories. Various techniques for descriptive statistical analysis were employed to gain insights into the data to help develop a conceptual framework to organize resources and track interactions between different resources. Results: Investigating diverse information at the primary, secondary, and tertiary levels enabled us to develop a conceptual framework for COVID-19?related efforts and initiatives. The framework of resource categorization provides a gateway to access global initiatives with enriched metadata, and assists users in tracking the workflow of tertiary, secondary, and primary resources with relationships between various fragments of information. The results demonstrated mapping initiatives at the tertiary level to secondary level and then to the primary level to reach firsthand data, research, and trials. Conclusions: Adopting the proposed three-level structure allows for a consistent organization and management of existing COVID-19 knowledge resources and provides a roadmap for classifying future resources. This study is one of the earliest studies to introduce an infrastructure for locating and placing the right information at the right place. By implementing the proposed framework according to the stated guidelines, this study allows for the development of applications such as interactive dashboards to facilitate the contextual identification and tracking of interdependent COVID-19 knowledge resources. UR - https://www.jmir.org/2021/6/e29730 UR - http://dx.doi.org/10.2196/29730 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999833 ID - info:doi/10.2196/29730 ER - TY - JOUR AU - Rotter, Dominik AU - Doebler, Philipp AU - Schmitz, Florian PY - 2021/6/1 TI - Interests, Motives, and Psychological Burdens in Times of Crisis and Lockdown: Google Trends Analysis to Inform Policy Makers JO - J Med Internet Res SP - e26385 VL - 23 IS - 6 KW - coronavirus KW - Google Trends KW - infodemiology KW - infoveillance KW - pandemic KW - information search KW - trend KW - COVID-19 KW - burden KW - mental health KW - policy KW - online health information N2 - 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. UR - https://www.jmir.org/2021/6/e26385 UR - http://dx.doi.org/10.2196/26385 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999837 ID - info:doi/10.2196/26385 ER - TY - JOUR AU - Liu, Jialin AU - Liu, Siru AU - Zheng, Tao AU - Bi, Yongdong PY - 2021/6/1 TI - Physicians? Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study JO - JMIR Med Inform SP - e26463 VL - 9 IS - 6 KW - telemedicine KW - COVID-19 KW - survey KW - physician N2 - 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. UR - https://medinform.jmir.org/2021/6/e26463 UR - http://dx.doi.org/10.2196/26463 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945493 ID - info:doi/10.2196/26463 ER - TY - JOUR AU - Zimianiti, Ioanna AU - Thanaraaj, Vyshnavi AU - Watson, Francesca AU - Osibona, Oluwapelumi PY - 2021/6/1 TI - Medical Students Learning on the COVID-19 Front Line JO - JMIR Med Educ SP - e28264 VL - 7 IS - 2 KW - medical education KW - COVID-19 KW - frontline workers KW - medical student KW - viewpoint KW - perspective KW - infectious disease KW - experience KW - barrier KW - motivation UR - https://mededu.jmir.org/2021/2/e28264 UR - http://dx.doi.org/10.2196/28264 UR - http://www.ncbi.nlm.nih.gov/pubmed/34038377 ID - info:doi/10.2196/28264 ER - TY - JOUR AU - Lee, Hyojung AU - Kim, Yeahwon AU - Kim, Eunsu AU - ?Lee, Sunmi PY - 2021/6/1 TI - Risk Assessment of Importation and Local Transmission of COVID-19 in South Korea: Statistical Modeling Approach JO - JMIR Public Health Surveill SP - e26784 VL - 7 IS - 6 KW - COVID-19 KW - transmission dynamics KW - South Korea KW - international travels KW - imported and local transmission KW - basic reproduction number KW - effective reproduction number KW - mitigation intervention strategies KW - risk KW - assessment KW - transmission KW - mitigation KW - strategy KW - travel KW - mobility KW - spread KW - intervention KW - diagnosis KW - monitoring KW - testing N2 - 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 ?=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. UR - https://publichealth.jmir.org/2021/6/e26784 UR - http://dx.doi.org/10.2196/26784 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819165 ID - info:doi/10.2196/26784 ER - TY - JOUR AU - Manjunath, Krishnamurthy Nandi AU - Majumdar, Vijaya AU - Rozzi, Antonietta AU - Huiru, Wang AU - Mishra, Avinash AU - Kimura, Keishin AU - Nagarathna, Raghuram AU - Nagendra, Ramarao Hongasandra PY - 2021/6/1 TI - Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey JO - JMIR Form Res SP - e23630 VL - 5 IS - 6 KW - health behavior KW - self-report KW - cross-national survey KW - COVID-19 KW - behavior KW - perception KW - lifestyle KW - nutrition KW - real-time N2 - 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 (?=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (?=.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. UR - https://formative.jmir.org/2021/6/e23630 UR - http://dx.doi.org/10.2196/23630 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900928 ID - info:doi/10.2196/23630 ER - TY - JOUR AU - Efficace, Fabio AU - Breccia, Massimo AU - Fazi, Paola AU - Cottone, Francesco AU - Holzner, Bernhard AU - Vignetti, Marco PY - 2021/6/1 TI - 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 JO - JMIR Res Protoc SP - e25271 VL - 10 IS - 6 KW - digital health KW - hematology KW - leukemia KW - lymphoma KW - multiple myeloma KW - patient-reported outcomes KW - quality of life KW - symptoms KW - COVID-19 N2 - 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 UR - https://www.researchprotocols.org/2021/6/e25271 UR - http://dx.doi.org/10.2196/25271 UR - http://www.ncbi.nlm.nih.gov/pubmed/33890580 ID - info:doi/10.2196/25271 ER - TY - JOUR AU - Yoon, Sungwon AU - Goh, Hendra AU - Nadarajan, Devi Gayathri AU - Sung, Sharon AU - Teo, Irene AU - Lee, Jungup AU - Ong, H. Marcus E. AU - Graves, Nicholas AU - Teo, Lin Tess PY - 2021/5/31 TI - 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 JO - J Med Internet Res SP - e26282 VL - 23 IS - 5 KW - COVID-19 KW - frontline health care workers KW - mHealth KW - well-being KW - psychosocial N2 - 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. UR - https://www.jmir.org/2021/5/e26282 UR - http://dx.doi.org/10.2196/26282 UR - http://www.ncbi.nlm.nih.gov/pubmed/33979296 ID - info:doi/10.2196/26282 ER - TY - JOUR AU - Bongolan, Pearl Vena AU - Minoza, Antonio Jose Marie AU - de Castro, Romulo AU - Sevilleja, Emmanuel Jesus PY - 2021/5/31 TI - Age-Stratified Infection Probabilities Combined With a Quarantine-Modified Model for COVID-19 Needs Assessments: Model Development Study JO - J Med Internet Res SP - e19544 VL - 23 IS - 5 KW - COVID-19 KW - epidemic modeling KW - age stratification theory KW - infection probability KW - SEIR KW - mathematical modelling N2 - 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. UR - https://www.jmir.org/2021/5/e19544 UR - http://dx.doi.org/10.2196/19544 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900929 ID - info:doi/10.2196/19544 ER - TY - JOUR AU - Detweiler Guarino, Isadora AU - Cowan, R. Devin AU - Fellows, M. Abigail AU - Buckey, C. Jay PY - 2021/5/31 TI - Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study JO - JMIR Form Res SP - e26989 VL - 5 IS - 5 KW - computerized cognitive behavioral therapy KW - interactive media KW - COVID-19 KW - computer-based therapy KW - usability KW - acceptability KW - cognitive behavioral therapy KW - therapy KW - effectiveness KW - digital health KW - depression KW - stress N2 - Background: Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic. Objective: The primary aim is to determine users? levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions. Methods: Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time. Results: A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two. Conclusions: Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions. Trial Registration: ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061 UR - https://formative.jmir.org/2021/5/e26989 UR - http://dx.doi.org/10.2196/26989 UR - http://www.ncbi.nlm.nih.gov/pubmed/33973856 ID - info:doi/10.2196/26989 ER - TY - JOUR AU - Gios, Lorenzo AU - Crema Falceri, Giulia AU - Micocci, Stefano AU - Patil, Luigi AU - Testa, Sara AU - Sforzin, Simona AU - Turra, Ettore AU - Conforti, Diego AU - Malfatti, Giulia AU - Moz, Monica AU - Nicolini, Andrea AU - Guarda, Paolo AU - Bacchiega, Alessandro AU - Mion, Carlo AU - Marchesoni, Michele AU - Maimone, Rosa AU - Molini, Benedetto Pietro AU - Zanella, Alberto AU - Osmani, Venet AU - Mayora-Ibarra, Oscar AU - Forti, Stefano PY - 2021/5/31 TI - 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 JO - JMIR Form Res SP - e25713 VL - 5 IS - 5 KW - telemedicine KW - telemonitoring KW - quarantine management KW - COVID-19 KW - connected care N2 - 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. UR - https://formative.jmir.org/2021/5/e25713 UR - http://dx.doi.org/10.2196/25713 UR - http://www.ncbi.nlm.nih.gov/pubmed/33909586 ID - info:doi/10.2196/25713 ER - TY - JOUR AU - Gabrielli, Silvia AU - Rizzi, Silvia AU - Bassi, Giulia AU - Carbone, Sara AU - Maimone, Rosa AU - Marchesoni, Michele AU - Forti, Stefano PY - 2021/5/28 TI - Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study JO - JMIR Mhealth Uhealth SP - e27965 VL - 9 IS - 5 KW - mobile mental health KW - chatbots KW - anxiety KW - stress KW - university students KW - digital health KW - healthy-coping intervention KW - COVID-19 N2 - Background: University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. Objective: The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. Methods: In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale?Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. Results: Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. Conclusions: This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions. UR - https://mhealth.jmir.org/2021/5/e27965 UR - http://dx.doi.org/10.2196/27965 UR - http://www.ncbi.nlm.nih.gov/pubmed/33950849 ID - info:doi/10.2196/27965 ER - TY - JOUR AU - Majam, Mohammed AU - Msolomba, Vanessa AU - Scott, Lesley AU - Stevens, Wendy AU - Marange, Fadzai AU - Kahamba, Trish AU - Venter, Francois AU - Conserve, Fadael Donaldson PY - 2021/5/28 TI - Self-Sampling for SARS-CoV-2 Diagnostic Testing by Using Nasal and Saliva Specimens: Protocol for Usability and Clinical Evaluation JO - JMIR Res Protoc SP - e24811 VL - 10 IS - 5 KW - SARS-CoV-2 KW - SARS-CoV-2SS KW - testing KW - COVID-19 KW - South Africa KW - usabillity KW - self-sampling KW - diagnostic KW - sensitivity KW - specificity N2 - 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 UR - https://www.researchprotocols.org/2021/5/e24811 UR - http://dx.doi.org/10.2196/24811 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882023 ID - info:doi/10.2196/24811 ER - TY - JOUR AU - Balaji, Aanika AU - Clever, Lou Sarah PY - 2021/5/28 TI - Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial JO - JMIR Med Educ SP - e24300 VL - 7 IS - 2 KW - medical student KW - education KW - primary care KW - telehealth KW - video visits KW - internal medicine KW - medical education KW - teleconsultation KW - digital health KW - COVID-19 N2 - Background: The COVID-19 pandemic has brought about sweeping change in health care delivery, which has shifted from in-person consultations to a web-based format. Few medical schools provide web-based medicine or telemedicine training to their learners, though this is likely to be important for future medical practice. Objective: This tutorial communicates a framework for incorporating medical students into primary care telemedicine clinics. Methods: A third-year medical student and internal medicine attending physician from the Johns Hopkins University completed telemedicine clinic visits in April 2020 by using a variety of video platforms and via telephone calls. Results: Nine telemedicine visits were completed over 4 clinic days. Our patients were, on average, aged 68 years. The majority of patients were female (6/9, 67%), and most appointments were completed via a video platform (6/9, 67%). Additionally, our experience is summarized and describe (1) practical tips for how to prepare for a telehealth visit; (2) technology considerations; (3) recommendations for participation during a telehealth visit; (4) debriefing and feedback; (5) challenges to care; and (6) student, care provider, and patient reactions to telemedicine visits. Conclusions: Telemedicine clinics have been successfully used for managing patients with chronic conditions, those who have attended low-risk urgent care visits, and those with mental health concerns. Patients have reported high patient satisfaction scores for telemedicine visits, and the majority of patients are comfortable with having medical students as part of their care team. Moving forward, telemedicine will remain a popular method for receiving health care. This study has highlighted that medical students can successfully be integrated into telemedicine clinics and that they should be exposed to telehealth whenever possible prior to residency. UR - https://mededu.jmir.org/2021/2/e24300 UR - http://dx.doi.org/10.2196/24300 UR - http://www.ncbi.nlm.nih.gov/pubmed/33974552 ID - info:doi/10.2196/24300 ER - TY - JOUR AU - Sweeney-Reed, M. Catherine AU - Wolff, Doreen AU - Niggel, Jakob AU - Kabesch, Michael AU - Apfelbacher, Christian PY - 2021/5/28 TI - Pool Testing as a Strategy for Prevention of SARS-CoV-2 Outbreaks in Schools: Protocol for a Feasibility Study JO - JMIR Res Protoc SP - e28673 VL - 10 IS - 5 KW - SARS-CoV-2 KW - COVID-19 KW - schools KW - pool testing KW - gargle test KW - test strategy KW - monitoring KW - surveillance KW - PCR N2 - 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 UR - https://www.researchprotocols.org/2021/5/e28673 UR - http://dx.doi.org/10.2196/28673 UR - http://www.ncbi.nlm.nih.gov/pubmed/33979297 ID - info:doi/10.2196/28673 ER - TY - JOUR AU - Benito-León, Julián AU - del Castillo, Dolores M. ª. AU - Estirado, Alberto AU - Ghosh, Ritwik AU - Dubey, Souvik AU - Serrano, Ignacio J. PY - 2021/5/27 TI - Using Unsupervised Machine Learning to Identify Age- and Sex-Independent Severity Subgroups Among Patients with COVID-19: Observational Longitudinal Study JO - J Med Internet Res SP - e25988 VL - 23 IS - 5 KW - COVID-19 KW - machine learning KW - outcome KW - severity KW - subgroup KW - emergency KW - detection KW - intervention KW - testing KW - data set KW - characterization N2 - 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. UR - https://www.jmir.org/2021/5/e25988 UR - http://dx.doi.org/10.2196/25988 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872186 ID - info:doi/10.2196/25988 ER - TY - JOUR AU - Akhtar, Hashaam AU - Akhtar, Samar AU - Rahman, Fazal-Ul AU - Afridi, Maham AU - Khalid, Sundas AU - Ali, Sabahat AU - Akhtar, Nasim AU - Khader, S. Yousef AU - Ahmad, Hamaad AU - Khan, Mujeeb Muhammad PY - 2021/5/27 TI - An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e28594 VL - 7 IS - 5 KW - COVID-19 KW - antibiotics KW - Pakistan KW - multidrug resistant infections KW - antibiotic resistance KW - first wave N2 - 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. UR - https://publichealth.jmir.org/2021/5/e28594 UR - http://dx.doi.org/10.2196/28594 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945498 ID - info:doi/10.2196/28594 ER - TY - JOUR AU - Ibrahim, Ahmed AU - Zhang, Heng AU - Clinch, Sarah AU - Poliakoff, Ellen AU - Parsia, Bijan AU - Harper, Simon PY - 2021/5/27 TI - Digital Phenotypes for Understanding Individuals' Compliance With COVID-19 Policies and Personalized Nudges: Longitudinal Observational Study JO - JMIR Form Res SP - e23461 VL - 5 IS - 5 KW - behavior KW - compliance KW - COVID-19 KW - digital phenotyping KW - nudges KW - personalization KW - policy KW - sensor KW - smartphone N2 - 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. UR - https://formative.jmir.org/2021/5/e23461 UR - http://dx.doi.org/10.2196/23461 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999832 ID - info:doi/10.2196/23461 ER - TY - JOUR AU - Hou, Zhiyuan AU - Song, Suhang AU - Du, Fanxing AU - Shi, Lu AU - Zhang, Donglan AU - Lin, Leesa AU - Yu, Hongjie PY - 2021/5/26 TI - The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study JO - JMIR Public Health Surveill SP - e26372 VL - 7 IS - 5 KW - COVID-19 KW - prevention KW - vaccination KW - behavior KW - children KW - China N2 - 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. UR - https://publichealth.jmir.org/2021/5/e26372 UR - http://dx.doi.org/10.2196/26372 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882450 ID - info:doi/10.2196/26372 ER - TY - JOUR AU - Izquierdo, Luis Jose AU - Soriano, B. Joan PY - 2021/5/26 TI - Authors? Reply to: Minimizing Selection and Classification Biases Comment on ?Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing? JO - J Med Internet Res SP - e29405 VL - 23 IS - 5 KW - artificial intelligence KW - big data KW - COVID-19 KW - electronic health records KW - tachypnea KW - SARS-CoV-2 KW - predictive model KW - prognosis KW - classification bias KW - critical care UR - https://www.jmir.org/2021/5/e29405 UR - http://dx.doi.org/10.2196/29405 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989164 ID - info:doi/10.2196/29405 ER - TY - JOUR AU - Martos Pérez, Francisco AU - Gomez Huelgas, Ricardo AU - Martín Escalante, Dolores María AU - Casas Rojo, Manuel José PY - 2021/5/26 TI - Minimizing Selection and Classification Biases. Comment on ?Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing? JO - J Med Internet Res SP - e27142 VL - 23 IS - 5 KW - artificial intelligence KW - big data KW - COVID-19 KW - electronic health records KW - tachypnea KW - SARS-CoV-2 KW - predictive model KW - prognosis KW - classification bias KW - critical care UR - https://www.jmir.org/2021/5/e27142 UR - http://dx.doi.org/10.2196/27142 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989163 ID - info:doi/10.2196/27142 ER - TY - JOUR AU - Singh, Laura AU - Kanstrup, Marie AU - Depa, Katherine AU - Falk, Ann-Charlotte AU - Lindström, Veronica AU - Dahl, Oili AU - Göransson, E. Katarina AU - Rudman, Ann AU - Holmes, A. Emily PY - 2021/5/26 TI - Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses JO - JMIR Form Res SP - e27473 VL - 5 IS - 5 KW - intrusive memories KW - psychological trauma KW - prevention KW - pilot trial KW - COVID-19 KW - digital intervention KW - remote delivery KW - cognitive science KW - person-based approach KW - mixed methods KW - co-design KW - health care staff N2 - 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. UR - https://formative.jmir.org/2021/5/e27473 UR - http://dx.doi.org/10.2196/27473 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886490 ID - info:doi/10.2196/27473 ER - TY - JOUR AU - Larimer, Karen AU - Wegerich, Stephan AU - Splan, Joel AU - Chestek, David AU - Prendergast, Heather AU - Vanden Hoek, Terry PY - 2021/5/26 TI - 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 JO - JMIR Res Protoc SP - e27271 VL - 10 IS - 5 KW - analytic KW - artificial intelligence KW - biomarker KW - cloud KW - COVID-19 KW - decompensation KW - detection KW - development KW - index KW - monitoring KW - outcome KW - remote monitoring KW - symptom validation KW - wearable N2 - 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 (?=.05; power [1??]=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 UR - https://www.researchprotocols.org/2021/5/e27271 UR - http://dx.doi.org/10.2196/27271 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949966 ID - info:doi/10.2196/27271 ER - TY - JOUR AU - Gao, Yang AU - Zhong, D. Linda L. AU - Quach, Binh AU - Davies, Bruce AU - Ash, I. Garrett AU - Lin, Zhi-Xiu AU - Feng, Yibin AU - Lau, M. Benson W. AU - Wagner, D. Peter AU - Yang, Xian AU - Guo, Yike AU - Jia, Wei AU - Bian, Zhaoxiang AU - Baker, S. Julien PY - 2021/5/26 TI - COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study JO - JMIR Res Protoc SP - e25556 VL - 10 IS - 5 KW - COVID-19 KW - rehabilitation KW - cardiorespiratory exercise KW - Chinese medicine N2 - 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 ? 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 UR - https://www.researchprotocols.org/2021/5/e25556 UR - http://dx.doi.org/10.2196/25556 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970864 ID - info:doi/10.2196/25556 ER - TY - JOUR AU - Daughton, R. Ashlynn AU - Shelley, D. Courtney AU - Barnard, Martha AU - Gerts, Dax AU - Watson Ross, Chrysm AU - Crooker, Isabel AU - Nadiga, Gopal AU - Mukundan, Nilesh AU - Vaquera Chavez, Yadira Nidia AU - Parikh, Nidhi AU - Pitts, Travis AU - Fairchild, Geoffrey PY - 2021/5/25 TI - Mining and Validating Social Media Data for COVID-19?Related Human Behaviors Between January and July 2020: Infodemiology Study JO - J Med Internet Res SP - e27059 VL - 23 IS - 5 KW - Twitter KW - social media KW - human behavior KW - infectious disease KW - COVID-19 KW - coronavirus KW - infodemiology KW - infoveillance KW - social distancing KW - shelter-in-place KW - mobility KW - COVID-19 intervention N2 - 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. UR - https://www.jmir.org/2021/5/e27059 UR - http://dx.doi.org/10.2196/27059 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882015 ID - info:doi/10.2196/27059 ER - TY - JOUR AU - Yang, Xue AU - Yip, K. Benjamin H. AU - Mak, P. Arthur D. AU - Zhang, Dexing AU - Lee, P. Eric K. AU - Wong, S. Samuel Y. PY - 2021/5/25 TI - The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study JO - JMIR Public Health Surveill SP - e24623 VL - 7 IS - 5 KW - social media KW - depression KW - suicidal ideation KW - social loneliness KW - posttraumatic stress KW - suicide KW - mental health KW - COVID-19 KW - loneliness KW - age KW - mediation N2 - Background: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. Objective: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. Methods: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. Results: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (?262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (?234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (?=?.07; P=.04) but not among younger people (?=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (?=.09; P=.02) and older people (?=.10; P=.01). The indirect effect via social loneliness was significant among older people (?=?.01; P=.04) but not among younger people (?=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (?=.02; P=.04) and older people (?=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Conclusions: Social media may be a ?double-edged sword? for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic. UR - https://publichealth.jmir.org/2021/5/e24623 UR - http://dx.doi.org/10.2196/24623 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835937 ID - info:doi/10.2196/24623 ER - TY - JOUR AU - Espinosa-Gonzalez, Belen Ana AU - Neves, Luisa Ana AU - Fiorentino, Francesca AU - Prociuk, Denys AU - Husain, Laiba AU - Ramtale, Christian Sonny AU - Mi, Emma AU - Mi, Ella AU - Macartney, Jack AU - Anand, N. Sneha AU - Sherlock, Julian AU - Saravanakumar, Kavitha AU - Mayer, Erik AU - de Lusignan, Simon AU - Greenhalgh, Trisha AU - Delaney, C. Brendan PY - 2021/5/25 TI - 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 JO - JMIR Res Protoc SP - e29072 VL - 10 IS - 5 KW - COVID-19 severity KW - risk prediction tool KW - early warning score KW - hospital admission KW - primary care KW - electronic health records N2 - 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 UR - https://www.researchprotocols.org/2021/5/e29072 UR - http://dx.doi.org/10.2196/29072 UR - http://www.ncbi.nlm.nih.gov/pubmed/33939619 ID - info:doi/10.2196/29072 ER - TY - JOUR AU - Diniz, Grilo Carmen Simone AU - Franzon, Arruda Ana Carolina AU - Fioretti-Foschi, Beatriz AU - Niy, Yoshie Denise AU - Pedrilio, Sanches Livia AU - Amaro Jr, Edson AU - Sato, Ricardo João PY - 2021/5/21 TI - 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 JO - JMIR Res Protoc SP - e25016 VL - 10 IS - 5 KW - app KW - childbirth KW - communication KW - COVID-19 KW - health literacy KW - informatics KW - internet KW - intervention KW - maternal health KW - neonatal health KW - neonate public health KW - society KW - technology KW - women N2 - 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 UR - https://www.researchprotocols.org/2021/5/e25016 UR - http://dx.doi.org/10.2196/25016 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945496 ID - info:doi/10.2196/25016 ER - TY - JOUR AU - Wang, Cuiyan AU - López-Núñez, Inmaculada María AU - Pan, Riyu AU - Wan, Xiaoyang AU - Tan, Yilin AU - Xu, Linkang AU - Choo, Faith AU - Ho, Roger AU - Ho, Cyrus AU - Aparicio García, E. Marta PY - 2021/5/21 TI - The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study JO - JMIR Form Res SP - e27818 VL - 5 IS - 5 KW - anxiety KW - China KW - coronavirus KW - COVID-19 KW - depression KW - developing countries KW - knowledge KW - masks KW - pandemic KW - physical KW - precaution KW - psychological impact KW - Spain KW - stress N2 - 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. UR - https://formative.jmir.org/2021/5/e27818 UR - http://dx.doi.org/10.2196/27818 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900933 ID - info:doi/10.2196/27818 ER - TY - JOUR AU - Munsch, Nicolas AU - Martin, Alistair AU - Gruarin, Stefanie AU - Nateqi, Jama AU - Abdarahmane, Isselmou AU - Weingartner-Ortner, Rafael AU - Knapp, Bernhard PY - 2021/5/21 TI - Authors? Reply to: Screening Tools: Their Intended Audiences and Purposes. Comment on ?Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study? JO - J Med Internet Res SP - e26543 VL - 23 IS - 5 KW - COVID-19 KW - symptom checkers KW - benchmark KW - digital health KW - symptom KW - chatbot KW - accuracy UR - https://www.jmir.org/2021/5/e26543 UR - http://dx.doi.org/10.2196/26543 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989162 ID - info:doi/10.2196/26543 ER - TY - JOUR AU - Millen, Elizabeth AU - Gilsdorf, Andreas AU - Fenech, Matthew AU - Gilbert, Stephen PY - 2021/5/21 TI - Screening Tools: Their Intended Audiences and Purposes. Comment on ?Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study? JO - J Med Internet Res SP - e26148 VL - 23 IS - 5 KW - COVID-19 KW - symptom checkers KW - benchmark KW - digital health KW - symptom KW - chatbot KW - accuracy UR - https://www.jmir.org/2021/5/e26148 UR - http://dx.doi.org/10.2196/26148 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989169 ID - info:doi/10.2196/26148 ER - TY - JOUR AU - Tao, Zhuo-Ying AU - Su, Yu-Xiong PY - 2021/5/21 TI - 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? JO - J Med Internet Res SP - e29145 VL - 23 IS - 5 KW - COVID-19 KW - dentistry KW - oral health KW - dental health KW - online health KW - social media KW - tweet KW - Weibo KW - China KW - health information UR - https://www.jmir.org/2021/5/e29145 UR - http://dx.doi.org/10.2196/29145 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989166 ID - info:doi/10.2196/29145 ER - TY - JOUR AU - Yadav, Prakash Om PY - 2021/5/21 TI - 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? JO - J Med Internet Res SP - e26255 VL - 23 IS - 5 KW - COVID-19 KW - dentistry KW - oral health KW - dental health KW - online health KW - social media KW - tweet KW - Weibo KW - China KW - health information UR - https://www.jmir.org/2021/5/e26255 UR - http://dx.doi.org/10.2196/26255 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989161 ID - info:doi/10.2196/26255 ER - TY - JOUR AU - Yu, Cheng-Sheng AU - Chang, Shy-Shin AU - Chang, Tzu-Hao AU - Wu, L. Jenny AU - Lin, Yu-Jiun AU - Chien, Hsiung-Fei AU - Chen, Ray-Jade PY - 2021/5/20 TI - A COVID-19 Pandemic Artificial Intelligence?Based System With Deep Learning Forecasting and Automatic Statistical Data Acquisition: Development and Implementation Study JO - J Med Internet Res SP - e27806 VL - 23 IS - 5 KW - COVID-19 KW - artificial intelligence KW - time series KW - deep learning KW - machine learning KW - statistical analysis KW - pandemic KW - data visualization N2 - 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. UR - https://www.jmir.org/2021/5/e27806 UR - http://dx.doi.org/10.2196/27806 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900932 ID - info:doi/10.2196/27806 ER - TY - JOUR AU - Älgå, Andreas AU - Eriksson, Oskar AU - Nordberg, Martin PY - 2021/5/20 TI - Authors' Reply to: COVID-19 as a ?Force Majeure? for Non?COVID-19 Clinical and Translational Research. Comment on ?Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study? JO - J Med Internet Res SP - e29156 VL - 23 IS - 5 KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - pandemic KW - topic modeling KW - research KW - literature KW - medical research KW - publishing KW - force majeure UR - https://www.jmir.org/2021/5/e29156 UR - http://dx.doi.org/10.2196/29156 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989170 ID - info:doi/10.2196/29156 ER - TY - JOUR AU - Milovanovic, Petar AU - Dumic, Igor PY - 2021/5/20 TI - COVID-19 as a ?Force Majeure? for Non?COVID-19 Clinical and Translational Research. Comment on ?Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study? JO - J Med Internet Res SP - e27937 VL - 23 IS - 5 KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - pandemic KW - topic modeling KW - research KW - literature KW - medical research KW - publishing KW - force majeure UR - https://www.jmir.org/2021/5/e27937 UR - http://dx.doi.org/10.2196/27937 UR - http://www.ncbi.nlm.nih.gov/pubmed/33989167 ID - info:doi/10.2196/27937 ER - TY - JOUR AU - Vilendrer, Stacie AU - Amano, Alexis AU - Brown Johnson, G. Cati AU - Favet, Marissa AU - Safaeinili, Nadia AU - Villasenor, Jacqueline AU - Shaw, G. Jonathan AU - Hertelendy, J. Attila AU - Asch, M. Steven AU - Mahoney, Megan PY - 2021/5/20 TI - An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study JO - J Med Internet Res SP - e26573 VL - 23 IS - 5 KW - COVID-19 KW - pandemic KW - health literacy KW - social media KW - quality improvement KW - police KW - emergency responders KW - physicians KW - disasters KW - natural disasters KW - health behavior KW - literacy KW - app KW - intervention KW - adoption KW - accessibility KW - usability KW - support KW - testing N2 - Background: The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app?based interventions is lacking. Objective: We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center?sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19?related needs of these workers early in the pandemic. Methods: To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework. Results: From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a ?culture of heroism? that could both protect against and exacerbate health vulnerability. Conclusions: First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non?first responder essential workers may optimize acceptance and adoption. UR - https://www.jmir.org/2021/5/e26573 UR - http://dx.doi.org/10.2196/26573 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878023 ID - info:doi/10.2196/26573 ER - TY - JOUR AU - Dixon, E. Brian AU - Mukherjee, Sumit AU - Wiensch, Ashley AU - Gray, L. Mary AU - Ferres, Lavista Juan M. AU - Grannis, J. Shaun PY - 2021/5/20 TI - Capturing COVID-19?Like Symptoms at Scale Using Banner Ads on an Online News Platform: Pilot Survey Study JO - J Med Internet Res SP - e24742 VL - 23 IS - 5 KW - COVID-19 KW - coronavirus KW - epidemiology KW - research subject recruitment KW - signs and symptoms N2 - Background: Identifying new COVID-19 cases is challenging. Not every suspected case undergoes testing, because testing kits and other equipment are limited in many parts of the world. Yet populations increasingly use the internet to manage both home and work life during the pandemic, giving researchers mediated connections to millions of people sheltering in place. Objective: The goal of this study was to assess the feasibility of using an online news platform to recruit volunteers willing to report COVID-19?like symptoms and behaviors. Methods: An online epidemiologic survey captured COVID-19?related symptoms and behaviors from individuals recruited through banner ads offered through Microsoft News. Respondents indicated whether they were experiencing symptoms, whether they received COVID-19 testing, and whether they traveled outside of their local area. Results: A total of 87,322 respondents completed the survey across a 3-week span at the end of April 2020, with 54.3% of the responses from the United States and 32.0% from Japan. Of the total respondents, 19,631 (22.3%) reported at least one symptom associated with COVID-19. Nearly two-fifths of these respondents (39.1%) reported more than one COVID-19?like symptom. Individuals who reported being tested for COVID-19 were significantly more likely to report symptoms (47.7% vs 21.5%; P<.001). Symptom reporting rates positively correlated with per capita COVID-19 testing rates (R2=0.26; P<.001). Respondents were geographically diverse, with all states and most ZIP Codes represented. More than half of the respondents from both countries were older than 50 years of age. Conclusions: News platforms can be used to quickly recruit study participants, enabling collection of infectious disease symptoms at scale and with populations that are older than those found through social media platforms. Such platforms could enable epidemiologists and researchers to quickly assess trends in emerging infections potentially before at-risk populations present to clinics and hospitals for testing and/or treatment. UR - https://www.jmir.org/2021/5/e24742 UR - http://dx.doi.org/10.2196/24742 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872190 ID - info:doi/10.2196/24742 ER - TY - JOUR AU - Stevens, P. Jennifer AU - Mechanic, Oren AU - Markson, Lawrence AU - O'Donoghue, Ashley AU - Kimball, B. Alexa PY - 2021/5/20 TI - Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study JO - J Med Internet Res SP - e23905 VL - 23 IS - 5 KW - access KW - barrier KW - cohort KW - COVID-19 KW - demographic KW - equity of care KW - equity KW - outpatient KW - telehealth N2 - Background: During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. Objective: Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. Methods: Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. Results: At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. Conclusions: Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities. UR - https://www.jmir.org/2021/5/e23905 UR - http://dx.doi.org/10.2196/23905 UR - http://www.ncbi.nlm.nih.gov/pubmed/33974549 ID - info:doi/10.2196/23905 ER - TY - JOUR AU - Godoy, Barros Ivan Rodrigues AU - Neto, Pecci Luís AU - Skaf, Abdalla AU - Leão-Filho, Muniz Hilton AU - Freddi, Lourenço Tomás De Andrade AU - Jasinowodolinski, Dany AU - Yamada, Fukunishi André PY - 2021/5/20 TI - Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study JO - JMIR Med Educ SP - e28733 VL - 7 IS - 2 KW - audiovisual reports KW - COVID-19 KW - fellowship KW - radiology KW - smartphones KW - video recording KW - web technology N2 - Background: Traditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program. Objective: This study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing. Methods: One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation. Results: Most of the applicants (n=122, 99%) answered positively (with responses of ?agree? or ?strongly agree?) that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms. Conclusions: The use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicant?s experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones. UR - https://mededu.jmir.org/2021/2/e28733 UR - http://dx.doi.org/10.2196/28733 UR - http://www.ncbi.nlm.nih.gov/pubmed/33956639 ID - info:doi/10.2196/28733 ER - TY - JOUR AU - Papautsky, Lerner Elizabeth AU - Rice, R. Dylan AU - Ghoneima, Hana AU - McKowen, W. Anna Laura AU - Anderson, Nicholas AU - Wootton, R. Angie AU - Veldhuis, Cindy PY - 2021/5/19 TI - Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study JO - J Med Internet Res SP - e25446 VL - 23 IS - 5 KW - COVID-19 KW - health care delays KW - internet survey KW - preventive care KW - delay KW - interruption KW - lockdown KW - precaution KW - prevention KW - social media KW - survey N2 - 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. UR - https://www.jmir.org/2021/5/e25446 UR - http://dx.doi.org/10.2196/25446 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886489 ID - info:doi/10.2196/25446 ER - TY - JOUR AU - Stewart, H. Nancy AU - Koza, Anya AU - Dhaon, Serena AU - Shoushtari, Christiana AU - Martinez, Maylyn AU - Arora, M. Vineet PY - 2021/5/19 TI - Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study JO - J Med Internet Res SP - e27331 VL - 23 IS - 5 KW - social media KW - sleep disorders KW - frontline health care workers KW - burnout KW - insomnia KW - sleep KW - health care worker KW - stress KW - survey KW - demographic KW - outcome KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/5/e27331 UR - http://dx.doi.org/10.2196/27331 UR - http://www.ncbi.nlm.nih.gov/pubmed/33875414 ID - info:doi/10.2196/27331 ER - TY - JOUR AU - Kwok, Hang Stephen Wai AU - Vadde, Kumar Sai AU - Wang, Guanjin PY - 2021/5/19 TI - Tweet Topics and Sentiments Relating to COVID-19 Vaccination Among Australian Twitter Users: Machine Learning Analysis JO - J Med Internet Res SP - e26953 VL - 23 IS - 5 KW - COVID-19 KW - vaccination KW - public topics KW - public sentiments KW - Twitter KW - infodemiology KW - infoveillance KW - social listening KW - infodemic KW - social media KW - natural language processing KW - machine learning KW - latent Dirichlet allocation N2 - 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. UR - https://www.jmir.org/2021/5/e26953 UR - http://dx.doi.org/10.2196/26953 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886492 ID - info:doi/10.2196/26953 ER - TY - JOUR AU - Tomczyk, Samuel AU - Barth, Simon AU - Schmidt, Silke AU - Muehlan, Holger PY - 2021/5/19 TI - Utilizing Health Behavior Change and Technology Acceptance Models to Predict the Adoption of COVID-19 Contact Tracing Apps: Cross-sectional Survey Study JO - J Med Internet Res SP - e25447 VL - 23 IS - 5 KW - mHealth KW - COVID-19 KW - UTAUT1 KW - UTAUT2 KW - health behavior change KW - theory of planned behavior KW - contact tracing KW - app KW - model KW - technology acceptance KW - cross-sectional studies KW - social norms KW - health communication KW - privacy KW - anxiety N2 - 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. UR - https://www.jmir.org/2021/5/e25447 UR - http://dx.doi.org/10.2196/25447 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882016 ID - info:doi/10.2196/25447 ER - TY - JOUR AU - Halabi, Reem AU - Smith, Geoffrey AU - Sylwestrzak, Marc AU - Clay, Brian AU - Longhurst, A. Christopher AU - Lander, Lina PY - 2021/5/19 TI - The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study JO - J Med Internet Res SP - e28845 VL - 23 IS - 5 KW - inpatient telemedicine KW - bedside iPad KW - video visits KW - personal protective equipment KW - COVID-19 KW - virtual visits KW - pandemic KW - telehealth KW - telemedicine KW - digital health UR - https://www.jmir.org/2021/5/e28845 UR - http://dx.doi.org/10.2196/28845 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945494 ID - info:doi/10.2196/28845 ER - TY - JOUR AU - Cui, Shu AU - Zhang, Chao AU - Wang, Shijiang AU - Zhang, Xingong AU - Wang, Lei AU - Zhang, Ling AU - Yuan, Qiuyu AU - Huang, Cui AU - Cheng, Fangshuo AU - Zhang, Kai AU - Zhou, Xiaoqin PY - 2021/5/19 TI - Experiences and Attitudes of Elementary School Students and Their Parents Toward Online Learning in China During the COVID-19 Pandemic: Questionnaire Study JO - J Med Internet Res SP - e24496 VL - 23 IS - 5 KW - attitude KW - elementary school students KW - parents KW - online learning KW - COVID-19 N2 - Background: Due to widespread SARS-CoV-2 infection, an emergency homeschooling plan was rigorously implemented throughout China. Objective: This study aimed to investigate the experiences and attitudes of elementary school students and their parents (two generations from the same family) toward online learning in China during the pandemic. Methods: A 16-item questionnaire was distributed at the 10-day and 40-day marks after the start of the first online course to 867 parent-child pairs and 141 parent-child pairs, respectively. The questionnaire was comprised of questions pertaining to course and homework completeness, effectiveness, reliability, and abundance as well as the students? enthusiasm for taking part in online classes and their satisfaction with the courses. Results: Our findings indicate that 90.7% (786/867) of students exhibited high or moderate enthusiasm for participating in online classes. However, most students performed poorly in online learning classes and after-school homework. With regard to satisfaction, parents' and students' average scores were 7.35 and 7.25, respectively (10-point scoring system). During the second stage of this study, parents' positive evaluations for online learning declined, including those for the effectiveness and reliability of the courses. Furthermore, the proportion of students who completed the courses and homework on time decreased; this difference proved statistically significant (P=.047). The parents? and students? overall satisfaction with online learning also declined during the second stage (parents: 7.21; students: 7.23); however, the difference in overall satisfaction between the two stages was not statistically significant (parents: P=.53; students: P=.60). Several of the parents (315/867, 36.2%) indicated that assisting with and supervising the students? online learning resulted in increased stress. Further, 36% of parents expressed dissatisfaction with or provided suggestions for online learning; most parents and students hoped to return to face-to-face classes (parents: 823/867, 94.9%; students: 811/867, 93.5%). Finally, our results presented the following six main issues that parents were the most concerned about: (1) disappointment regarding timely interaction in courses; (2) apprehensiveness about students? understanding of the course; (3) the increased burden of annoying adult responsibilities; (4) concern about children's eyesight; (5) the idea that teachers? explanations were not detailed enough; and (6) concerns about the decline of students' interest in and attention toward online courses. Conclusions: Online learning can prevent the spread of infectious diseases while still allowing elementary school students to attain knowledge. However, in our study, children?s completion of the courses and homework were not satisfactory. Furthermore, their parents often experienced stress and had many concerns and complaints. Measures such as increasing the interactivity of the courses and prohibiting teachers from assigning tasks to parents could improve the effectiveness of these courses and the mental health of parents and students. UR - https://www.jmir.org/2021/5/e24496 UR - http://dx.doi.org/10.2196/24496 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878022 ID - info:doi/10.2196/24496 ER - TY - JOUR AU - Ali, Sabahat AU - Khalid, Sundas AU - Afridi, Maham AU - Akhtar, Samar AU - Khader, S. Yousef AU - Akhtar, Hashaam PY - 2021/5/19 TI - Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome JO - JMIR Public Health Surveill SP - e27609 VL - 7 IS - 5 KW - COVID-19 KW - remdesivir KW - treatment KW - tocilizumab UR - https://publichealth.jmir.org/2021/5/e27609 UR - http://dx.doi.org/10.2196/27609 UR - http://www.ncbi.nlm.nih.gov/pubmed/34009133 ID - info:doi/10.2196/27609 ER - TY - JOUR AU - Fiol-DeRoque, Antònia Maria AU - Serrano-Ripoll, Jesús Maria AU - Jiménez, Rafael AU - Zamanillo-Campos, Rocío AU - Yáñez-Juan, María Aina AU - Bennasar-Veny, Miquel AU - Leiva, Alfonso AU - Gervilla, Elena AU - García-Buades, Esther M. AU - García-Toro, Mauro AU - Alonso-Coello, Pablo AU - Pastor-Moreno, Guadalupe AU - Ruiz-Pérez, Isabel AU - Sitges, Carolina AU - García-Campayo, Javier AU - Llobera-Cánaves, Joan AU - Ricci-Cabello, Ignacio PY - 2021/5/18 TI - A Mobile Phone?Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e27039 VL - 9 IS - 5 KW - COVID-19 KW - randomized controlled trial KW - mental health KW - health care workers KW - mHealth KW - app N2 - Background: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. Objective: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. Methods: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. Results: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference ?0.04; 95% CI ?0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (?0.29; 95% CI ?0.48 to ?0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (?0.25; 95% CI ?0.49 to ?0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. Conclusions: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. Trial Registration: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818. UR - https://mhealth.jmir.org/2021/5/e27039 UR - http://dx.doi.org/10.2196/27039 UR - http://www.ncbi.nlm.nih.gov/pubmed/33909587 ID - info:doi/10.2196/27039 ER - TY - JOUR AU - Fokas, S. Athanassios AU - Kastis, A. George PY - 2021/5/18 TI - SARS-CoV-2: The Second Wave in Europe JO - J Med Internet Res SP - e22431 VL - 23 IS - 5 KW - mathematical modelling of epidemics KW - COVID-19 KW - SARS CoV-2 KW - pandemic KW - lockdown in Europe UR - https://www.jmir.org/2021/5/e22431 UR - http://dx.doi.org/10.2196/22431 UR - http://www.ncbi.nlm.nih.gov/pubmed/33939621 ID - info:doi/10.2196/22431 ER - TY - JOUR AU - Goodman-Casanova, Marian Jessica AU - Dura-Perez, Elena AU - Guerrero-Pertiñez, Gloria AU - Barnestein-Fonseca, Pilar AU - Guzman-Parra, Jose AU - Vega-Nuñez, Amanda AU - Varela-Moreno, Esperanza AU - Cuesta-Vargas, Antonio AU - Mayoral-Cleries, Fermin PY - 2021/5/18 TI - Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study JO - JMIR Res Protoc SP - e26431 VL - 10 IS - 5 KW - caregiver KW - cognition KW - cognitive impairment KW - cohort KW - COVID-19 KW - dementia KW - older people KW - informal caregivers KW - information and communications technologies KW - isolation KW - older adults KW - outcome KW - quality of life KW - social isolation KW - stress KW - technologies N2 - 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 UR - https://www.researchprotocols.org/2021/5/e26431 UR - http://dx.doi.org/10.2196/26431 UR - http://www.ncbi.nlm.nih.gov/pubmed/33909588 ID - info:doi/10.2196/26431 ER - TY - JOUR AU - Cresswell, Kathrin AU - Tahir, Ahsen AU - Sheikh, Zakariya AU - Hussain, Zain AU - Domínguez Hernández, Andrés AU - Harrison, Ewen AU - Williams, Robin AU - Sheikh, Aziz AU - Hussain, Amir PY - 2021/5/17 TI - Understanding Public Perceptions of COVID-19 Contact Tracing Apps: Artificial Intelligence?Enabled Social Media Analysis JO - J Med Internet Res SP - e26618 VL - 23 IS - 5 KW - artificial intelligence KW - sentiment analysis KW - COVID-19 KW - contact tracing KW - social media KW - perception KW - app KW - exploratory KW - suitability KW - AI KW - Facebook KW - Twitter KW - United Kingdom KW - sentiment KW - attitude KW - infodemiology KW - infoveillance N2 - 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. UR - https://www.jmir.org/2021/5/e26618 UR - http://dx.doi.org/10.2196/26618 UR - http://www.ncbi.nlm.nih.gov/pubmed/33939622 ID - info:doi/10.2196/26618 ER - TY - JOUR AU - Fischer, Emilio Alex AU - Van Tonder, Tanya AU - Gumede, B. Siphamandla AU - Lalla-Edward, T. Samanta PY - 2021/5/17 TI - Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study JO - JMIR Form Res SP - e25273 VL - 5 IS - 5 KW - coronavirus KW - SARS-CoV-2 KW - COVID-19 KW - technology KW - mHealth KW - app N2 - 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. UR - https://formative.jmir.org/2021/5/e25273 UR - http://dx.doi.org/10.2196/25273 UR - http://www.ncbi.nlm.nih.gov/pubmed/33956640 ID - info:doi/10.2196/25273 ER - TY - JOUR AU - Xiao, Yunyu AU - Hinrichs, Rachel AU - Johnson, Nina AU - McKinley, Amanda AU - Carlson, Joan AU - Agley, Jon AU - Yip, Fai Paul Siu PY - 2021/5/17 TI - Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e26948 VL - 10 IS - 5 KW - suicide KW - suicidal prevention KW - college KW - university KW - health disparities KW - equity KW - suicidal ideation KW - suicide attempt KW - COVID-19 KW - college student KW - young adult KW - disparity KW - review N2 - 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 UR - https://www.researchprotocols.org/2021/5/e26948 UR - http://dx.doi.org/10.2196/26948 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878016 ID - info:doi/10.2196/26948 ER - TY - JOUR AU - Liu, Zhifen AU - Qiao, Dan AU - Xu, Yifan AU - Zhao, Wentao AU - Yang, Yang AU - Wen, Dan AU - Li, Xinrong AU - Nie, Xiaoping AU - Dong, Yongkang AU - Tang, Shiyou AU - Jiang, Yi AU - Wang, Ying AU - Zhao, Juan AU - Xu, Yong PY - 2021/5/14 TI - The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial JO - J Med Internet Res SP - e26883 VL - 23 IS - 5 KW - mental health KW - depression KW - anxiety KW - COVID-19 KW - treatment KW - cCBT KW - computerized cognitive behavioral therapy N2 - Background: The prevalence of depressive and anxiety symptoms in patients with COVID-19 is higher than usual. Previous studies have shown that there are drug-to-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was needed. Cognitive behavioral therapy (CBT) is the first-line psychological therapy in clinical treatment. Computerized CBT (cCBT) was proven to be an effective alternative to CBT and does not require face-to-face therapy between a therapist and the patient, which suited the COVID-19 pandemic response. Objective: This study aims to evaluate the efficacy of the cCBT program we developed in improving depressive and anxiety symptoms among patients with COVID-19. Methods: We customized a cCBT program focused on improving depressive and anxiety symptoms among patients with COVID-19, and then, we assessed its effectiveness. Screening was based on symptoms of depression or anxiety for patients who scored ?7 on the Hamilton Depression Rating Scale (HAMD17) or the Hamilton Anxiety Scale (HAMA). A total of 252 patients with COVID-19 at five sites were randomized into two groups: cCBT + treatment as usual (TAU; n=126) and TAU without cCBT (n=126). The cCBT + TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were the HAMD17 and HAMA scores. The secondary outcome measures were the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Athens Insomnia Scale (AIS). Assessments were carried out pre- and postintervention. The patients? symptoms of anxiety and depression in one of the centers were assessed again within 1 month after the postintervention assessment. Results: The cCBT + TAU group displayed a significantly decreased score on the HAMD17, HAMA, SDS, SAS, and AIS after the intervention compared to the TAU group (all P<.001). A mixed-effects repeated measures model revealed significant improvement in symptoms of depression (HAMD17 and SDS scores, both P<.001), anxiety (HAMA and SAS scores, both P<.001), and insomnia (AIS score, P=.002) during the postintervention and follow-up periods in the cCBT + TAU group. Additionally, the improvement of insomnia among females (P=.14) and those with middle school education (P=.48) in the cCBT + TAU group showed no significant differences when compared to the TAU group. Conclusions: The findings of this study suggest that the cCBT program we developed was an effective nonpharmacological treatment for symptoms of anxiety, depression, and insomnia among patients with COVID-19. Further research is warranted to investigate the long-term effects of cCBT for symptoms of anxiety, depression, and insomnia in patients with COVID-19. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030084; http://www.chictr.org.cn/showprojen.aspx?proj=49952 UR - https://www.jmir.org/2021/5/e26883 UR - http://dx.doi.org/10.2196/26883 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900931 ID - info:doi/10.2196/26883 ER - TY - JOUR AU - Harling, Guy AU - Gómez-Olivé, Xavier Francesc AU - Tlouyamma, Joseph AU - Mutevedzi, Tinofa AU - Kabudula, Whiteson Chodziwadziwa AU - Mahlako, Ruth AU - Singh, Urisha AU - Ohene-Kwofie, Daniel AU - Buckland, Rose AU - Ndagurwa, Pedzisai AU - Gareta, Dickman AU - Gunda, Resign AU - Mngomezulu, Thobeka AU - Nxumalo, Siyabonga AU - Wong, B. Emily AU - Kahn, Kathleen AU - Siedner, J. Mark AU - Maimela, Eric AU - Tollman, Stephen AU - Collinson, Mark AU - Herbst, Kobus PY - 2021/5/13 TI - Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study JO - JMIR Public Health Surveill SP - e26073 VL - 7 IS - 5 KW - behaviour change KW - COVID-19 KW - economic well-being KW - health care access KW - health knowledge KW - mental health KW - South Africa KW - surveillance KW - nonpharmaceutical interventions N2 - 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. UR - https://publichealth.jmir.org/2021/5/e26073 UR - http://dx.doi.org/10.2196/26073 UR - http://www.ncbi.nlm.nih.gov/pubmed/33827046 ID - info:doi/10.2196/26073 ER - TY - JOUR AU - Clingan, A. Caroline AU - Dittakavi, Manasa AU - Rozwadowski, Michelle AU - Gilley, N. Kristen AU - Cislo, R. Christine AU - Barabas, Jenny AU - Sandford, Erin AU - Olesnavich, Mary AU - Flora, Christopher AU - Tyler, Jonathan AU - Mayer, Caleb AU - Stoneman, Emily AU - Braun, Thomas AU - Forger, B. Daniel AU - Tewari, Muneesh AU - Choi, Won Sung PY - 2021/5/12 TI - Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study JO - JMIR Res Protoc SP - e29562 VL - 10 IS - 5 KW - mobile health KW - app KW - mHealth KW - wearable KW - sensor KW - COVID-19 KW - health care worker KW - frontline worker KW - smartphone KW - digital health N2 - 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 UR - https://www.researchprotocols.org/2021/5/e29562 UR - http://dx.doi.org/10.2196/29562 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945497 ID - info:doi/10.2196/29562 ER - TY - JOUR AU - Nakanishi, Miharu AU - Shibasaki, Ryosuke AU - Yamasaki, Syudo AU - Miyazawa, Satoshi AU - Usami, Satoshi AU - Nishiura, Hiroshi AU - Nishida, Atsushi PY - 2021/5/11 TI - On-site Dining in Tokyo During the COVID-19 Pandemic: Time Series Analysis Using Mobile Phone Location Data JO - JMIR Mhealth Uhealth SP - e27342 VL - 9 IS - 5 KW - COVID-19 KW - mobility data KW - on-site dining KW - public health and social measures KW - public health KW - mobile phone KW - mobility KW - protection KW - time series KW - location KW - infectious disease KW - transmission N2 - 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. UR - https://mhealth.jmir.org/2021/5/e27342 UR - http://dx.doi.org/10.2196/27342 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886486 ID - info:doi/10.2196/27342 ER - TY - JOUR AU - Lai, Jocelyn AU - Rahmani, Amir AU - Yunusova, Asal AU - Rivera, P. Alexander AU - Labbaf, Sina AU - Hu, Sirui AU - Dutt, Nikil AU - Jain, Ramesh AU - Borelli, L. Jessica PY - 2021/5/11 TI - Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study JO - JMIR Form Res SP - e26186 VL - 5 IS - 5 KW - COVID-19 KW - emerging adulthood KW - multimodal personal chronicles KW - case study KW - wearable internet of things KW - individualized mHealth KW - college students KW - mental health N2 - Background: The year 2020 has been challenging for many, particularly for young adults who have been adversely affected by the COVID-19 pandemic. Emerging adulthood is a developmental phase with significant changes in the patterns of daily living; it is a risky phase for the onset of major mental illness. College students during the pandemic face significant risk, potentially losing several protective factors (eg, housing, routine, social support, job, and financial security) that are stabilizing for mental health and physical well-being. Individualized multiple assessments of mental health, referred to as multimodal personal chronicles, present an opportunity to examine indicators of health in an ongoing and personalized way using mobile sensing devices and wearable internet of things. Objective: To assess the feasibility and provide an in-depth examination of the impact of the COVID-19 pandemic on college students through multimodal personal chronicles, we present a case study of an individual monitored using a longitudinal subjective and objective assessment approach over a 9-month period throughout 2020, spanning the prepandemic period of January through September. Methods: The individual, referred to as Lee, completed psychological assessments measuring depression, anxiety, and loneliness across 4 time points in January, April, June, and September. We used the data emerging from the multimodal personal chronicles (ie, heart rate, sleep, physical activity, affect, behaviors) in relation to psychological assessments to understand patterns that help to explicate changes in the individual?s psychological well-being across the pandemic. Results: Over the course of the pandemic, Lee?s depression severity was highest in April, shortly after shelter-in-place orders were mandated. His depression severity remained mildly severe throughout the rest of the months. Associations in positive and negative affect, physiology, sleep, and physical activity patterns varied across time periods. Lee?s positive affect and negative affect were positively correlated in April (r=0.53, P=.04) whereas they were negatively correlated in September (r=?0.57, P=.03). Only in the month of January was sleep negatively associated with negative affect (r=?0.58, P=.03) and diurnal beats per minute (r=?0.54, P=.04), and then positively associated with heart rate variability (resting root mean square of successive differences between normal heartbeats) (r=0.54, P=.04). When looking at his available contextual data, Lee noted certain situations as supportive coping factors and other situations as potential stressors. Conclusions: We observed more pandemic concerns in April and noticed other contextual events relating to this individual?s well-being, reflecting how college students continue to experience life events during the pandemic. The rich monitoring data alongside contextual data may be beneficial for clinicians to understand client experiences and offer personalized treatment plans. We discuss benefits as well as future directions of this system, and the conclusions we can draw regarding the links between the COVID-19 pandemic and college student mental health. UR - https://formative.jmir.org/2021/5/e26186 UR - http://dx.doi.org/10.2196/26186 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882022 ID - info:doi/10.2196/26186 ER - TY - JOUR AU - Rivera, Ronald AU - Smart, Jonathan AU - Sakaria, Sangeeta AU - Wray, Alisa AU - Wiechmann, Warren AU - Boysen-Osborn, Megan AU - Toohey, Shannon PY - 2021/5/11 TI - Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era JO - JMIR Med Educ SP - e25213 VL - 7 IS - 2 KW - distance education KW - videoconferencing KW - emergency medicine KW - teaching KW - learning KW - web-based lecture KW - medical education KW - technology KW - SARS-CoV-2 KW - COVID-19 UR - https://mededu.jmir.org/2021/2/e25213 UR - http://dx.doi.org/10.2196/25213 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872191 ID - info:doi/10.2196/25213 ER - TY - JOUR AU - Prioleau, Temiloluwa PY - 2021/5/11 TI - Learning From the Experiences of COVID-19 Survivors: Web-Based Survey Study JO - JMIR Form Res SP - e23009 VL - 5 IS - 5 KW - patient-reported outcomes KW - coronavirus KW - COVID-19 KW - outcome KW - crowdsourcing KW - social media KW - internet KW - survivor KW - experience N2 - 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. UR - https://formative.jmir.org/2021/5/e23009 UR - http://dx.doi.org/10.2196/23009 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878012 ID - info:doi/10.2196/23009 ER - TY - JOUR AU - Post, Lori AU - Boctor, J. Michael AU - Issa, Z. Tariq AU - Moss, B. Charles AU - Murphy, Leo Robert AU - Achenbach, J. Chad AU - Ison, G. Michael AU - Resnick, Danielle AU - Singh, Lauren AU - White, Janine AU - Welch, B. Sarah AU - Oehmke, F. James PY - 2021/5/10 TI - SARS-CoV-2 Surveillance System in Canada: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e25753 VL - 7 IS - 5 KW - global COVID surveillance KW - COVID-19 KW - COVID-21 KW - new COVID strains KW - Canada Public Health Surveillance KW - Great COVID Shutdown KW - Canadian COVID-19 KW - surveillance metrics KW - wave 2 Canada COVID-19 KW - dynamic panel data KW - generalized method of the moments KW - Canadian econometrics KW - Canada SARS-CoV-2 KW - Canadian COVID-19 surveillance system KW - Canadian COVID transmission speed KW - Canadian COVID transmission acceleration KW - COVID transmission deceleration KW - COVID transmission jerk KW - COVID 7-day lag KW - Alberta KW - British Columbia KW - Manitoba KW - New Brunswick KW - Newfoundland and Labrador KW - Northwest Territories KW - Nova Scotia KW - Nunavut KW - Ontario KW - Prince Edward Island KW - Quebec KW - Saskatchewan KW - Yukon N2 - 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. UR - https://publichealth.jmir.org/2021/5/e25753 UR - http://dx.doi.org/10.2196/25753 UR - http://www.ncbi.nlm.nih.gov/pubmed/33852410 ID - info:doi/10.2196/25753 ER - TY - JOUR AU - Abu El Sood, Hanaa AU - Abu Kamer, Ali Shimaa AU - Kamel, Reham AU - Magdy, Hesham AU - Osman, S. Fatma AU - Fahim, Manal AU - Mohsen, Amira AU - AbdelFatah, Mohamad AU - Hassany, Mohamed AU - Afifi, Salma AU - Eid, Alaa PY - 2021/5/7 TI - 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 JO - JMIR Public Health Surveill SP - e27412 VL - 7 IS - 5 KW - pandemic preparedness KW - Egypt KW - ARI KW - epidemic mitigation KW - COVID-19 UR - https://publichealth.jmir.org/2021/5/e27412 UR - http://dx.doi.org/10.2196/27412 UR - http://www.ncbi.nlm.nih.gov/pubmed/33830932 ID - info:doi/10.2196/27412 ER - TY - JOUR AU - Kundu, Sampurna AU - Chauhan, Kirti AU - Mandal, Debarghya PY - 2021/5/6 TI - Survival Analysis of Patients With COVID-19 in India by Demographic Factors: Quantitative Study JO - JMIR Form Res SP - e23251 VL - 5 IS - 5 KW - survival analysis KW - COVID-19 KW - patient data KW - Kaplan-Meier KW - hazard model KW - modeling KW - survival KW - mortality KW - demographic KW - India KW - transmission N2 - 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 UR - https://formative.jmir.org/2021/5/e23251 UR - http://dx.doi.org/10.2196/23251 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882017 ID - info:doi/10.2196/23251 ER - TY - JOUR AU - Griswold, Dylan AU - Gempeler, Andrés AU - Rosseau, Gail AU - Kaseje, Neema AU - Johnson, D. Walter AU - Kolias, Angelos AU - Hutchinson, J. Peter AU - Rubiano, M. Andres PY - 2021/5/6 TI - 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 JO - JMIR Res Protoc SP - e25207 VL - 10 IS - 5 KW - systematic review KW - broad-evidence synthesis KW - COVID-19 KW - global health KW - trauma surgery KW - evidence-based practice KW - chest CT KW - rapid testing KW - testing KW - diagnosis KW - scan KW - computed tomography KW - review KW - antigen KW - immune system KW - health care worker KW - surgery KW - emergency KW - protocol N2 - 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 UR - https://www.researchprotocols.org/2021/5/e25207 UR - http://dx.doi.org/10.2196/25207 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878019 ID - info:doi/10.2196/25207 ER - TY - JOUR AU - Basch, E. Charles AU - Basch, H. Corey AU - Hillyer, C. Grace AU - Meleo-Erwin, C. Zoe AU - Zagnit, A. Emily PY - 2021/5/6 TI - YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study JO - JMIR Public Health Surveill SP - e28352 VL - 7 IS - 5 KW - YouTube KW - vaccination KW - COVID-19 KW - social media KW - communication KW - misinformation KW - disinformation KW - adverse reactions N2 - 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. UR - https://publichealth.jmir.org/2021/5/e28352 UR - http://dx.doi.org/10.2196/28352 UR - http://www.ncbi.nlm.nih.gov/pubmed/33886487 ID - info:doi/10.2196/28352 ER - TY - JOUR AU - Vaghela, Uddhav AU - Rabinowicz, Simon AU - Bratsos, Paris AU - Martin, Guy AU - Fritzilas, Epameinondas AU - Markar, Sheraz AU - Purkayastha, Sanjay AU - Stringer, Karl AU - Singh, Harshdeep AU - Llewellyn, Charlie AU - Dutta, Debabrata AU - Clarke, M. Jonathan AU - Howard, Matthew AU - AU - Serban, Ovidiu AU - Kinross, James PY - 2021/5/6 TI - Using a Secure, Continually Updating, Web Source Processing Pipeline to Support the Real-Time Data Synthesis and Analysis of Scientific Literature: Development and Validation Study JO - J Med Internet Res SP - e25714 VL - 23 IS - 5 KW - structured data synthesis KW - data science KW - critical analysis KW - web crawl data KW - pipeline KW - database KW - literature KW - research KW - COVID-19 KW - infodemic KW - decision making KW - data KW - data synthesis KW - misinformation KW - infrastructure KW - methodology N2 - Background: The scale and quality of the global scientific response to the COVID-19 pandemic have unquestionably saved lives. However, the COVID-19 pandemic has also triggered an unprecedented ?infodemic?; the velocity and volume of data production have overwhelmed many key stakeholders such as clinicians and policy makers, as they have been unable to process structured and unstructured data for evidence-based decision making. Solutions that aim to alleviate this data synthesis?related challenge are unable to capture heterogeneous web data in real time for the production of concomitant answers and are not based on the high-quality information in responses to a free-text query. Objective: The main objective of this project is to build a generic, real-time, continuously updating curation platform that can support the data synthesis and analysis of a scientific literature framework. Our secondary objective is to validate this platform and the curation methodology for COVID-19?related medical literature by expanding the COVID-19 Open Research Dataset via the addition of new, unstructured data. Methods: To create an infrastructure that addresses our objectives, the PanSurg Collaborative at Imperial College London has developed a unique data pipeline based on a web crawler extraction methodology. This data pipeline uses a novel curation methodology that adopts a human-in-the-loop approach for the characterization of quality, relevance, and key evidence across a range of scientific literature sources. Results: REDASA (Realtime Data Synthesis and Analysis) is now one of the world?s largest and most up-to-date sources of COVID-19?related evidence; it consists of 104,000 documents. By capturing curators? critical appraisal methodologies through the discrete labeling and rating of information, REDASA rapidly developed a foundational, pooled, data science data set of over 1400 articles in under 2 weeks. These articles provide COVID-19?related information and represent around 10% of all papers about COVID-19. Conclusions: This data set can act as ground truth for the future implementation of a live, automated systematic review. The three benefits of REDASA?s design are as follows: (1) it adopts a user-friendly, human-in-the-loop methodology by embedding an efficient, user-friendly curation platform into a natural language processing search engine; (2) it provides a curated data set in the JavaScript Object Notation format for experienced academic reviewers? critical appraisal choices and decision-making methodologies; and (3) due to the wide scope and depth of its web crawling method, REDASA has already captured one of the world?s largest COVID-19?related data corpora for searches and curation. UR - https://www.jmir.org/2021/5/e25714 UR - http://dx.doi.org/10.2196/25714 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835932 ID - info:doi/10.2196/25714 ER - TY - JOUR AU - Shah, Amika AU - Guessi, Milena AU - Wali, Sahr AU - Ware, Patrick AU - McDonald, Michael AU - O'Sullivan, Mary AU - Posada, Duero Juan AU - Ross, Heather AU - Seto, Emily PY - 2021/5/5 TI - The Resilience of Cardiac Care Through Virtualized Services During the COVID-19 Pandemic: Case Study of a Heart Function Clinic JO - JMIR Cardio SP - e25277 VL - 5 IS - 1 KW - telemedicine KW - telehealth KW - digital health KW - digital medicine KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - public health KW - surveillance KW - outbreak KW - pandemic KW - infectious disease KW - cardiology KW - patient KW - organizational innovation KW - organizational objectives KW - global health KW - resilience N2 - Background: Virtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people?s interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. Objective: At Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people?s experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. Methods: A single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. Conclusions: We contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic. UR - https://cardio.jmir.org/2021/1/e25277 UR - http://dx.doi.org/10.2196/25277 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878021 ID - info:doi/10.2196/25277 ER - TY - JOUR AU - Golden, A. Eddye AU - Zweig, Micol AU - Danieletto, Matteo AU - Landell, Kyle AU - Nadkarni, Girish AU - Bottinger, Erwin AU - Katz, Lindsay AU - Somarriba, Ricardo AU - Sharma, Vansh AU - Katz, L. Craig AU - Marin, B. Deborah AU - DePierro, Jonathan AU - Charney, S. Dennis PY - 2021/5/5 TI - A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation JO - JMIR Form Res SP - e26590 VL - 5 IS - 5 KW - mHealth KW - resilience KW - mental health KW - COVID-19 KW - HCWs KW - digital health KW - health app KW - mental health platform KW - mobile phone N2 - 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. UR - https://formative.jmir.org/2021/5/e26590 UR - http://dx.doi.org/10.2196/26590 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872189 ID - info:doi/10.2196/26590 ER - TY - JOUR AU - Denis, Fabrice AU - Septans, Anne-Lise AU - Le Goff, Florian AU - Jeanneau, Stephan AU - Lescure, François-Xavier PY - 2021/5/4 TI - Analysis of COVID-19 Transmission Sources in France by Self-Assessment Before and After the Partial Lockdown: Observational Study JO - J Med Internet Res SP - e26932 VL - 23 IS - 5 KW - COVID-19 KW - web application KW - digital health KW - analysis KW - transmission KW - France KW - self-assessment KW - lockdown KW - observational KW - survey KW - impact KW - public health N2 - 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 UR - https://www.jmir.org/2021/5/e26932 UR - http://dx.doi.org/10.2196/26932 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878018 ID - info:doi/10.2196/26932 ER - TY - JOUR AU - Mangono, Tichakunda AU - Smittenaar, Peter AU - Caplan, Yael AU - Huang, S. Vincent AU - Sutermaster, Staci AU - Kemp, Hannah AU - Sgaier, K. Sema PY - 2021/5/3 TI - Information-Seeking Patterns During the COVID-19 Pandemic Across the United States: Longitudinal Analysis of Google Trends Data JO - J Med Internet Res SP - e22933 VL - 23 IS - 5 KW - Google Trends KW - coronavirus KW - COVID-19 KW - principal component analysis KW - information-seeking trends KW - information retrieval KW - trend KW - infodemiology KW - infoveillance KW - virus KW - public health KW - information seeking KW - online health information N2 - 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. UR - https://www.jmir.org/2021/5/e22933 UR - http://dx.doi.org/10.2196/22933 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878015 ID - info:doi/10.2196/22933 ER - TY - JOUR AU - Adikari, Achini AU - Nawaratne, Rashmika AU - De Silva, Daswin AU - Ranasinghe, Sajani AU - Alahakoon, Oshadi AU - Alahakoon, Damminda PY - 2021/4/30 TI - Emotions of COVID-19: Content Analysis of Self-Reported Information Using Artificial Intelligence JO - J Med Internet Res SP - e27341 VL - 23 IS - 4 KW - COVID-19 KW - pandemic KW - lockdown KW - human emotions KW - affective computing KW - human-centric artificial intelligence KW - artificial intelligence KW - AI KW - machine learning KW - natural language processing KW - language modeling KW - infodemiology KW - infoveillance N2 - 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. UR - https://www.jmir.org/2021/4/e27341 UR - http://dx.doi.org/10.2196/27341 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819167 ID - info:doi/10.2196/27341 ER - TY - JOUR AU - Zheng, Yingfeng AU - Wang, Wei AU - Zhong, Yuxin AU - Wu, Fengchun AU - Zhu, Zhuoting AU - Tham, Yih-Chung AU - Lamoureux, Ecosse AU - Xiao, Liang AU - Zhu, Erta AU - Liu, Haoning AU - Jin, Ling AU - Liang, Linyi AU - Luo, Lixia AU - He, Mingguang AU - Morgan, Ian AU - Congdon, Nathan AU - Liu, Yizhi PY - 2021/4/30 TI - A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e24316 VL - 23 IS - 4 KW - homeschooling KW - children KW - anxiety, digital eye strain KW - peer to peer KW - live streaming KW - digital health KW - intervention KW - health information KW - physical activity KW - COVID-19 KW - online learning KW - behavior KW - app KW - mobile phone N2 - Background: The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective: The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children?s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods: In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results: On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root?transformed self-reported anxiety scores was greater in the intervention (?0.23, 95% CI ?0.27 to ?0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference ?0.36, 95% CI ?0.63 to ?0.08; P=.02). There was a significant reduction in square-root?transformed eye strain in the intervention group (?0.08, 95% CI ?0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference ?0.15, 95% CI ?0.26 to ?0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions: This digital behavior change intervention reduced children?s anxiety and eye strain during COVID-19?associated online schooling. Trial Registration: ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097 UR - https://www.jmir.org/2021/4/e24316 UR - http://dx.doi.org/10.2196/24316 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882021 ID - info:doi/10.2196/24316 ER - TY - JOUR AU - O'Keefe, B. James AU - Tong, J. Elizabeth AU - Taylor Jr, H. Thomas AU - O?Keefe, Datoo Ghazala A. AU - Tong, C. David PY - 2021/4/30 TI - Use of a Telemedicine Risk Assessment Tool to Predict the Risk of Hospitalization of 496 Outpatients With COVID-19: Retrospective Analysis JO - JMIR Public Health Surveill SP - e25075 VL - 7 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - nonhospitalized KW - risk assessment KW - outpatient KW - outcomes KW - telemedicine N2 - 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. UR - https://publichealth.jmir.org/2021/4/e25075 UR - http://dx.doi.org/10.2196/25075 UR - http://www.ncbi.nlm.nih.gov/pubmed/33667174 ID - info:doi/10.2196/25075 ER - TY - JOUR AU - Mahoney, Christopher Martin AU - Park, Eunhee AU - Schlienz, J. Nicolas AU - Duerr, CeCe AU - Hawk, W. Larry PY - 2021/4/30 TI - Transitioning to Remote Clinic Visits in a Smoking Cessation Trial During the COVID-19 Pandemic: Mixed Methods Evaluation JO - JMIR Form Res SP - e25541 VL - 5 IS - 4 KW - smoking KW - cessation KW - clinical trial KW - telehealth KW - COVID-19 KW - coronavirus KW - telemedicine KW - conferencing KW - mixed methods KW - experience KW - patient N2 - 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 UR - https://formative.jmir.org/2021/4/e25541 UR - http://dx.doi.org/10.2196/25541 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878020 ID - info:doi/10.2196/25541 ER - TY - JOUR AU - Xun, Helen AU - He, Waverley AU - Chen, Jonlin AU - Sylvester, Scott AU - Lerman, F. Sheera AU - Caffrey, Julie PY - 2021/4/30 TI - Characterization and Comparison of the Utilization of Facebook Groups Between Public Medical Professionals and Technical Communities to Facilitate Idea Sharing and Crowdsourcing During the COVID-19 Pandemic: Cross-sectional Observational Study JO - JMIR Form Res SP - e22983 VL - 5 IS - 4 KW - cognitive intelligence KW - communication KW - COVID-19 KW - crowdsourcing KW - evidence-based KW - Facebook KW - Facebook groups KW - internet KW - social media KW - virtual communities N2 - Background: Strict social distancing measures owing to the COVID-19 pandemic have led people to rely more heavily on social media, such as Facebook groups, as a means of communication and information sharing. Multiple Facebook groups have been formed by medical professionals, laypeople, and engineering or technical groups to discuss current issues and possible solutions to the current medical crisis. Objective: This study aimed to characterize Facebook groups formed by laypersons, medical professionals, and technical professionals, with specific focus on information dissemination and requests for crowdsourcing. Methods: Facebook was queried for user-created groups with the keywords ?COVID,? ?Coronavirus,? and ?SARS-CoV-2? at a single time point on March 31, 2020. The characteristics of each group were recorded, including language, privacy settings, security requirements to attain membership, and membership type. For each membership type, the group with the greatest number of members was selected, and in each of these groups, the top 100 posts were identified using Facebook?s algorithm. Each post was categorized and characterized (evidence-based, crowd-sourced, and whether the poster self-identified). STATA (version 13 SE, Stata Corp) was used for statistical analysis. Results: Our search yielded 257 COVID-19?related Facebook groups. Majority of the groups (n=229, 89%) were for laypersons, 26 (10%) were for medical professionals, and only 2 (1%) were for technical professionals. The number of members was significantly greater in medical groups (21,215, SD 35,040) than in layperson groups (7623, SD 19,480) (P<.01). Medical groups were significantly more likely to require security checks to attain membership (81% vs 43%; P<.001) and less likely to be public (3 vs 123; P<.001) than layperson groups. Medical groups had the highest user engagement, averaging 502 (SD 633) reactions (P<.01) and 224 (SD 311) comments (P<.01) per post. Medical professionals were more likely to use the Facebook groups for education and information sharing, including academic posts (P<.001), idea sharing (P=.003), resource sharing (P=.02) and professional opinions (P<.001), and requesting for crowdsourcing (P=.003). Layperson groups were more likely to share news (P<.001), humor and motivation (P<.001), and layperson opinions (P<.001). There was no significant difference in the number of evidence-based posts among the groups (P=.10). Conclusions: Medical professionals utilize Facebook groups as a forum to facilitate collective intelligence (CI) and are more likely to use Facebook groups for education and information sharing, including academic posts, idea sharing, resource sharing, and professional opinions, which highlights the power of social media to facilitate CI across geographic distances. Layperson groups were more likely to share news, humor, and motivation, which suggests the utilization of Facebook groups to provide comedic relief as a coping mechanism. Further investigations are necessary to study Facebook groups? roles in facilitating CI, crowdsourcing, education, and community-building. UR - https://formative.jmir.org/2021/4/e22983 UR - http://dx.doi.org/10.2196/22983 UR - http://www.ncbi.nlm.nih.gov/pubmed/33878013 ID - info:doi/10.2196/22983 ER - TY - JOUR AU - Ciccone, J. Emily AU - Zivich, N. Paul AU - Lodge, K. Evans AU - Zhu, Deanna AU - Law, Elle AU - Miller, Elyse AU - Taylor, L. Jasmine AU - Chung, Suemin AU - Xu, Jason AU - Volfovsky, Alexander AU - Beatty, Cherese AU - Abernathy, Haley AU - King, Elise AU - Garrett, E. Haley AU - Markmann, J. Alena AU - Rebuli, E. Meghan AU - Sellers, Subhashini AU - Weber, J. David AU - Reyes, Raquel AU - Alavian, Naseem AU - Juliano, J. Jonathan AU - Boyce, M. Ross AU - Aiello, E. Allison PY - 2021/4/30 TI - SARS-CoV-2 Infection in Health Care Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study JO - JMIR Res Protoc SP - e25410 VL - 10 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - health personnel KW - cohort studies KW - Bluetooth contact tracking KW - survey-based research KW - occupational health KW - seroprevalence KW - mobile phone N2 - 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 UR - https://www.researchprotocols.org/2021/4/e25410 UR - http://dx.doi.org/10.2196/25410 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769944 ID - info:doi/10.2196/25410 ER - TY - JOUR AU - Eibensteiner, Fabian AU - Ritschl, Valentin AU - Nawaz, A. Faisal AU - Fazel, S. Sajjad AU - Tsagkaris, Christos AU - Kulnik, Tino Stefan AU - Crutzen, Rik AU - Klager, Elisabeth AU - Völkl-Kernstock, Sabine AU - Schaden, Eva AU - Kletecka-Pulker, Maria AU - Willschke, Harald AU - Atanasov, G. Atanas PY - 2021/4/29 TI - People?s Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis JO - J Med Internet Res SP - e28973 VL - 23 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - vaccination KW - Twitter KW - survey KW - vaccination willingness KW - vaccination hesitancy KW - coronavirus KW - vaccine confidence KW - willingness KW - hesitancy KW - social media KW - safety KW - concern KW - public health KW - opinion KW - perception N2 - 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. UR - https://www.jmir.org/2021/4/e28973 UR - http://dx.doi.org/10.2196/28973 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872185 ID - info:doi/10.2196/28973 ER - TY - JOUR AU - Legler, Sean AU - Diehl, Matthew AU - Hilliard, Brian AU - Olson, Andrew AU - Markowitz, Rebecca AU - Tignanelli, Christopher AU - Melton, B. Genevieve AU - Broccard, Alain AU - Kirsch, Jonathan AU - Usher, Michael PY - 2021/4/29 TI - Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study JO - J Med Internet Res SP - e25987 VL - 23 IS - 4 KW - telemedicine KW - hospital medicine KW - COVID-19 KW - telehealth KW - hospital KW - mixed methods KW - evaluation KW - impact KW - exposure KW - risk KW - communication N2 - 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. UR - https://www.jmir.org/2021/4/e25987 UR - http://dx.doi.org/10.2196/25987 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872187 ID - info:doi/10.2196/25987 ER - TY - JOUR AU - Yu, Fengyun AU - Geldsetzer, Pascal AU - Meierkord, Anne AU - Yang, Juntao AU - Chen, Qiushi AU - Jiao, Lirui AU - Abou-Arraj, E. Nadeem AU - Pan, An AU - Wang, Chen AU - Bärnighausen, Till AU - Chen, Simiao PY - 2021/4/29 TI - Knowledge About COVID-19 Among Adults in China: Cross-sectional Online Survey JO - J Med Internet Res SP - e26940 VL - 23 IS - 4 KW - COVID-19 KW - knowledge KW - perception KW - risk KW - public health KW - China KW - cross-sectional KW - survey N2 - 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. UR - https://www.jmir.org/2021/4/e26940 UR - http://dx.doi.org/10.2196/26940 UR - http://www.ncbi.nlm.nih.gov/pubmed/33844637 ID - info:doi/10.2196/26940 ER - TY - JOUR AU - Xu, Stanley AU - Glenn, Sungching AU - Sy, Lina AU - Qian, Lei AU - Hong, Vennis AU - Ryan, S. Denison AU - Jacobsen, Steven PY - 2021/4/29 TI - Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study JO - J Med Internet Res SP - e26558 VL - 23 IS - 4 KW - cohort KW - COVID-19 KW - difference-in-difference analysis KW - health care utilization KW - health care worker KW - impact KW - knowledge KW - pandemic KW - policy KW - retrospective KW - telehealth KW - telemedicine KW - usage KW - utilization N2 - 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. UR - https://www.jmir.org/2021/4/e26558 UR - http://dx.doi.org/10.2196/26558 UR - http://www.ncbi.nlm.nih.gov/pubmed/33882020 ID - info:doi/10.2196/26558 ER - TY - JOUR AU - Poly, Nasrin Tahmina AU - Islam, Mohaimenul Md AU - Li, Jack Yu-Chuan AU - Alsinglawi, Belal AU - Hsu, Min-Huei AU - Jian, Shan Wen AU - Yang, Hsuan-Chia PY - 2021/4/29 TI - Application of Artificial Intelligence for Screening COVID-19 Patients Using Digital Images: Meta-analysis JO - JMIR Med Inform SP - e21394 VL - 9 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - pneumonia KW - artificial intelligence KW - deep learning N2 - 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. UR - https://medinform.jmir.org/2021/4/e21394 UR - http://dx.doi.org/10.2196/21394 UR - http://www.ncbi.nlm.nih.gov/pubmed/33764884 ID - info:doi/10.2196/21394 ER - TY - JOUR AU - Albright, Glenn AU - Khalid, Nikita AU - Shockley, Kristen AU - Robinson, Kelsey AU - Hughes, Kevin AU - Pace-Danley, Bethany PY - 2021/4/29 TI - Innovative Virtual Role Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 JO - JMIR Form Res SP - e27164 VL - 5 IS - 4 KW - simulations KW - behavior change KW - motivational interviewing KW - virtual humans KW - role play KW - substance use KW - prevention KW - alcohol KW - public awareness KW - innovation KW - interview KW - COVID-19 KW - pilot study KW - simulation KW - communication KW - problem solving N2 - Background: Substance use places a substantial burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of interventions can supplement the work being done by existing public health initiatives. Objective: This pilot study examines the impact of the One Degree: Shift the Influence role play simulation, designed to teach family, friends, and coworkers to effectively manage problem-solving conversations with individuals that they are concerned about regarding substance use. Methods: Participants recruited for this mixed methods study completed a presurvey, the simulation, and a postsurvey, and were sent a 6-week follow-up survey. The simulation involves practicing a role play conversation with a virtual human coded with emotions, a memory, and a personality. A virtual coach provides feedback in using evidence-based communication strategies such as motivational interviewing. Results: A matched sample analysis of variance revealed significant increases at follow-up in composite attitudinal constructs of preparedness (P<.001) and self-efficacy (P=.01), including starting a conversation with someone regarding substance use, avoiding upsetting someone while bringing up concerns, focusing on observable facts, and problem solving. Qualitative data provided further evidence of the simulation?s positive impact on the ability to have meaningful conversations about substance use. Conclusions: This study provides preliminary evidence that conversation-based simulations like One Degree: Shift the Influence that use role play practice can teach individuals to use evidence-based communication strategies and can cost-effectively reach geographically dispersed populations to support public health initiatives for primary prevention. UR - https://formative.jmir.org/2021/4/e27164 UR - http://dx.doi.org/10.2196/27164 UR - http://www.ncbi.nlm.nih.gov/pubmed/33848972 ID - info:doi/10.2196/27164 ER - TY - JOUR AU - Hernandez-Ramos, Rosa AU - Aguilera, Adrian AU - Garcia, Faviola AU - Miramontes-Gomez, Jose AU - Pathak, Elizabeth Laura AU - Figueroa, Astrid Caroline AU - Lyles, Rees Courtney PY - 2021/4/29 TI - Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach JO - JMIR Form Res SP - e25299 VL - 5 IS - 4 KW - digital literacy KW - digital divide KW - underserved KW - patient-centered KW - digital health KW - mhealth KW - intervention KW - telehealth KW - COVID-19 N2 - Background: The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. Objective: This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. Methods: We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre?COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Results: Recruitment across both pre?COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient?s digital literacy skills. Comparing recruitment during pre?COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4% (11/32) in the pre?COVID-19 cohort to 27.3% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Conclusions: Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient?s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Trial Registration: Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253 UR - https://formative.jmir.org/2021/4/e25299 UR - http://dx.doi.org/10.2196/25299 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872184 ID - info:doi/10.2196/25299 ER - TY - JOUR AU - Adly, Sedky Aya AU - Adly, Sedky Mahmoud AU - Adly, Sedky Afnan PY - 2021/4/28 TI - Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial JO - J Med Internet Res SP - e23446 VL - 23 IS - 4 KW - telemedicine KW - oxygen therapy KW - noninvasive positive airway pressure KW - BiPAP KW - osteopathic medicine KW - physical therapy KW - SARS-CoV-2 KW - COVID-19 KW - teletherapy KW - telemanagement N2 - 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 UR - https://www.jmir.org/2021/4/e23446 UR - http://dx.doi.org/10.2196/23446 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819166 ID - info:doi/10.2196/23446 ER - TY - JOUR AU - Post, Lori AU - Culler, Kasen AU - Moss, B. Charles AU - Murphy, L. Robert AU - Achenbach, J. Chad AU - Ison, G. Michael AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - White, Janine AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, Francis James PY - 2021/4/28 TI - Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses JO - JMIR Public Health Surveill SP - e25695 VL - 7 IS - 4 KW - SARS-CoV-2 surveillance KW - wave two KW - second wave KW - global COVID surveillance KW - Europe Public Health Surveillance KW - Europe COVID KW - Europe surveillance metrics KW - dynamic panel data KW - generalized method of the moments KW - Europe econometrics KW - Europe SARS-CoV-2 KW - Europe COVID surveillance system KW - European COVID transmission speed KW - European COVID transmission acceleration KW - COVID transmission deceleration KW - COVID transmission jerk KW - COVID 7-day lag KW - SARS-CoV-2 KW - Arellano-Bond estimator KW - GMM KW - Albania KW - Andorra KW - Austria KW - Belarus KW - Belgium KW - Bosnia and Herzegovina KW - Bulgaria KW - Croatia KW - Czech Republic KW - Denmark KW - Estonia KW - Finland KW - France KW - Germany KW - Greece KW - Greenland KW - Hungary KW - Iceland KW - Ireland KW - Isle of Man KW - Italy KW - Latvia KW - Liechtenstein KW - Lithuania KW - Luxembourg KW - Moldova KW - Monaco KW - Montenegro KW - Netherlands KW - Norway KW - Poland KW - Portugal KW - Romania KW - San Marino KW - Serbia KW - Slovakia KW - Slovenia KW - Spain KW - Sweden KW - Switzerland KW - Ukraine KW - United Kingdom KW - Vatican City N2 - 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. UR - https://publichealth.jmir.org/2021/4/e25695 UR - http://dx.doi.org/10.2196/25695 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818391 ID - info:doi/10.2196/25695 ER - TY - JOUR AU - Patrício, André AU - Costa, S. Rafael AU - Henriques, Rui PY - 2021/4/28 TI - Predictability of COVID-19 Hospitalizations, Intensive Care Unit Admissions, and Respiratory Assistance in Portugal: Longitudinal Cohort Study JO - J Med Internet Res SP - e26075 VL - 23 IS - 4 KW - COVID-19 KW - machine learning KW - intensive care admissions KW - respiratory assistance KW - predictive models KW - data modeling KW - clinical informatics N2 - 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. UR - https://www.jmir.org/2021/4/e26075 UR - http://dx.doi.org/10.2196/26075 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835931 ID - info:doi/10.2196/26075 ER - TY - JOUR AU - Naeim, Arash AU - Baxter-King, Ryan AU - Wenger, Neil AU - Stanton, L. Annette AU - Sepucha, Karen AU - Vavreck, Lynn PY - 2021/4/28 TI - 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 JO - JMIR Public Health Surveill SP - e24277 VL - 7 IS - 4 KW - COVID-19 KW - prevention KW - behavior KW - advice KW - health care provider KW - economy KW - health information KW - concern KW - survey N2 - 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. UR - https://publichealth.jmir.org/2021/4/e24277 UR - http://dx.doi.org/10.2196/24277 UR - http://www.ncbi.nlm.nih.gov/pubmed/33908887 ID - info:doi/10.2196/24277 ER - TY - JOUR AU - Prinelli, Federica AU - Bianchi, Fabrizio AU - Drago, Gaspare AU - Ruggieri, Silvia AU - Sojic, Aleksandra AU - Jesuthasan, Nithiya AU - Molinaro, Sabrina AU - Bastiani, Luca AU - Maggi, Stefania AU - Noale, Marianna AU - Galli, Massimo AU - Giacomelli, Andrea AU - Antonelli Incalzi, Raffaele AU - Adorni, Fulvio AU - Cibella, Fabio AU - PY - 2021/4/28 TI - Association Between Smoking and SARS-CoV-2 Infection: Cross-sectional Study of the EPICOVID19 Internet-Based Survey JO - JMIR Public Health Surveill SP - e27091 VL - 7 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - smoking habit KW - dose-response relationship KW - nasopharyngeal swab testing KW - infection severity KW - web-based survey KW - self-reported KW - cross-sectional design N2 - 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 UR - https://publichealth.jmir.org/2021/4/e27091 UR - http://dx.doi.org/10.2196/27091 UR - http://www.ncbi.nlm.nih.gov/pubmed/33668011 ID - info:doi/10.2196/27091 ER - TY - JOUR AU - Giesbrecht, F. Gerald AU - Bagshawe, Mercedes AU - van Sloten, Melinda AU - MacKinnon, L. Anna AU - Dhillon, Ashley AU - van de Wouw, Marcel AU - Vaghef-Mehrabany, Elnaz AU - Rojas, Laura AU - Cattani, Danielle AU - Lebel, Catherine AU - Tomfohr-Madsen, Lianne PY - 2021/4/28 TI - 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 JO - JMIR Res Protoc SP - e25407 VL - 10 IS - 4 KW - pregnancy KW - anxiety KW - depression KW - stress KW - social support KW - resilience KW - COVID-19 KW - infant development KW - pandemic N2 - 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 UR - https://www.researchprotocols.org/2021/4/e25407 UR - http://dx.doi.org/10.2196/25407 UR - http://www.ncbi.nlm.nih.gov/pubmed/33848971 ID - info:doi/10.2196/25407 ER - TY - JOUR AU - Romer, Daniel AU - Jamieson, Hall Kathleen PY - 2021/4/27 TI - 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 JO - J Med Internet Res SP - e25215 VL - 23 IS - 4 KW - COVID-19 KW - conspiracy beliefs KW - social media KW - print news media KW - broadcast news media KW - conservative media KW - vaccination KW - mask wearing KW - belief KW - misinformation KW - infodemic KW - United States KW - intention KW - prevention N2 - 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 (?=.17, 99% CI .10-.25) and that reliance on mainstream print predicted a decrease in their belief (?=?.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 (?=.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 (?=.17, 99% CI .09-.26) and vaccination intention (?=.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. UR - https://www.jmir.org/2021/4/e25215 UR - http://dx.doi.org/10.2196/25215 UR - http://www.ncbi.nlm.nih.gov/pubmed/33857008 ID - info:doi/10.2196/25215 ER - TY - JOUR AU - Post, Lori AU - Ohiomoba, O. Ramael AU - Maras, Ashley AU - Watts, J. Sean AU - Moss, B. Charles AU - Murphy, Leo Robert AU - Ison, G. Michael AU - Achenbach, J. Chad AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - White, Janine AU - Chaudhury, S. Azraa AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, Francis James PY - 2021/4/27 TI - Latin America and the Caribbean SARS-CoV-2 Surveillance: Longitudinal Trend Analysis JO - JMIR Public Health Surveill SP - e25728 VL - 7 IS - 4 KW - 7-day persistence KW - acceleration KW - Arellano?Bond estimator KW - COVID-19 surveillance system KW - COVID-19 KW - dynamic panel data KW - econometrics KW - economic KW - generalized method of moments KW - global COVID-19 surveillance KW - Latin America and the Caribbean KW - longitudinal KW - metric KW - persistence KW - policy KW - public health surveillance KW - SARS-CoV-2 KW - second wave KW - surveillance metrics KW - transmission deceleration KW - transmission jerk KW - transmission speed KW - trend analysis N2 - 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. UR - https://publichealth.jmir.org/2021/4/e25728 UR - http://dx.doi.org/10.2196/25728 UR - http://www.ncbi.nlm.nih.gov/pubmed/33852413 ID - info:doi/10.2196/25728 ER - TY - JOUR AU - Fraticelli, Laurie AU - Freyssenge, Julie AU - Claustre, Clément AU - Martinez, Mikaël AU - Redjaline, Abdesslam AU - Serre, Patrice AU - Bochaton, Thomas AU - El Khoury, Carlos PY - 2021/4/27 TI - Estimating the Proportion of COVID-19 Contacts Among Households Based on Individuals With Myocardial Infarction History: Cross-sectional Telephone Survey JO - JMIR Form Res SP - e26955 VL - 5 IS - 4 KW - COVID-19 KW - survey KW - myocardial infarction KW - cases KW - contacts KW - household KW - estimate KW - cross-sectional KW - cardiovascular KW - risk KW - symptom N2 - 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. UR - https://formative.jmir.org/2021/4/e26955 UR - http://dx.doi.org/10.2196/26955 UR - http://www.ncbi.nlm.nih.gov/pubmed/33855968 ID - info:doi/10.2196/26955 ER - TY - JOUR AU - Zainel, Abdullatif Abduljaleel AU - Qotba, Hamda AU - Al-Maadeed, Alyaa AU - Al-Kohji, Sadriya AU - Al Mujalli, Hanan AU - Ali, Atif AU - Al Mannai, Lolwa AU - Aladab, Aisha AU - AlSaadi, Hamda AU - AlKarbi, Ali Khalid AU - Al-Baghdadi, Tholfakhar PY - 2021/4/27 TI - Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e24760 VL - 5 IS - 4 KW - COVID-19 KW - coronavirus KW - pandemic KW - psychological KW - coping strategies KW - children KW - adolescents KW - Qatar N2 - 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. UR - https://formative.jmir.org/2021/4/e24760 UR - http://dx.doi.org/10.2196/24760 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851577 ID - info:doi/10.2196/24760 ER - TY - JOUR AU - Tang, Lu AU - Liu, Wenlin AU - Thomas, Benjamin AU - Tran, Nga Hong Thoai AU - Zou, Wenxue AU - Zhang, Xueying AU - Zhi, Degui PY - 2021/4/26 TI - Texas Public Agencies? Tweets and Public Engagement During the COVID-19 Pandemic: Natural Language Processing Approach JO - JMIR Public Health Surveill SP - e26720 VL - 7 IS - 4 KW - COVID-19 KW - public health agencies KW - natural language processing KW - Twitter KW - health belief model KW - public engagement KW - social media KW - belief KW - public health KW - engagement KW - communication KW - strategy KW - content analysis KW - dissemination N2 - 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. UR - https://publichealth.jmir.org/2021/4/e26720 UR - http://dx.doi.org/10.2196/26720 UR - http://www.ncbi.nlm.nih.gov/pubmed/33847587 ID - info:doi/10.2196/26720 ER - TY - JOUR AU - Suruliraj, Banuchitra AU - Bessenyei, Kitti AU - Bagnell, Alexa AU - McGrath, Patrick AU - Wozney, Lori AU - Orji, Rita AU - Meier, Sandra PY - 2021/4/26 TI - Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey JO - JMIR Form Res SP - e24180 VL - 5 IS - 4 KW - app KW - awareness KW - behavior KW - COVID-19 KW - helpfulness KW - mobile health KW - mobile sensing KW - self-management KW - sensing KW - web-based survey N2 - 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 (?=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (?=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (?=.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. UR - https://formative.jmir.org/2021/4/e24180 UR - http://dx.doi.org/10.2196/24180 UR - http://www.ncbi.nlm.nih.gov/pubmed/33872181 ID - info:doi/10.2196/24180 ER - TY - JOUR AU - Yeung, YS Arnold AU - Roewer-Despres, Francois AU - Rosella, Laura AU - Rudzicz, Frank PY - 2021/4/23 TI - 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 JO - J Med Internet Res SP - e26628 VL - 23 IS - 4 KW - COVID-19 KW - machine learning KW - nonpharmaceutical interventions KW - cultural dimensions KW - random forest KW - AdaBoost KW - forecast KW - informatics KW - epidemiology KW - artificial intelligence N2 - 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. UR - https://www.jmir.org/2021/4/e26628 UR - http://dx.doi.org/10.2196/26628 UR - http://www.ncbi.nlm.nih.gov/pubmed/33844636 ID - info:doi/10.2196/26628 ER - TY - JOUR AU - Henriksen, André AU - Johannessen, Erlend AU - Hartvigsen, Gunnar AU - Grimsgaard, Sameline AU - Hopstock, Arnesdatter Laila PY - 2021/4/23 TI - Consumer-Based Activity Trackers as a Tool for Physical Activity Monitoring in Epidemiological Studies During the COVID-19 Pandemic: Development and Usability Study JO - JMIR Public Health Surveill SP - e23806 VL - 7 IS - 4 KW - COVID-19 KW - energy expenditure KW - steps KW - smart watch KW - fitness tracker KW - actigraphy KW - public health KW - lockdown KW - SARS-CoV-2 KW - pandemic KW - wearables N2 - Background: Consumer-based physical activity trackers have increased in popularity. The widespread use of these devices and the long-term nature of the recorded data provides a valuable source of physical activity data for epidemiological research. The challenges include the large heterogeneity between activity tracker models in terms of available data types, the accuracy of recorded data, and how this data can be shared between different providers and third-party systems. Objective: The aim of this study is to develop a system to record data on physical activity from different providers of consumer-based activity trackers and to examine its usability as a tool for physical activity monitoring in epidemiological research. The longitudinal nature of the data and the concurrent pandemic outbreak allowed us to show how the system can be used for surveillance of physical activity levels before, during, and after a COVID-19 lockdown. Methods: We developed a system (mSpider) for automatic recording of data on physical activity from participants wearing activity trackers from Apple, Fitbit, Garmin, Oura, Polar, Samsung, and Withings, as well as trackers storing data in Google Fit and Apple Health. To test the system throughout development, we recruited 35 volunteers to wear a provided activity tracker from early 2019 and onward. In addition, we recruited 113 participants with privately owned activity trackers worn before, during, and after the COVID-19 lockdown in Norway. We examined monthly changes in the number of steps, minutes of moderate-to-vigorous physical activity, and activity energy expenditure between 2019 and 2020 using bar plots and two-sided paired sample t tests and Wilcoxon signed-rank tests. Results: Compared to March 2019, there was a significant reduction in mean step count and mean activity energy expenditure during the March 2020 lockdown period. The reduction in steps and activity energy expenditure was temporary, and the following monthly comparisons showed no significant change between 2019 and 2020. A small significant increase in moderate-to-vigorous physical activity was observed for several monthly comparisons after the lockdown period and when comparing March-December 2019 with March-December 2020. Conclusions: mSpider is a working prototype currently able to record physical activity data from providers of consumer-based activity trackers. The system was successfully used to examine changes in physical activity levels during the COVID-19 period. UR - https://publichealth.jmir.org/2021/4/e23806 UR - http://dx.doi.org/10.2196/23806 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843598 ID - info:doi/10.2196/23806 ER - TY - JOUR AU - Orrange, Sharon AU - Patel, Arpna AU - Mack, Jean Wendy AU - Cassetta, Julia PY - 2021/4/22 TI - Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study JO - JMIR Hum Factors SP - e28589 VL - 8 IS - 2 KW - telemedicine KW - patient satisfaction KW - COVID-19 KW - health services research KW - health policy KW - health care delivery KW - physicians KW - medicine N2 - 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. UR - https://humanfactors.jmir.org/2021/2/e28589 UR - http://dx.doi.org/10.2196/28589 UR - http://www.ncbi.nlm.nih.gov/pubmed/33822736 ID - info:doi/10.2196/28589 ER - TY - JOUR AU - Han, J. Paul K. AU - Scharnetzki, Elizabeth AU - Scherer, M. Aaron AU - Thorpe, Alistair AU - Lary, Christine AU - Waterston, B. Leo AU - Fagerlin, Angela AU - Dieckmann, F. Nathan PY - 2021/4/22 TI - Communicating Scientific Uncertainty About the COVID-19 Pandemic: Online Experimental Study of an Uncertainty-Normalizing Strategy JO - J Med Internet Res SP - e27832 VL - 23 IS - 4 KW - uncertainty KW - communication KW - ambiguity KW - vaccination KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/4/e27832 UR - http://dx.doi.org/10.2196/27832 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769947 ID - info:doi/10.2196/27832 ER - TY - JOUR AU - Patel, I. Darpan AU - Gamez, Yazmin AU - Shah, Lajja AU - Patel, Jaini PY - 2021/4/22 TI - Decline of Psychological Health Following the Designation of COVID-19 as a Pandemic: Descriptive Study JO - J Med Internet Res SP - e24964 VL - 23 IS - 4 KW - anxiety KW - COVID-19 KW - descriptive study KW - mental health KW - pandemic KW - physical health KW - quality of life KW - stress N2 - Background: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, and as of this writing, Texas, United States, has reported >675,000 cases with over 14,000 deaths. Many of the preventive measures implemented during the pandemic can increase sedentary lifestyles, which can lead to the development of chronic diseases, including obesity, among the general population and cause serious threats to people?s physical health and overall quality of life. Individuals with pre-existing comorbidities are at an increased risk of COVID-19 and may hence have higher levels of stress. Objective: This study aimed to investigate the relationship between physical activity levels and mental health status on an individual level and to compare them between those with and those without comorbidities in a cohort of Texas residents, before and after COVID-19 was declared a pandemic. Methods: An electronic survey was disseminated throughout various regions of Texas. In total, 160 individuals were asked questions about their demographic characteristics, time spent on daily physical activities, and daily mental health status before and after COVID-19 was declared a pandemic. Frequency distributions and descriptive statistics were analyzed. Results: Overall, 94 (58%) participants reported having ?1 medical condition, and 31 (13.1%) had >3 medical conditions. Physical activity levels among participants with ?1 pre-existing comorbidity drastically?but not significantly?decreased, as evident from a 10% increase in sedentary lifestyles after COVID-19 was declared a pandemic. On the contrary, we observed a 9% increase in the number of individuals without a pre-existing comorbidity who reported 30-60 min of physical activity per week. There was a 2-fold increase in the number of participants reporting more frequent feelings of nervousness, too much worry, trouble relaxing, and the fear of something awful happening after the pandemic. More specifically, individuals with pre-existing medical conditions reported, on average, a 10% higher incidence of feelings of stress, anxiety, and sadness compared to their healthy counterparts after COVID-19 was declared a pandemic. Conclusions: Stressful life conditions and chronic comorbidities are risk factors that can affect mental health and reduce the ability to perform activities of daily life. Therefore, when implementing pandemic protocols, municipalities should consider providing mental health support to their citizens to protect them from this rather inconspicuous adverse effect. UR - https://www.jmir.org/2021/4/e24964 UR - http://dx.doi.org/10.2196/24964 UR - http://www.ncbi.nlm.nih.gov/pubmed/33793408 ID - info:doi/10.2196/24964 ER - TY - JOUR AU - Utunen, Heini AU - Van Kerkhove, D. Maria AU - Tokar, Anna AU - O'Connell, Gillian AU - Gamhewage, M. Gaya AU - Fall, Socé Ibrahima PY - 2021/4/21 TI - One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization?s Technical Guidance JO - JMIR Public Health Surveill SP - e28945 VL - 7 IS - 4 KW - COVID-19 KW - e-learning KW - massive open web-based courses KW - OpenWHO KW - pandemic KW - public health KW - web-based learning KW - World Health Organization UR - https://publichealth.jmir.org/2021/4/e28945 UR - http://dx.doi.org/10.2196/28945 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881404 ID - info:doi/10.2196/28945 ER - TY - JOUR AU - Wang, Menghua AU - Liao, Banghua AU - Jian, Zhongyu AU - Jin, Xi AU - Xiang, Liyuan AU - Yuan, Chi AU - Li, Hong AU - Wang, Kunjie PY - 2021/4/21 TI - Participation in Virtual Urology Conferences During the COVID-19 Pandemic: Cross-sectional Survey Study JO - J Med Internet Res SP - e24369 VL - 23 IS - 4 KW - virtual conference KW - COVID-19 KW - survey N2 - Background: Due to the influence of the COVID-19 pandemic, conventional face-to-face academic conferences have been restricted, and many of these conferences have moved onto the internet. Objective: The aim of this study was to investigate the virtual conferences in the field of urology during the COVID-19 pandemic and provide suggestions for better organization of such conferences. Methods: A cross-sectional survey was conducted from May 30 to June 15, 2020, in China. Our team designed a 23-item questionnaire to investigate the conferences attended by urologists during the COVID-19 pandemic. SPSS 22.0 (IBM Corporation) was applied to analyze the data collected. Results: A total of 330 Chinese urologists participated in our survey, and the response rate was 89.7% (330/368). Among the participants, 40.9% (135/330) were associate chief physicians. The proportion of participants who took part in conventional face-to-face academic conferences decreased from 92.7% (306/330) before the COVID-19 pandemic to 22.1% (73/330) during the pandemic (P<.001). In contrast, the proportion of urologists who took part in virtual conferences increased from 69.4% (229/330) to 90% (297/330) (P<.001). Most urologists (70.7%, 210/297) chose to participate in the virtual conferences at home and thought that a meeting length of 1-2 hours was most appropriate. Among the urologists, 73.7% (219/297) reported that their participation in the virtual conferences went smoothly, while the remaining respondents reported that they had experienced lags in video and audio streaming during the virtual conferences. When comparing conventional face-to-face conferences with virtual conferences, 70.7% (210/297) of the respondents thought that both conference formats were acceptable, while 17.9% (53/297) preferred virtual conferences and 11.5% (34/297) preferred conventional face-to-face meetings. Conclusions: Virtual conferences are increasing in popularity during the COVID-19 pandemic; however, many aspects of these conferences could be improved for better organization. UR - https://www.jmir.org/2021/4/e24369 UR - http://dx.doi.org/10.2196/24369 UR - http://www.ncbi.nlm.nih.gov/pubmed/33844635 ID - info:doi/10.2196/24369 ER - TY - JOUR AU - Cummings, C. Brandon AU - Ansari, Sardar AU - Motyka, R. Jonathan AU - Wang, Guan AU - Medlin Jr, P. Richard AU - Kronick, L. Steven AU - Singh, Karandeep AU - Park, K. Pauline AU - Napolitano, M. Lena AU - Dickson, P. Robert AU - Mathis, R. Michael AU - Sjoding, W. Michael AU - Admon, J. Andrew AU - Blank, Ross AU - McSparron, I. Jakob AU - Ward, R. Kevin AU - Gillies, E. Christopher PY - 2021/4/21 TI - Predicting Intensive Care Transfers and Other Unforeseen Events: Analytic Model Validation Study and Comparison to Existing Methods JO - JMIR Med Inform SP - e25066 VL - 9 IS - 4 KW - COVID-19 KW - biomedical informatics KW - critical care KW - machine learning KW - deterioration KW - predictive analytics KW - informatics KW - prediction KW - intensive care unit KW - ICU KW - mortality N2 - 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. UR - https://medinform.jmir.org/2021/4/e25066 UR - http://dx.doi.org/10.2196/25066 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818393 ID - info:doi/10.2196/25066 ER - TY - JOUR AU - Telles, Roberto Charles AU - Roy, Archisman AU - Ajmal, Rehan Mohammad AU - Mustafa, Khalid Syed AU - Ahmad, Ayaz Mohammad AU - de la Serna, Moises Juan AU - Frigo, Pires Elisandro AU - Rosales, Hernández Manuel PY - 2021/4/21 TI - The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis JO - JMIR Public Health Surveill SP - e20699 VL - 7 IS - 4 KW - social distancing policies KW - COVID-19 KW - airborne transmission KW - convergence and stability properties N2 - 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. UR - https://publichealth.jmir.org/2021/4/e20699 UR - http://dx.doi.org/10.2196/20699 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729168 ID - info:doi/10.2196/20699 ER - TY - JOUR AU - De Leo, Stefano PY - 2021/4/21 TI - Impact of COVID-19 Testing Strategies and Lockdowns on Disease Management Across Europe, South America, and the United States: Analysis Using Skew-Normal Distributions JO - JMIRx Med SP - e21269 VL - 2 IS - 2 KW - COVID-19 KW - testing strategy KW - skew-normal distributions KW - lockdown KW - forecast KW - modeling KW - outbreak KW - infectious disease KW - prediction N2 - 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. UR - https://xmed.jmir.org/2021/2/e21269 UR - http://dx.doi.org/10.2196/21269 UR - http://www.ncbi.nlm.nih.gov/pubmed/34032814 ID - info:doi/10.2196/21269 ER - TY - JOUR AU - Houlding, Elizabeth AU - Mate, V. Kedar K. AU - Engler, Kim AU - Ortiz-Paredes, David AU - Pomey, Marie-Pascale AU - Cox, Joseph AU - Hijal, Tarek AU - Lebouché, Bertrand PY - 2021/4/20 TI - Barriers to Use of Remote Monitoring Technologies Used to Support Patients With COVID-19: Rapid Review JO - JMIR Mhealth Uhealth SP - e24743 VL - 9 IS - 4 KW - remote monitoring KW - technology KW - COVID-19, telehealth KW - asynchronous technology KW - synchronous technology KW - mHealth KW - monitoring KW - review KW - barrier KW - benefit KW - equity N2 - Background: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective: The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods: A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results: Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19?specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality ?best practice? guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). Conclusions: Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing ?best practice? guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations). UR - https://mhealth.jmir.org/2021/4/e24743 UR - http://dx.doi.org/10.2196/24743 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769943 ID - info:doi/10.2196/24743 ER - TY - JOUR AU - Furstrand, Dorthe AU - Pihl, Andreas AU - Orbe, Bayram Elif AU - Kingod, Natasja AU - Søndergaard, Jens PY - 2021/4/20 TI - ?Ask a Doctor About Coronavirus?: How Physicians on Social Media Can Provide Valid Health Information During a Pandemic JO - J Med Internet Res SP - e24586 VL - 23 IS - 4 KW - COVID-19 KW - coronavirus KW - digital health literacy KW - eHealth literacy KW - Facebook KW - framework KW - health information KW - health literacy KW - health promotion KW - infodemic KW - infodemiology KW - mental health KW - misinformation KW - pandemic KW - patient-physician relationship KW - public health KW - social media KW - trust KW - web-based community UR - https://www.jmir.org/2021/4/e24586 UR - http://dx.doi.org/10.2196/24586 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835935 ID - info:doi/10.2196/24586 ER - TY - JOUR AU - Resnicow, Ken AU - Bacon, Elizabeth AU - Yang, Penny AU - Hawley, Sarah AU - Van Horn, Lee M. AU - An, Lawrence PY - 2021/4/20 TI - Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey JO - J Med Internet Res SP - e23488 VL - 23 IS - 4 KW - COVID-19 KW - protective behavior KW - psychological predictors KW - reactance KW - conspiracy beliefs KW - public health KW - health communication KW - communication KW - protection KW - behavior KW - psychology N2 - 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. UR - https://www.jmir.org/2021/4/e23488 UR - http://dx.doi.org/10.2196/23488 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835930 ID - info:doi/10.2196/23488 ER - TY - JOUR AU - Wang, Zhicheng AU - Lin, Leesa AU - Guo, Yan AU - Xiong, Huayi AU - Tang, Kun PY - 2021/4/20 TI - The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork JO - J Med Internet Res SP - e23311 VL - 23 IS - 4 KW - nonpharmaceutical interventions KW - on-duty deaths KW - COVID-19 KW - overwork death KW - crowdsourced data KW - intervention KW - mortality KW - casualty KW - cross-sectional KW - overwork KW - stress N2 - 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. UR - https://www.jmir.org/2021/4/e23311 UR - http://dx.doi.org/10.2196/23311 UR - http://www.ncbi.nlm.nih.gov/pubmed/33822735 ID - info:doi/10.2196/23311 ER - TY - JOUR AU - Jha, Prakash Indra AU - Awasthi, Raghav AU - Kumar, Ajit AU - Kumar, Vibhor AU - Sethi, Tavpritesh PY - 2021/4/20 TI - Learning the Mental Health Impact of COVID-19 in the United States With Explainable Artificial Intelligence: Observational Study JO - JMIR Ment Health SP - e25097 VL - 8 IS - 4 KW - COVID-19 KW - mental health KW - Bayesian network KW - machine learning KW - artificial intelligence KW - disorder KW - susceptibility KW - well-being KW - explainable artificial intelligence N2 - 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. UR - https://mental.jmir.org/2021/4/e25097 UR - http://dx.doi.org/10.2196/25097 UR - http://www.ncbi.nlm.nih.gov/pubmed/33877051 ID - info:doi/10.2196/25097 ER - TY - JOUR AU - Fernandes, Magela Geraldo AU - Motta, Felipe AU - Sasaki, Paravidine Lizandra Moura AU - Silva, Da Ângelo Pereira AU - Miranda, Monforte Andreza AU - Carvalho, De Aleida Oliveira AU - Gomides, Monteiro Ana Paula AU - Soares, Munhoz Alexandre Anderson De Sousa AU - Santos Jr, Dos Agenor De Castro Moreira AU - Alves, Oliveira Caroline De AU - Gomes, Martins Ciro AU - Siracusa, De Clara Correia AU - Araújo Jr, De David Alves AU - Mendonça-Silva, Lane Dayde AU - Jesus, De José Alfredo Lacerda AU - Costa, Nascimento Karina AU - Castro, De Maria Eduarda Canellas AU - Kurizky, Shu Patricia AU - França, Sérgio Paulo AU - Tristão, Rosana AU - Pereira, Ribeiro Yacara AU - Castro, De Luiz Claudio Gonçalves AU - Zaconeta, Moreno Alberto AU - Albuquerque, De Cleandro Pires AU - Mota, Da Licia Maria Henrique PY - 2021/4/20 TI - Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study JO - JMIR Res Protoc SP - e26477 VL - 10 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - pregnancy KW - neonate KW - children KW - outcome KW - development KW - prospective KW - cohort KW - women KW - fetus KW - baby KW - implication N2 - 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 UR - https://www.researchprotocols.org/2021/4/e26477 UR - http://dx.doi.org/10.2196/26477 UR - http://www.ncbi.nlm.nih.gov/pubmed/33793409 ID - info:doi/10.2196/26477 ER - TY - JOUR AU - König, Alexandra AU - Riviere, Kevin AU - Linz, Nicklas AU - Lindsay, Hali AU - Elbaum, Julia AU - Fabre, Roxane AU - Derreumaux, Alexandre AU - Robert, Philippe PY - 2021/4/19 TI - Measuring Stress in Health Professionals Over the Phone Using Automatic Speech Analysis During the COVID-19 Pandemic: Observational Pilot Study JO - J Med Internet Res SP - e24191 VL - 23 IS - 4 KW - stress detection KW - speech KW - voice analysis KW - COVID-19 KW - phone monitoring KW - computer linguistics N2 - Background: During the COVID-19 pandemic, health professionals have been directly confronted with the suffering of patients and their families. By making them main actors in the management of this health crisis, they have been exposed to various psychosocial risks (stress, trauma, fatigue, etc). Paradoxically, stress-related symptoms are often underreported in this vulnerable population but are potentially detectable through passive monitoring of changes in speech behavior. Objective: This study aims to investigate the use of rapid and remote measures of stress levels in health professionals working during the COVID-19 outbreak. This was done through the analysis of participants? speech behavior during a short phone call conversation and, in particular, via positive, negative, and neutral storytelling tasks. Methods: Speech samples from 89 health care professionals were collected over the phone during positive, negative, and neutral storytelling tasks; various voice features were extracted and compared with classical stress measures via standard questionnaires. Additionally, a regression analysis was performed. Results: Certain speech characteristics correlated with stress levels in both genders; mainly, spectral (ie, formant) features, such as the mel-frequency cepstral coefficient, and prosodic characteristics, such as the fundamental frequency, appeared to be sensitive to stress. Overall, for both male and female participants, using vocal features from the positive tasks for regression yielded the most accurate prediction results of stress scores (mean absolute error 5.31). Conclusions: Automatic speech analysis could help with early detection of subtle signs of stress in vulnerable populations over the phone. By combining the use of this technology with timely intervention strategies, it could contribute to the prevention of burnout and the development of comorbidities, such as depression or anxiety. UR - https://www.jmir.org/2021/4/e24191 UR - http://dx.doi.org/10.2196/24191 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739930 ID - info:doi/10.2196/24191 ER - TY - JOUR AU - Chung, Heewon AU - Ko, Hoon AU - Kang, Seong Wu AU - Kim, Won Kyung AU - Lee, Hooseok AU - Park, Chul AU - Song, Hyun-Ok AU - Choi, Tae-Young AU - Seo, Ho Jae AU - Lee, Jinseok PY - 2021/4/19 TI - Prediction and Feature Importance Analysis for Severity of COVID-19 in South Korea Using Artificial Intelligence: Model Development and Validation JO - J Med Internet Res SP - e27060 VL - 23 IS - 4 KW - COVID-19 KW - artificial intelligence KW - blood samples KW - mortality prediction N2 - 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. UR - https://www.jmir.org/2021/4/e27060 UR - http://dx.doi.org/10.2196/27060 UR - http://www.ncbi.nlm.nih.gov/pubmed/33764883 ID - info:doi/10.2196/27060 ER - TY - JOUR AU - Ilyin, O. Sergey PY - 2021/4/19 TI - A Recursive Model of the Spread of COVID-19: Modelling Study JO - JMIR Public Health Surveill SP - e21468 VL - 7 IS - 4 KW - epidemiology KW - COVID-19 KW - model KW - modelling KW - prediction KW - spread KW - infection KW - effective KW - contagious KW - transmission N2 - 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. UR - https://publichealth.jmir.org/2021/4/e21468 UR - http://dx.doi.org/10.2196/21468 UR - http://www.ncbi.nlm.nih.gov/pubmed/33871381 ID - info:doi/10.2196/21468 ER - TY - JOUR AU - Kwok, On Kin AU - Wei, In Wan AU - Huang, Ying AU - Kam, Man Kai AU - Chan, Yang Emily Ying AU - Riley, Steven AU - Chan, Henry Ho Hin AU - Hui, Cheong David Shu AU - Wong, Shan Samuel Yeung AU - Yeoh, Kiong Eng PY - 2021/4/16 TI - Evolving Epidemiological Characteristics of COVID-19 in Hong Kong From January to August 2020: Retrospective Study JO - J Med Internet Res SP - e26645 VL - 23 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - evolving epidemiology KW - containment delay KW - serial interval KW - Hong Kong KW - epidemiology KW - public health KW - transmission KW - China KW - intervention KW - case study N2 - 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. UR - https://www.jmir.org/2021/4/e26645 UR - http://dx.doi.org/10.2196/26645 UR - http://www.ncbi.nlm.nih.gov/pubmed/33750740 ID - info:doi/10.2196/26645 ER - TY - JOUR AU - Oh, Bumjo AU - Hwangbo, Suhyun AU - Jung, Taeyeong AU - Min, Kyungha AU - Lee, Chanhee AU - Apio, Catherine AU - Lee, Hyejin AU - Lee, Seungyeoun AU - Moon, Kyong Min AU - Kim, Shin-Woo AU - Park, Taesung PY - 2021/4/16 TI - Prediction Models for the Clinical Severity of Patients With COVID-19 in Korea: Retrospective Multicenter Cohort Study JO - J Med Internet Res SP - e25852 VL - 23 IS - 4 KW - clinical decision support system KW - clinical characteristics KW - COVID-19 KW - SARS-CoV-2 KW - prognostic tool KW - severity N2 - 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. UR - https://www.jmir.org/2021/4/e25852 UR - http://dx.doi.org/10.2196/25852 UR - http://www.ncbi.nlm.nih.gov/pubmed/33822738 ID - info:doi/10.2196/25852 ER - TY - JOUR AU - Bachtiger, Patrik AU - Adamson, Alexander AU - Chow, Ji-Jian AU - Sisodia, Rupa AU - Quint, K. Jennifer AU - Peters, S. Nicholas PY - 2021/4/14 TI - The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study JO - JMIR Public Health Surveill SP - e26734 VL - 7 IS - 4 KW - COVID-19 KW - influenza KW - vaccination KW - COVID KW - Pandemic KW - National Health Service KW - Health Service KW - flu KW - virus KW - vaccine KW - impact KW - uptake KW - observational KW - United Kingdom KW - public health KW - intention KW - electronic health record N2 - 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. UR - https://publichealth.jmir.org/2021/4/e26734 UR - http://dx.doi.org/10.2196/26734 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651708 ID - info:doi/10.2196/26734 ER - TY - JOUR AU - Domínguez-Olmedo, L. Juan AU - Gragera-Martínez, Álvaro AU - Mata, Jacinto AU - Pachón Álvarez, Victoria PY - 2021/4/14 TI - Machine Learning Applied to Clinical Laboratory Data in Spain for COVID-19 Outcome Prediction: Model Development and Validation JO - J Med Internet Res SP - e26211 VL - 23 IS - 4 KW - COVID-19 KW - electronic health record KW - machine learning KW - mortality KW - prediction N2 - 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. UR - https://www.jmir.org/2021/4/e26211 UR - http://dx.doi.org/10.2196/26211 UR - http://www.ncbi.nlm.nih.gov/pubmed/33793407 ID - info:doi/10.2196/26211 ER - TY - JOUR AU - Guo, Ziqiu AU - Zhao, Zhi Sheng AU - Guo, Ningyuan AU - Wu, Yongda AU - Weng, Xue AU - Wong, Yuen-Ha Janet AU - Lam, Hing Tai AU - Wang, Ping Man PY - 2021/4/14 TI - Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study JO - J Med Internet Res SP - e24577 VL - 23 IS - 4 KW - COVID-19 KW - eHealth literacy KW - preventive behaviors KW - socioeconomic disparities KW - web-based information seeking N2 - 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. UR - https://www.jmir.org/2021/4/e24577 UR - http://dx.doi.org/10.2196/24577 UR - http://www.ncbi.nlm.nih.gov/pubmed/33784240 ID - info:doi/10.2196/24577 ER - TY - JOUR AU - Gerts, Dax AU - Shelley, D. Courtney AU - Parikh, Nidhi AU - Pitts, Travis AU - Watson Ross, Chrysm AU - Fairchild, Geoffrey AU - Vaquera Chavez, Yadria Nidia AU - Daughton, R. Ashlynn PY - 2021/4/14 TI - ?Thought I?d Share First? and Other Conspiracy Theory Tweets from the COVID-19 Infodemic: Exploratory Study JO - JMIR Public Health Surveill SP - e26527 VL - 7 IS - 4 KW - COVID-19 KW - coronavirus KW - social media KW - misinformation KW - health communication KW - Twitter KW - infodemic KW - infodemiology KW - conspiracy theories KW - vaccine hesitancy KW - 5G KW - unsupervised learning KW - random forest KW - active learning KW - supervised learning KW - machine learning KW - conspiracy KW - communication KW - vaccine KW - public health N2 - Background: The COVID-19 outbreak has left many people isolated within their homes; these people are turning to social media for news and social connection, which leaves them vulnerable to believing and sharing misinformation. Health-related misinformation threatens adherence to public health messaging, and monitoring its spread on social media is critical to understanding the evolution of ideas that have potentially negative public health impacts. Objective: The aim of this study is to use Twitter data to explore methods to characterize and classify four COVID-19 conspiracy theories and to provide context for each of these conspiracy theories through the first 5 months of the pandemic. Methods: We began with a corpus of COVID-19 tweets (approximately 120 million) spanning late January to early May 2020. We first filtered tweets using regular expressions (n=1.8 million) and used random forest classification models to identify tweets related to four conspiracy theories. Our classified data sets were then used in downstream sentiment analysis and dynamic topic modeling to characterize the linguistic features of COVID-19 conspiracy theories as they evolve over time. Results: Analysis using model-labeled data was beneficial for increasing the proportion of data matching misinformation indicators. Random forest classifier metrics varied across the four conspiracy theories considered (F1 scores between 0.347 and 0.857); this performance increased as the given conspiracy theory was more narrowly defined. We showed that misinformation tweets demonstrate more negative sentiment when compared to nonmisinformation tweets and that theories evolve over time, incorporating details from unrelated conspiracy theories as well as real-world events. Conclusions: Although we focus here on health-related misinformation, this combination of approaches is not specific to public health and is valuable for characterizing misinformation in general, which is an important first step in creating targeted messaging to counteract its spread. Initial messaging should aim to preempt generalized misinformation before it becomes widespread, while later messaging will need to target evolving conspiracy theories and the new facets of each as they become incorporated. UR - https://publichealth.jmir.org/2021/4/e26527 UR - http://dx.doi.org/10.2196/26527 UR - http://www.ncbi.nlm.nih.gov/pubmed/33764882 ID - info:doi/10.2196/26527 ER - TY - JOUR AU - Zeng, Chengbo AU - Zhang, Jiajia AU - Li, Zhenlong AU - Sun, Xiaowen AU - Olatosi, Bankole AU - Weissman, Sharon AU - Li, Xiaoming PY - 2021/4/13 TI - Spatial-Temporal Relationship Between Population Mobility and COVID-19 Outbreaks in South Carolina: Time Series Forecasting Analysis JO - J Med Internet Res SP - e27045 VL - 23 IS - 4 KW - COVID-19 KW - mobility KW - incidence KW - South Carolina N2 - 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. UR - https://www.jmir.org/2021/4/e27045 UR - http://dx.doi.org/10.2196/27045 UR - http://www.ncbi.nlm.nih.gov/pubmed/33784239 ID - info:doi/10.2196/27045 ER - TY - JOUR AU - Dennis, S. Alexander AU - Moravec, L. Patricia AU - Kim, Antino AU - Dennis, R. Alan PY - 2021/4/13 TI - Assessment of the Effectiveness of Identity-Based Public Health Announcements in Increasing the Likelihood of Complying With COVID-19 Guidelines: Randomized Controlled Cross-sectional Web-Based Study JO - JMIR Public Health Surveill SP - e25762 VL - 7 IS - 4 KW - Amazon Mechanical Turk KW - compliance KW - COVID-19 KW - custom KW - effectiveness KW - guideline KW - identity KW - public health KW - public health announcement KW - public service announcement KW - social media KW - web-based health information N2 - Background: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. Objective: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals? identities increases their compliance. Methods: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. Results: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual?s identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. Conclusions: Using social media to deliver COVID-19 public health announcements customized to individuals? identities is a promising measure to increase compliance with public health guidelines. Trial Registration: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899. UR - https://publichealth.jmir.org/2021/4/e25762 UR - http://dx.doi.org/10.2196/25762 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819910 ID - info:doi/10.2196/25762 ER - TY - JOUR AU - Taeymans, Jan AU - Luijckx, Eefje AU - Rogan, Slavko AU - Haas, Karin AU - Baur, Heiner PY - 2021/4/13 TI - Physical Activity, Nutritional Habits, and Sleeping Behavior in Students and Employees of a Swiss University During the COVID-19 Lockdown Period: Questionnaire Survey Study JO - JMIR Public Health Surveill SP - e26330 VL - 7 IS - 4 KW - COVID-19 KW - healthy lifestyle KW - pandemics KW - public health KW - universities N2 - Background: The new coronavirus SARS-CoV-2 led to the COVID-19 pandemic starting in January 2020. The Swiss Federal Council prescribed a lockdown of nonessential businesses. Students and employees of higher education institutions had to install home offices and participate in online lectures. Objective: The aim of this survey study was to evaluate lifestyle habits, such as physical activity (PA), sitting time, nutritional habits (expressed as median modified Mediterranean Diet Score [mMDS]), alcohol consumption habits, and sleeping behavior during a 2-month period of confinement and social distancing due to the COVID-19 pandemic. Survey participants were students and employees of a Swiss university of applied sciences. Methods: All students and employees from Bern University of Applied Sciences, Department of Health Professions (ie, nursing, nutrition and dietetics, midwifery, and physiotherapy divisions) were invited to complete an anonymous online survey during the COVID-19 confinement period. Information on the lifestyle dimensions of PA, sitting time, nutritional and alcohol consumption habits, and sleep behavior was gathered using adaptations of validated questionnaires. Frequency analyses and nonparametric statistical methods were used for data analysis. Significance was set at 5% ? level of error. Results: Prevalence of non-health-enhancing PA was 37.1%, with participants of the division of physiotherapy showing the lowest prevalence. Prevalence of long sitting time (>8 hours/day) was 36.1%. The median mMDS was 9, where the maximal score was 15, with participants of the division of nutrition and dietetics being more adherent to a Mediterranean diet as compared to the other groups. Prevalence of nonadherence to the Swiss alcohol consumption recommendations was 8.3%. Prevalence of low sleeping quality was 44.7%, while the median sleeping duration was 8 hours, which is considered healthy for adult populations. Conclusions: In the group analysis, differences in PA, sitting time, and mMDS were observed between different divisions of health professions as well as between Bachelor of Science students, Master of Science students, and employees. Therefore, public health messages regarding healthy lifestyle habits during home confinement should be more group specific. The results of this study may provide support for the implementation of group-specific health promotion interventions at universities in pandemic conditions. Trial Registration: ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108 UR - https://publichealth.jmir.org/2021/4/e26330 UR - http://dx.doi.org/10.2196/26330 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630747 ID - info:doi/10.2196/26330 ER - TY - JOUR AU - Mbwogge, Mathew PY - 2021/4/12 TI - Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review JO - JMIRx Med SP - e27254 VL - 2 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - test and trace KW - universal testing KW - mass testing KW - contact tracing KW - infection surveillance KW - prevention and control KW - review N2 - 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. UR - https://xmed.jmir.org/2021/2/e27254 UR - http://dx.doi.org/10.2196/27254 UR - http://www.ncbi.nlm.nih.gov/pubmed/33857269 ID - info:doi/10.2196/27254 ER - TY - JOUR AU - Lebrasseur, Audrey AU - Fortin-Bédard, Noémie AU - Lettre, Josiane AU - Raymond, Emilie AU - Bussières, Eve-Line AU - Lapierre, Nolwenn AU - Faieta, Julie AU - Vincent, Claude AU - Duchesne, Louise AU - Ouellet, Marie-Christine AU - Gagnon, Eric AU - Tourigny, André AU - Lamontagne, Marie-Ève AU - Routhier, François PY - 2021/4/12 TI - Impact of the COVID-19 Pandemic on Older Adults: Rapid Review JO - JMIR Aging SP - e26474 VL - 4 IS - 2 KW - COVID-19 KW - impact KW - rapid review KW - older adults KW - aged individuals KW - review N2 - 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. UR - https://aging.jmir.org/2021/2/e26474 UR - http://dx.doi.org/10.2196/26474 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720839 ID - info:doi/10.2196/26474 ER - TY - JOUR AU - Mo, Han Phoenix Kit AU - Fong, In Vivian Wai AU - Song, Bo AU - Di, Jiangli AU - Wang, Qian AU - Wang, Linhong PY - 2021/4/12 TI - 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 JO - J Med Internet Res SP - e24053 VL - 23 IS - 4 KW - COVID-19 KW - pregnant women KW - depression KW - anxiety KW - self-efficacy KW - mental health KW - survey KW - threat KW - emotion N2 - 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. UR - https://www.jmir.org/2021/4/e24053 UR - http://dx.doi.org/10.2196/24053 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729983 ID - info:doi/10.2196/24053 ER - TY - JOUR AU - He, Qian AU - Du, Fei AU - Simonse, L. Lianne W. PY - 2021/4/12 TI - 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 JO - JMIR Med Inform SP - e23238 VL - 9 IS - 4 KW - COVID-19 KW - design KW - eHealth KW - artificial intelligence KW - service design KW - patient journey map KW - user-centered design KW - digital service solutions in health KW - home isolation KW - AI KW - touchpoint N2 - 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. UR - https://medinform.jmir.org/2021/4/e23238 UR - http://dx.doi.org/10.2196/23238 UR - http://www.ncbi.nlm.nih.gov/pubmed/33444156 ID - info:doi/10.2196/23238 ER - TY - JOUR AU - Calderaro, Cerqueira Débora AU - Kahlow, Stadler Barbara AU - Munhoz, Araújo Gabriela AU - Dias, Basualto Samuel Elias AU - Lopes, Ziroldo João Vitor AU - Borges, Rizzo Aline AU - Mariz, Ataíde Henrique De AU - Gomes, Poti Kirla Wagner AU - Valadares, Azevedo Lilian David De AU - Araújo, Costa Nafice AU - Ribeiro, Euzébio Sandra Lucia AU - Kakehasi, Maria Adriana AU - Reis, Gomides Ana Paula Monteiro AU - Marques, Cláudia AU - Reis-Neto, Torres Edgard AU - Paiva, Santos Eduardo Dos AU - Pileggi, Salviato Gecilmara AU - Ferreira, Aparecida Gilda AU - Provenza, Roberto José AU - Mota, Henrique Licia Maria AU - Xavier, Machado Ricardo AU - Teodoro, Martins Maycoln Leôni AU - Pinheiro, Medeiros Marcelo De AU - PY - 2021/4/9 TI - 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 JO - JMIR Res Protoc SP - e24617 VL - 10 IS - 4 KW - SARS-CoV-2 KW - COVID-19 KW - medical education KW - observational KW - cross-sectional KW - case-control study KW - voluntary KW - mental health KW - rheumatic disease KW - medical student KW - protocol KW - survey N2 - 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 UR - https://www.researchprotocols.org/2021/4/e24617 UR - http://dx.doi.org/10.2196/24617 UR - http://www.ncbi.nlm.nih.gov/pubmed/33735094 ID - info:doi/10.2196/24617 ER - TY - JOUR AU - Viana dos Santos Santana, Íris AU - CM da Silveira, Andressa AU - Sobrinho, Álvaro AU - Chaves e Silva, Lenardo AU - Dias da Silva, Leandro AU - Santos, S. Danilo F. AU - Gurjão, C. Edmar AU - Perkusich, Angelo PY - 2021/4/8 TI - Classification Models for COVID-19 Test Prioritization in Brazil: Machine Learning Approach JO - J Med Internet Res SP - e27293 VL - 23 IS - 4 KW - COVID-19 KW - test prioritization KW - classification models KW - medical diagnosis N2 - 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. UR - https://www.jmir.org/2021/4/e27293 UR - http://dx.doi.org/10.2196/27293 UR - http://www.ncbi.nlm.nih.gov/pubmed/33750734 ID - info:doi/10.2196/27293 ER - TY - JOUR AU - Shapiro, B. Mark AU - Karim, Fazle AU - Muscioni, Guido AU - Augustine, Saju Abel PY - 2021/4/7 TI - Adaptive Susceptible-Infectious-Removed Model for Continuous Estimation of the COVID-19 Infection Rate and Reproduction Number in the United States: Modeling Study JO - J Med Internet Res SP - e24389 VL - 23 IS - 4 KW - compartmental models KW - COVID-19 KW - decision-making KW - estimate KW - infection rate KW - infectious disease KW - modeling KW - pandemic KW - prediction KW - reproduction number KW - SARS-CoV-2 KW - United States N2 - 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. UR - https://www.jmir.org/2021/4/e24389 UR - http://dx.doi.org/10.2196/24389 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755577 ID - info:doi/10.2196/24389 ER - TY - JOUR AU - Chen, Yuanfang AU - Ouyang, Liu AU - Bao, S. Forrest AU - Li, Qian AU - Han, Lei AU - Zhang, Hengdong AU - Zhu, Baoli AU - Ge, Yaorong AU - Robinson, Patrick AU - Xu, Ming AU - Liu, Jie AU - Chen, Shi PY - 2021/4/7 TI - A Multimodality Machine Learning Approach to Differentiate Severe and Nonsevere COVID-19: Model Development and Validation JO - J Med Internet Res SP - e23948 VL - 23 IS - 4 KW - COVID-19 KW - clinical type KW - multimodality KW - classification KW - machine learning KW - diagnosis KW - prediction KW - reliable KW - decision support N2 - 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. UR - https://www.jmir.org/2021/4/e23948 UR - http://dx.doi.org/10.2196/23948 UR - http://www.ncbi.nlm.nih.gov/pubmed/33714935 ID - info:doi/10.2196/23948 ER - TY - JOUR AU - Peng, T. Henry AU - Rhind, G. Shawn AU - Beckett, Andrew PY - 2021/4/7 TI - Convalescent Plasma for the Prevention and Treatment of COVID-19: A Systematic Review and Quantitative Analysis JO - JMIR Public Health Surveill SP - e25500 VL - 7 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - antibodies KW - convalescent plasma KW - immunotherapy KW - prevention KW - treatment KW - review KW - quantitative KW - therapeutic KW - immunology KW - research KW - literature KW - knowledge KW - recommendation N2 - Background: The COVID-19 pandemic, caused by a novel coronavirus termed SARS-CoV-2, has spread quickly worldwide. Convalescent plasma (CP) obtained from patients following recovery from COVID-19 infection and development of antibodies against the virus is an attractive option for either prophylactic or therapeutic treatment, since antibodies may have direct or indirect antiviral activities and immunotherapy has proven effective in principle and in many clinical reports. Objective: We seek to characterize the latest advances and evidence in the use of CP for COVID-19 through a systematic review and quantitative analysis, identify knowledge gaps in this setting, and offer recommendations and directives for future research. Methods: PubMed, Web of Science, and Embase were continuously searched for studies assessing the use of CP for COVID-19, including clinical studies, commentaries, reviews, guidelines or protocols, and in vitro testing of CP antibodies. The screening process and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal of all clinical studies was conducted using a universal tool independent of study designs. A meta-analysis of case-control and randomized controlled trials (RCTs) was conducted using a random-effects model. Results: Substantial literature has been published covering various aspects of CP therapy for COVID-19. Of the references included in this review, a total of 243 eligible studies including 64 clinical studies, 79 commentary articles, 46 reviews, 19 guidance and protocols, and 35 in vitro testing of CP antibodies matched the criteria. Positive results have been mostly observed so far when using CP for the treatment of COVID-19. There were remarkable heterogeneities in the CP therapy with respect to patient demographics, donor antibody titers, and time and dose of CP administration. The studies assessing the safety of CP treatment reported low incidence of adverse events. Most clinical studies, in particular case reports and case series, had poor quality. Only 1 RCT was of high quality. Randomized and nonrandomized data were found in 2 and 11 studies, respectively, and were included for meta-analysis, suggesting that CP could reduce mortality and increase viral clearance. Despite promising pilot studies, the benefits of CP treatment can only be clearly established through carefully designed RCTs. Conclusions: There is developing support for CP therapy, particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. These studies provide important lessons that should inform the planning of well-designed RCTs to generate more robust knowledge for the efficacy of CP in patients with COVID-19. Future research is necessary to fill the knowledge gap regarding prevention and treatment for patients with COVID-19 with CP while other therapeutics are being developed. UR - https://publichealth.jmir.org/2021/4/e25500 UR - http://dx.doi.org/10.2196/25500 UR - http://www.ncbi.nlm.nih.gov/pubmed/33825689 ID - info:doi/10.2196/25500 ER - TY - JOUR AU - Benneyan, James AU - Gehrke, Christopher AU - Ilies, Iulian AU - Nehls, Nicole PY - 2021/4/7 TI - Community and Campus COVID-19 Risk Uncertainty Under University Reopening Scenarios: Model-Based Analysis JO - JMIR Public Health Surveill SP - e24292 VL - 7 IS - 4 KW - COVID-19 KW - university reopening KW - community impact KW - epidemic model KW - model KW - community KW - university KW - safety KW - strategy KW - risk KW - infectious disease N2 - 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. UR - https://publichealth.jmir.org/2021/4/e24292 UR - http://dx.doi.org/10.2196/24292 UR - http://www.ncbi.nlm.nih.gov/pubmed/33667173 ID - info:doi/10.2196/24292 ER - TY - JOUR AU - Platt, Moritz AU - Hasselgren, Anton AU - Román-Belmonte, Manuel Juan AU - Tuler de Oliveira, Marcela AU - De la Corte-Rodríguez, Hortensia AU - Delgado Olabarriaga, Sílvia AU - Rodríguez-Merchán, Carlos E. AU - Mackey, Ken Tim PY - 2021/4/6 TI - Test, Trace, and Put on the Blockchain?: A Viewpoint Evaluating the Use of Decentralized Systems for Algorithmic Contact Tracing to Combat a Global Pandemic JO - JMIR Public Health Surveill SP - e26460 VL - 7 IS - 4 KW - COVID-19 KW - public health KW - blockchain KW - distributed ledger technology KW - mobile apps KW - pandemic mitigation KW - contact tracing KW - epidemiological monitoring UR - https://publichealth.jmir.org/2021/4/e26460 UR - http://dx.doi.org/10.2196/26460 UR - http://www.ncbi.nlm.nih.gov/pubmed/33727212 ID - info:doi/10.2196/26460 ER - TY - JOUR AU - Staffini, Alessio AU - Svensson, Kishi Akiko AU - Chung, Ung-Il AU - Svensson, Thomas PY - 2021/4/6 TI - An Agent-Based Model of the Local Spread of SARS-CoV-2: Modeling Study JO - JMIR Med Inform SP - e24192 VL - 9 IS - 4 KW - computational epidemiology KW - COVID-19 KW - SARS-CoV-2 KW - agent-based modeling KW - public health KW - computational models KW - modeling KW - agent KW - spread KW - computation KW - epidemiology KW - policy N2 - 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. UR - https://medinform.jmir.org/2021/4/e24192 UR - http://dx.doi.org/10.2196/24192 UR - http://www.ncbi.nlm.nih.gov/pubmed/33750735 ID - info:doi/10.2196/24192 ER - TY - JOUR AU - Lalande, Kathleen AU - Greenman, S. Paul AU - Bouchard, Karen AU - Johnson, M. Susan AU - Tulloch, Heather PY - 2021/4/6 TI - The Healing Hearts Together Randomized Controlled Trial and the COVID-19 Pandemic: A Tutorial for Transitioning From an In-Person to a Web-Based Intervention JO - J Med Internet Res SP - e25502 VL - 23 IS - 4 KW - web-based intervention KW - internet-based intervention KW - randomized controlled trial KW - COVID-19 KW - research KW - tutorial KW - digital medicine KW - behavioral medicine KW - telehealth KW - telemedicine KW - cardiovascular rehabilitation UR - https://www.jmir.org/2021/4/e25502 UR - http://dx.doi.org/10.2196/25502 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729984 ID - info:doi/10.2196/25502 ER - TY - JOUR AU - Parise, Martina AU - Tartaglione, Linda AU - Cutruzzolà, Antonio AU - Maiorino, Ida Maria AU - Esposito, Katherine AU - Pitocco, Dario AU - Gnasso, Agostino AU - Irace, Concetta PY - 2021/4/6 TI - Teleassistance for Patients With Type 1 Diabetes During the COVID-19 Pandemic: Results of a Pilot Study JO - J Med Internet Res SP - e24552 VL - 23 IS - 4 KW - chronic disease KW - COVID-19 KW - diabetes KW - effectiveness KW - management KW - technology KW - teleassistance KW - telehealth KW - telemedicine KW - time in range KW - type 1 diabetes N2 - Background: Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers. Objective: During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period. Methods: This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit. Results: Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ?7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters. Conclusions: These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible. UR - https://www.jmir.org/2021/4/e24552 UR - http://dx.doi.org/10.2196/24552 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769945 ID - info:doi/10.2196/24552 ER - TY - JOUR AU - Asgari Mehrabadi, Milad AU - Dutt, Nikil AU - Rahmani, M. Amir PY - 2021/4/6 TI - The Causality Inference of Public Interest in Restaurants and Bars on Daily COVID-19 Cases in the United States: Google Trends Analysis JO - JMIR Public Health Surveill SP - e22880 VL - 7 IS - 4 KW - bars KW - coronavirus KW - COVID-19 KW - deep learning KW - infodemiology KW - infoveillance KW - Google Trends KW - LSTM KW - machine learning KW - restaurants N2 - 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. UR - https://publichealth.jmir.org/2021/4/e22880 UR - http://dx.doi.org/10.2196/22880 UR - http://www.ncbi.nlm.nih.gov/pubmed/33690143 ID - info:doi/10.2196/22880 ER - TY - JOUR AU - Ossom-Williamson, Peace AU - Williams, Maximilian Isaac AU - Kim, Kukhyoung AU - Kindratt, B. Tiffany PY - 2021/4/6 TI - Reporting and Availability of COVID-19 Demographic Data by US Health Departments (April to October 2020): Observational Study JO - JMIR Public Health Surveill SP - e24288 VL - 7 IS - 4 KW - coronavirus disease 2019 KW - COVID-19 KW - SARS-CoV-2 KW - race KW - ethnicity KW - age KW - sex KW - health equity KW - open data KW - dashboards N2 - 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. UR - https://publichealth.jmir.org/2021/4/e24288 UR - http://dx.doi.org/10.2196/24288 UR - http://www.ncbi.nlm.nih.gov/pubmed/33821804 ID - info:doi/10.2196/24288 ER - TY - JOUR AU - Oyebode, Oladapo AU - Ndulue, Chinenye AU - Adib, Ashfaq AU - Mulchandani, Dinesh AU - Suruliraj, Banuchitra AU - Orji, Anulika Fidelia AU - Chambers, T. Christine AU - Meier, Sandra AU - Orji, Rita PY - 2021/4/6 TI - Health, Psychosocial, and Social Issues Emanating From the COVID-19 Pandemic Based on Social Media Comments: Text Mining and Thematic Analysis Approach JO - JMIR Med Inform SP - e22734 VL - 9 IS - 4 KW - social media KW - COVID-19 KW - coronavirus KW - infodemiology KW - infoveillance KW - natural language processing KW - text mining KW - thematic analysis KW - interventions KW - health issues KW - psychosocial issues KW - social issues N2 - Background: The COVID-19 pandemic has caused a global health crisis that affects many aspects of human lives. In the absence of vaccines and antivirals, several behavioral change and policy initiatives such as physical distancing have been implemented to control the spread of COVID-19. Social media data can reveal public perceptions toward how governments and health agencies worldwide are handling the pandemic, and the impact of the disease on people regardless of their geographic locations in line with various factors that hinder or facilitate the efforts to control the spread of the pandemic globally. Objective: This paper aims to investigate the impact of the COVID-19 pandemic on people worldwide using social media data. Methods: We applied natural language processing (NLP) and thematic analysis to understand public opinions, experiences, and issues with respect to the COVID-19 pandemic using social media data. First, we collected over 47 million COVID-19?related comments from Twitter, Facebook, YouTube, and three online discussion forums. Second, we performed data preprocessing, which involved applying NLP techniques to clean and prepare the data for automated key phrase extraction. Third, we applied the NLP approach to extract meaningful key phrases from over 1 million randomly selected comments and computed sentiment score for each key phrase and assigned sentiment polarity (ie, positive, negative, or neutral) based on the score using a lexicon-based technique. Fourth, we grouped related negative and positive key phrases into categories or broad themes. Results: A total of 34 negative themes emerged, out of which 15 were health-related issues, psychosocial issues, and social issues related to the COVID-19 pandemic from the public perspective. Some of the health-related issues were increased mortality, health concerns, struggling health systems, and fitness issues; while some of the psychosocial issues were frustrations due to life disruptions, panic shopping, and expression of fear. Social issues were harassment, domestic violence, and wrong societal attitude. In addition, 20 positive themes emerged from our results. Some of the positive themes were public awareness, encouragement, gratitude, cleaner environment, online learning, charity, spiritual support, and innovative research. Conclusions: We uncovered various negative and positive themes representing public perceptions toward the COVID-19 pandemic and recommended interventions that can help address the health, psychosocial, and social issues based on the positive themes and other research evidence. These interventions will help governments, health professionals and agencies, institutions, and individuals in their efforts to curb the spread of COVID-19 and minimize its impact, and in reacting to any future pandemics. UR - https://medinform.jmir.org/2021/4/e22734 UR - http://dx.doi.org/10.2196/22734 UR - http://www.ncbi.nlm.nih.gov/pubmed/33684052 ID - info:doi/10.2196/22734 ER - TY - JOUR AU - Chu, Cherry AU - Cram, Peter AU - Pang, Andrea AU - Stamenova, Vess AU - Tadrous, Mina AU - Bhatia, Sacha R. PY - 2021/4/5 TI - Rural Telemedicine Use Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study JO - J Med Internet Res SP - e26960 VL - 23 IS - 4 KW - chronic disease KW - chronic illness KW - COVID-19 KW - health care KW - health services KW - older adults KW - remote KW - rural KW - pandemic KW - population KW - telemedicine KW - virtual care N2 - 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. UR - https://www.jmir.org/2021/4/e26960 UR - http://dx.doi.org/10.2196/26960 UR - http://www.ncbi.nlm.nih.gov/pubmed/33769942 ID - info:doi/10.2196/26960 ER - TY - JOUR AU - Hussain, Amir AU - Tahir, Ahsen AU - Hussain, Zain AU - Sheikh, Zakariya AU - Gogate, Mandar AU - Dashtipour, Kia AU - Ali, Azhar AU - Sheikh, Aziz PY - 2021/4/5 TI - Artificial Intelligence?Enabled Analysis of Public Attitudes on Facebook and Twitter Toward COVID-19 Vaccines in the United Kingdom and the United States: Observational Study JO - J Med Internet Res SP - e26627 VL - 23 IS - 4 KW - artificial intelligence KW - COVID-19 KW - deep learning KW - Facebook KW - health informatics KW - natural language processing KW - public health KW - sentiment analysis KW - social media KW - Twitter KW - infodemiology KW - vaccination N2 - Background: Global efforts toward the development and deployment of a vaccine for COVID-19 are rapidly advancing. To achieve herd immunity, widespread administration of vaccines is required, which necessitates significant cooperation from the general public. As such, it is crucial that governments and public health agencies understand public sentiments toward vaccines, which can help guide educational campaigns and other targeted policy interventions. Objective: The aim of this study was to develop and apply an artificial intelligence?based approach to analyze public sentiments on social media in the United Kingdom and the United States toward COVID-19 vaccines to better understand the public attitude and concerns regarding COVID-19 vaccines. Methods: Over 300,000 social media posts related to COVID-19 vaccines were extracted, including 23,571 Facebook posts from the United Kingdom and 144,864 from the United States, along with 40,268 tweets from the United Kingdom and 98,385 from the United States from March 1 to November 22, 2020. We used natural language processing and deep learning?based techniques to predict average sentiments, sentiment trends, and topics of discussion. These factors were analyzed longitudinally and geospatially, and manual reading of randomly selected posts on points of interest helped identify underlying themes and validated insights from the analysis. Results: Overall averaged positive, negative, and neutral sentiments were at 58%, 22%, and 17% in the United Kingdom, compared to 56%, 24%, and 18% in the United States, respectively. Public optimism over vaccine development, effectiveness, and trials as well as concerns over their safety, economic viability, and corporation control were identified. We compared our findings to those of nationwide surveys in both countries and found them to correlate broadly. Conclusions: Artificial intelligence?enabled social media analysis should be considered for adoption by institutions and governments alongside surveys and other conventional methods of assessing public attitude. Such analyses could enable real-time assessment, at scale, of public confidence and trust in COVID-19 vaccines, help address the concerns of vaccine sceptics, and help develop more effective policies and communication strategies to maximize uptake. UR - https://www.jmir.org/2021/4/e26627 UR - http://dx.doi.org/10.2196/26627 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724919 ID - info:doi/10.2196/26627 ER - TY - JOUR AU - Reps, M. Jenna AU - Kim, Chungsoo AU - Williams, D. Ross AU - Markus, F. Aniek AU - Yang, Cynthia AU - Duarte-Salles, Talita AU - Falconer, Thomas AU - Jonnagaddala, Jitendra AU - Williams, Andrew AU - Fernández-Bertolín, Sergio AU - DuVall, L. Scott AU - Kostka, Kristin AU - Rao, Gowtham AU - Shoaibi, Azza AU - Ostropolets, Anna AU - Spotnitz, E. Matthew AU - Zhang, Lin AU - Casajust, Paula AU - Steyerberg, W. Ewout AU - Nyberg, Fredrik AU - Kaas-Hansen, Skov Benjamin AU - Choi, Hwa Young AU - Morales, Daniel AU - Liaw, Siaw-Teng AU - Abrahão, Fernandes Maria Tereza AU - Areia, Carlos AU - Matheny, E. Michael AU - Lynch, E. Kristine AU - Aragón, María AU - Park, Woong Rae AU - Hripcsak, George AU - Reich, G. Christian AU - Suchard, A. Marc AU - You, Chan Seng AU - Ryan, B. Patrick AU - Prieto-Alhambra, Daniel AU - Rijnbeek, R. Peter PY - 2021/4/5 TI - Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study JO - JMIR Med Inform SP - e21547 VL - 9 IS - 4 KW - external validation KW - transportability KW - COVID-19 KW - prognostic model KW - prediction KW - C-19 KW - modeling KW - datasets KW - observation KW - hospitalization KW - bias KW - risk KW - decision-making N2 - 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. UR - https://medinform.jmir.org/2021/4/e21547 UR - http://dx.doi.org/10.2196/21547 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661754 ID - info:doi/10.2196/21547 ER - TY - JOUR AU - Al-Ramahi, Mohammad AU - Elnoshokaty, Ahmed AU - El-Gayar, Omar AU - Nasralah, Tareq AU - Wahbeh, Abdullah PY - 2021/4/5 TI - Public Discourse Against Masks in the COVID-19 Era: Infodemiology Study of Twitter Data JO - JMIR Public Health Surveill SP - e26780 VL - 7 IS - 4 KW - pandemic KW - coronavirus KW - masks KW - social medial, opinion analysis KW - COVID-19 N2 - 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. UR - https://publichealth.jmir.org/2021/4/e26780 UR - http://dx.doi.org/10.2196/26780 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720841 ID - info:doi/10.2196/26780 ER - TY - JOUR AU - Schück, Stéphane AU - Foulquié, Pierre AU - Mebarki, Adel AU - Faviez, Carole AU - Khadhar, Mickaïl AU - Texier, Nathalie AU - Katsahian, Sandrine AU - Burgun, Anita AU - Chen, Xiaoyi PY - 2021/4/5 TI - Concerns Discussed on Chinese and French Social Media During the COVID-19 Lockdown: Comparative Infodemiology Study Based on Topic Modeling JO - JMIR Form Res SP - e23593 VL - 5 IS - 4 KW - comparative analysis KW - content analysis KW - topic model KW - social media KW - COVID-19 KW - lockdown KW - China KW - France KW - impact KW - population N2 - 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. UR - https://formative.jmir.org/2021/4/e23593 UR - http://dx.doi.org/10.2196/23593 UR - http://www.ncbi.nlm.nih.gov/pubmed/33750736 ID - info:doi/10.2196/23593 ER - TY - JOUR AU - Shaw, James AU - Brewer, C. LaPrincess AU - Veinot, Tiffany PY - 2021/4/5 TI - Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review JO - JMIR Form Res SP - e23233 VL - 5 IS - 4 KW - virtual care KW - health equity KW - health disparities KW - health informatics KW - COVID-19 KW - telemedicine KW - telehealth KW - digital health N2 - 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. UR - https://formative.jmir.org/2021/4/e23233 UR - http://dx.doi.org/10.2196/23233 UR - http://www.ncbi.nlm.nih.gov/pubmed/33739931 ID - info:doi/10.2196/23233 ER - TY - JOUR AU - Alharbi, Nader PY - 2021/3/31 TI - Forecasting the COVID-19 Pandemic in Saudi Arabia Using a Modified Singular Spectrum Analysis Approach: Model Development and Data Analysis JO - JMIRx Med SP - e21044 VL - 2 IS - 1 KW - COVID-19 KW - prediction KW - singular spectrum analysis KW - separability KW - eigenvalues KW - Saudi Arabia N2 - Background: Infectious disease is one of the main issues that threatens human health worldwide. The 2019 outbreak of the new coronavirus SARS-CoV-2, which causes the disease COVID-19, has become a serious global pandemic. Many attempts have been made to forecast the spread of the disease using various methods, including time series models. Among the attempts to model the pandemic, to the best of our knowledge, no studies have used the singular spectrum analysis (SSA) technique to forecast confirmed cases. Objective: The primary objective of this paper is to construct a reliable, robust, and interpretable model for describing, decomposing, and forecasting the number of confirmed cases of COVID-19 and predicting the peak of the pandemic in Saudi Arabia. Methods: A modified singular spectrum analysis (SSA) approach was applied for the analysis of the COVID-19 pandemic in Saudi Arabia. We proposed this approach and developed it in our previous studies regarding the separability and grouping steps in SSA, which play important roles in reconstruction and forecasting. The modified SSA approach mainly enables us to identify the number of interpretable components required for separability, signal extraction, and noise reduction. The approach was examined using different levels of simulated and real data with different structures and signal-to-noise ratios. In this study, we examined the capability of the approach to analyze COVID-19 data. We then used vector SSA to predict new data points and the peak of the pandemic in Saudi Arabia. Results: In the first stage, the confirmed daily cases on the first 42 days (March 02 to April 12, 2020) were used and analyzed to identify the value of the number of required eigenvalues (r) for separability between noise and signal. After obtaining the value of r, which was 2, and extracting the signals, vector SSA was used to predict and determine the pandemic peak. In the second stage, we updated the data and included 81 daily case values. We used the same window length and number of eigenvalues for reconstruction and forecasting of the points 90 days ahead. The results of both forecasting scenarios indicated that the peak would occur around the end of May or June 2020 and that the crisis would end between the end of June and the middle of August 2020, with a total number of infected people of approximately 330,000. Conclusions: Our results confirm the impressive performance of modified SSA in analyzing COVID-19 data and selecting the value of r for identifying the signal subspace from a noisy time series and then making a reliable prediction of daily confirmed cases using the vector SSA method. UR - https://xmed.jmir.org/2021/1/e21044 UR - http://dx.doi.org/10.2196/21044 UR - http://www.ncbi.nlm.nih.gov/pubmed/34076627 ID - info:doi/10.2196/21044 ER - TY - JOUR AU - van Noort, J. Esther M. AU - Claessens, Danny AU - Moor, C. Catharina AU - Berg, Den Carlijn A. L. Van AU - Kasteleyn, J. Marise AU - in 't Veen, M. Johannes C. C. AU - Van Schayck, P. Onno C. AU - Chavannes, H. Niels PY - 2021/3/31 TI - Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study JO - JMIR Form Res SP - e22603 VL - 5 IS - 3 KW - COVID-19 KW - patient-reported outcomes KW - ABCoV tool KW - monitoring KW - patient outcome KW - long-term impact KW - tool KW - assessment KW - online patient platform N2 - 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. UR - https://formative.jmir.org/2021/3/e22603 UR - http://dx.doi.org/10.2196/22603 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729982 ID - info:doi/10.2196/22603 ER - TY - JOUR AU - An, Lawrence AU - Bacon, Elizabeth AU - Hawley, Sarah AU - Yang, Penny AU - Russell, Daniel AU - Huffman, Scott AU - Resnicow, Ken PY - 2021/3/29 TI - Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study JO - J Med Internet Res SP - e25042 VL - 23 IS - 3 KW - internet KW - digital health KW - eHealth KW - eHealth literacy KW - coronavirus KW - COVID-19 KW - knowledge KW - conspiracy beliefs KW - protective behaviors KW - social distancing KW - survey KW - health communication KW - attitude KW - behavior N2 - 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 ?=.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 ?=?.083, P=.016 for Black participants) and education level (standardized ?=?.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 ?=.168, P<.001) and adherence to protective behaviors (standardized ?=.241, P<.001) and a negative association with conspiracy beliefs (standardized ?=?.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. UR - https://www.jmir.org/2021/3/e25042 UR - http://dx.doi.org/10.2196/25042 UR - http://www.ncbi.nlm.nih.gov/pubmed/33626015 ID - info:doi/10.2196/25042 ER - TY - JOUR AU - Chu, MY Amanda AU - Chan, NL Jacky AU - Tsang, TY Jenny AU - Tiwari, Agnes AU - So, KP Mike PY - 2021/3/29 TI - Analyzing Cross-country Pandemic Connectedness During COVID-19 Using a Spatial-Temporal Database: Network Analysis JO - JMIR Public Health Surveill SP - e27317 VL - 7 IS - 3 KW - air traffic KW - coronavirus KW - COVID-19 KW - human mobility KW - network analysis KW - travel restrictions UR - https://publichealth.jmir.org/2021/3/e27317 UR - http://dx.doi.org/10.2196/27317 UR - http://www.ncbi.nlm.nih.gov/pubmed/33711799 ID - info:doi/10.2196/27317 ER - TY - JOUR AU - Koohsari, Javad Mohammad AU - Nakaya, Tomoki AU - McCormack, R. Gavin AU - Shibata, Ai AU - Ishii, Kaori AU - Oka, Koichiro PY - 2021/3/26 TI - Changes in Workers? Sedentary and Physical Activity Behaviors in Response to the COVID-19 Pandemic and Their Relationships With Fatigue: Longitudinal Online Study JO - JMIR Public Health Surveill SP - e26293 VL - 7 IS - 3 KW - COVID-19 KW - physical inactivity KW - sitting time KW - mental health KW - Japan KW - prospective design N2 - 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. UR - https://publichealth.jmir.org/2021/3/e26293 UR - http://dx.doi.org/10.2196/26293 UR - http://www.ncbi.nlm.nih.gov/pubmed/33727211 ID - info:doi/10.2196/26293 ER - TY - JOUR AU - Scherr, Foster Thomas AU - DeSousa, Maria Jenna AU - Moore, Paige Carson AU - Hardcastle, Austin AU - Wright, Wilson David PY - 2021/3/26 TI - App Use and Usability of a Barcode-Based Digital Platform to Augment COVID-19 Contact Tracing: Postpilot Survey and Paradata Analysis JO - JMIR Public Health Surveill SP - e25859 VL - 7 IS - 3 KW - contact tracing KW - COVID-19 KW - mobile health KW - usability KW - app KW - usage KW - tracking KW - monitoring KW - survey KW - pilot N2 - Background: The COVID-19 pandemic has drastically changed life in the United States, as the country has recorded over 23 million cases and 383,000 deaths to date. In the leadup to widespread vaccine deployment, testing and surveillance are critical for detecting and stopping possible routes of transmission. Contact tracing has become an important surveillance measure to control COVID-19 in the United States, and mobile health interventions have found increased prominence in this space. Objective: The aim of this study was to investigate the use and usability of MyCOVIDKey, a mobile-based web app to assist COVID-19 contact tracing efforts, during the 6-week pilot period. Methods: A 6-week study was conducted on the Vanderbilt University campus in Nashville, Tennessee. The study participants, consisting primarily of graduate students, postdoctoral researchers, and faculty in the Chemistry Department at Vanderbilt University, were asked to use the MyCOVIDKey web app during the course of the study period. Paradata were collected as users engaged with the MyCOVIDKey web app. At the end of the study, all participants were asked to report on their user experience in a survey, and the results were analyzed in the context of the user paradata. Results: During the pilot period, 45 users enrolled in MyCOVIDKey. An analysis of their enrollment suggests that initial recruiting efforts were effective; however, participant recruitment and engagement efforts at the midpoint of the study were less effective. App use paralleled the number of users, indicating that incentives were useful for recruiting new users to sign up but did not result in users attempting to artificially inflate their use as a result of prize offers. Times to completion of key tasks were low, indicating that the main features of the app could be used quickly. Of the 45 users, 30 provided feedback through a postpilot survey, with 26 (58%) completing it in its entirety. The MyCOVIDKey app as a whole was rated 70.0 on the System Usability Scale, indicating that it performed above the accepted threshold for usability. When the key-in and self-assessment features were examined on their own, it was found that they individually crossed the same thresholds for acceptable usability but that the key-in feature had a higher margin for improvement. Conclusions: The MyCOVIDKey app was found overall to be a useful tool for COVID-19 contact tracing in a university setting. Most users suggested simple-to-implement improvements, such as replacing the web app framework with a native app format or changing the placement of the scanner within the app workflow. After these updates, this tool could be readily deployed and easily adapted to other settings across the country. The need for digital contact tracing tools is becoming increasingly apparent, particularly as COVID-19 case numbers continue to increase while more businesses begin to reopen. UR - https://publichealth.jmir.org/2021/3/e25859 UR - http://dx.doi.org/10.2196/25859 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630745 ID - info:doi/10.2196/25859 ER - TY - JOUR AU - Bente, Elise Britt AU - van 't Klooster, Roderick Jan Willem Jaap AU - Schreijer, Annemarie Maud AU - Berkemeier, Lea AU - van Gend, Elmar Joris AU - Slijkhuis, Hendrik Peter Jan AU - Kelders, Marion Saskia AU - van Gemert-Pijnen, Cornelia Julia Elisabeth Wilhelmina PY - 2021/3/26 TI - The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study JO - JMIR Form Res SP - e27882 VL - 5 IS - 3 KW - usability testing KW - user evaluation KW - user experience KW - contact tracing apps KW - CoronaMelder KW - COVID-19 KW - pandemic KW - mobile apps KW - mHealth KW - public health N2 - 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. UR - https://formative.jmir.org/2021/3/e27882 UR - http://dx.doi.org/10.2196/27882 UR - http://www.ncbi.nlm.nih.gov/pubmed/33724198 ID - info:doi/10.2196/27882 ER - TY - JOUR AU - Suppan, Mélanie AU - Abbas, Mohamed AU - Catho, Gaud AU - Stuby, Loric AU - Regard, Simon AU - Achab, Sophia AU - Harbarth, Stephan AU - Suppan, Laurent PY - 2021/3/25 TI - 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 JO - J Med Internet Res SP - e27443 VL - 23 IS - 3 KW - COVID-19 KW - transmission KW - serious game KW - infection prevention KW - health care worker KW - SARS-CoV-2 KW - nursing homes KW - randomized controlled trial KW - long-term care facilities KW - impact KW - game KW - intention KW - control KW - elderly N2 - 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 UR - https://www.jmir.org/2021/3/e27443 UR - http://dx.doi.org/10.2196/27443 UR - http://www.ncbi.nlm.nih.gov/pubmed/33685854 ID - info:doi/10.2196/27443 ER - TY - JOUR AU - Wang, Dandan AU - Qian, Yuxing PY - 2021/3/25 TI - Echo Chamber Effect in Rumor Rebuttal Discussions About COVID-19 in China: Social Media Content and Network Analysis Study JO - J Med Internet Res SP - e27009 VL - 23 IS - 3 KW - rumor rebuttal KW - infodemiology KW - infodemic KW - infoveillance KW - echo chamber effect KW - attitude KW - COVID-19 KW - Weibo N2 - Background: The dissemination of rumor rebuttal content on social media is vital for rumor control and disease containment during public health crises. Previous research on the effectiveness of rumor rebuttal, to a certain extent, ignored or simplified the structure of dissemination networks and users? cognition as well as decision-making and interaction behaviors. Objective: This study aimed to roughly evaluate the effectiveness of rumor rebuttal; dig deeply into the attitude-based echo chamber effect on users? responses to rumor rebuttal under multiple topics on Weibo, a Chinese social media platform, in the early stage of the COVID-19 epidemic; and evaluate the echo chamber?s impact on the information characteristics of user interaction content. Methods: We used Sina Weibo?s application programming interface to crawl rumor rebuttal content related to COVID-19 from 10 AM on January 23, 2020, to midnight on April 8, 2020. Using content analysis, sentiment analysis, social network analysis, and statistical analysis, we first analyzed whether and to what extent there was an echo chamber effect on the shaping of individuals? attitudes when retweeting or commenting on others? tweets. Then, we tested the heterogeneity of attitude distribution within communities and the homophily of interactions between communities. Based on the results at user and community levels, we made comprehensive judgments. Finally, we examined users? interaction content from three dimensions?sentiment expression, information seeking and sharing, and civility?to test the impact of the echo chamber effect. Results: Our results indicated that the retweeting mechanism played an essential role in promoting polarization, and the commenting mechanism played a role in consensus building. Our results showed that there might not be a significant echo chamber effect on community interactions and verified that, compared to like-minded interactions, cross-cutting interactions contained significantly more negative sentiment, information seeking and sharing, and incivility. We found that online users? information-seeking behavior was accompanied by incivility, and information-sharing behavior was accompanied by more negative sentiment, which was often accompanied by incivility. Conclusions: Our findings revealed the existence and degree of an echo chamber effect from multiple dimensions, such as topic, interaction mechanism, and interaction level, and its impact on interaction content. Based on these findings, we provide several suggestions for preventing or alleviating group polarization to achieve better rumor rebuttal. UR - https://www.jmir.org/2021/3/e27009 UR - http://dx.doi.org/10.2196/27009 UR - http://www.ncbi.nlm.nih.gov/pubmed/33690145 ID - info:doi/10.2196/27009 ER - TY - JOUR AU - Peterson, S. Kelly AU - Lewis, Julia AU - Patterson, V. Olga AU - Chapman, B. Alec AU - Denhalter, W. Daniel AU - Lye, A. Patricia AU - Stevens, W. Vanessa AU - Gamage, D. Shantini AU - Roselle, A. Gary AU - Wallace, S. Katherine AU - Jones, Makoto PY - 2021/3/24 TI - Automated Travel History Extraction From Clinical Notes for Informing the Detection of Emergent Infectious Disease Events: Algorithm Development and Validation JO - JMIR Public Health Surveill SP - e26719 VL - 7 IS - 3 KW - natural language processing KW - machine learning KW - travel history KW - COVID-19 KW - Zika KW - infectious disease surveillance KW - surveillance applications KW - biosurveillance KW - electronic health record N2 - 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. UR - https://publichealth.jmir.org/2021/3/e26719 UR - http://dx.doi.org/10.2196/26719 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759790 ID - info:doi/10.2196/26719 ER - TY - JOUR AU - Lynch, J. Christopher AU - Gore, Ross PY - 2021/3/23 TI - Short-Range Forecasting of COVID-19 During Early Onset at County, Health District, and State Geographic Levels Using Seven Methods: Comparative Forecasting Study JO - J Med Internet Res SP - e24925 VL - 23 IS - 3 KW - coronavirus disease 2019 KW - COVID-19 KW - infectious disease KW - emerging outbreak KW - forecasting KW - modeling and simulation KW - public health KW - modeling disease outbreaks N2 - 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. UR - https://www.jmir.org/2021/3/e24925 UR - http://dx.doi.org/10.2196/24925 UR - http://www.ncbi.nlm.nih.gov/pubmed/33621186 ID - info:doi/10.2196/24925 ER - TY - JOUR AU - El-Toukhy, Sherine PY - 2021/3/22 TI - Insights From the SmokeFree.gov Initiative Regarding the Use of Smoking Cessation Digital Platforms During the COVID-19 Pandemic: Cross-sectional Trends Analysis Study JO - J Med Internet Res SP - e24593 VL - 23 IS - 3 KW - COVID-19 KW - smoking KW - cessation KW - mHealth KW - risk KW - digital platform KW - social distancing KW - lockdown KW - trend N2 - Background: Smoking is a plausible risk factor for COVID-19 progression and complications. Smoking cessation digital platforms transcend pandemic-driven social distancing and lockdown measures in terms of assisting smokers in their quit attempts. Objective: This study aims to examine trends in the number of visitors, followers, and subscribers on smoking cessation digital platforms from January to April 2020 and to compare these traffic data to those observed during the same 4-month period in 2019. The examination of prepandemic and postpandemic trends in smoking cessation digital platform traffic can reveal whether interest in smoking cessation among smokers is attributable to the COVID-19 pandemic. Methods: We obtained cross-sectional data from daily visitors on the SmokeFree website; the followers of six SmokeFree social media accounts; and subscribers to the SmokeFree SMS text messaging and mobile app interventions of the National Cancer Institute?s SmokeFree.gov initiative platforms, which are publicly available to US smokers. Average daily percentage changes (ADPCs) were used to measure trends for the entire 2020 and 2019 study periods, whereas daily percentage changes (DPCs) were used to measure trends for each time segment of change within each 4-month period. Data analysis was conducted in May and June 2020. Results: The number of new daily visitors on the SmokeFree website (between days 39 and 44: DPC=18.79%; 95% CI 5.16% to 34.19%) and subscribers to the adult-focused interventions QuitGuide (between days 11 and 62: DPC=1.11%; 95% CI 0.80% to 1.43%) and SmokeFreeTXT (between days 11 and 89: DPC=0.23%; 95% CI 0.004% to 0.47%) increased, but this was followed by declines in traffic. No comparable peaks were observed in 2019. The number of new daily subscribers to quitSTART (ie, the teen-focused intervention) trended downward in 2020 (ADPC=?1.02%; 95% CI ?1.88% to ?0.15%), whereas the overall trend in the number of subscribers in 2019 was insignificant (P=.07). The number of SmokeFree social media account followers steadily increased by <0.1% over the 4-month study periods in 2019 and 2020. Conclusions: Peaks in traffic on the SmokeFree website and adult-focused intervention platforms in 2020 could be attributed to an increased interest in smoking cessation among smokers during the COVID-19 pandemic. Coordinated campaigns, especially those for adolescents, should emphasize the importance of smoking cessation as a preventive measure against SARS-CoV-2 infection and raise awareness of digital smoking cessation platforms to capitalize on smokers? heightened interest during the pandemic. UR - https://www.jmir.org/2021/3/e24593 UR - http://dx.doi.org/10.2196/24593 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646963 ID - info:doi/10.2196/24593 ER - TY - JOUR AU - Daly, R. Jessica AU - Depp, Colin AU - Graham, A. Sarah AU - Jeste, V. Dilip AU - Kim, Ho-Cheol AU - Lee, E. Ellen AU - Nebeker, Camille PY - 2021/3/22 TI - Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study JO - JMIR Aging SP - e25779 VL - 4 IS - 1 KW - aging KW - quarantine KW - mental health KW - physical health KW - social isolation KW - COVID-19 pandemic KW - continued care senior housing community KW - CCSHC KW - qualitative research KW - videoconferencing KW - older adults KW - gerontechnology KW - loneliness KW - housing for the elderly KW - independent living N2 - Background: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. Objective: This study aimed to assess the impact of the COVID-19 pandemic and the resulting ?Stay-at-Home? order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. Methods: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the ?stay-at-home? mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. Results: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. Conclusions: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research. UR - https://aging.jmir.org/2021/1/e25779 UR - http://dx.doi.org/10.2196/25779 UR - http://www.ncbi.nlm.nih.gov/pubmed/33690146 ID - info:doi/10.2196/25779 ER - TY - JOUR AU - Yu, Shaobin AU - Eisenman, David AU - Han, Ziqiang PY - 2021/3/18 TI - Temporal Dynamics of Public Emotions During the COVID-19 Pandemic at the Epicenter of the Outbreak: Sentiment Analysis of Weibo Posts From Wuhan JO - J Med Internet Res SP - e27078 VL - 23 IS - 3 KW - public health emergencies KW - emotion KW - infodemiology KW - temporal dynamics KW - sentiment analysis KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/3/e27078 UR - http://dx.doi.org/10.2196/27078 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661755 ID - info:doi/10.2196/27078 ER - TY - JOUR AU - Tran, Phoebe AU - Tran, Lam AU - Tran, Liem PY - 2021/3/18 TI - The Influence of Social Distancing on COVID-19 Mortality in US Counties: Cross-sectional Study JO - JMIR Public Health Surveill SP - e21606 VL - 7 IS - 3 KW - COVID-19 KW - marginal effects KW - mortality KW - negative binomial model KW - social distancing N2 - Background: Previous studies on the impact of social distancing on COVID-19 mortality in the United States have predominantly examined this relationship at the national level and have not separated COVID-19 deaths in nursing homes from total COVID-19 deaths. This approach may obscure differences in social distancing behaviors by county in addition to the actual effectiveness of social distancing in preventing COVID-19 deaths. Objective: This study aimed to determine the influence of county-level social distancing behavior on COVID-19 mortality (deaths per 100,000 people) across US counties over the period of the implementation of stay-at-home orders in most US states (March-May 2020). Methods: Using social distancing data from tracked mobile phones in all US counties, we estimated the relationship between social distancing (average proportion of mobile phone usage outside of home between March and May 2020) and COVID-19 mortality (when the state in which the county is located reported its first confirmed case of COVID-19 and up to May 31, 2020) with a mixed-effects negative binomial model while distinguishing COVID-19 deaths in nursing homes from total COVID-19 deaths and accounting for social distancing? and COVID-19?related factors (including the period between the report of the first confirmed case of COVID-19 and May 31, 2020; population density; social vulnerability; and hospital resource availability). Results from the mixed-effects negative binomial model were then used to generate marginal effects at the mean, which helped separate the influence of social distancing on COVID-19 deaths from other covariates while calculating COVID-19 deaths per 100,000 people. Results: We observed that a 1% increase in average mobile phone usage outside of home between March and May 2020 led to a significant increase in COVID-19 mortality by a factor of 1.18 (P<.001), while every 1% increase in the average proportion of mobile phone usage outside of home in February 2020 was found to significantly decrease COVID-19 mortality by a factor of 0.90 (P<.001). Conclusions: As stay-at-home orders have been lifted in many US states, continued adherence to other social distancing measures, such as avoiding large gatherings and maintaining physical distance in public, are key to preventing additional COVID-19 deaths in counties across the country. UR - https://publichealth.jmir.org/2021/3/e21606 UR - http://dx.doi.org/10.2196/21606 UR - http://www.ncbi.nlm.nih.gov/pubmed/33497348 ID - info:doi/10.2196/21606 ER - TY - JOUR AU - Roberts, A. James AU - David, E. Meredith PY - 2021/3/17 TI - Improving Predictions of COVID-19 Preventive Behavior: Development of a Sequential Mediation Model JO - J Med Internet Res SP - e23218 VL - 23 IS - 3 KW - pandemic KW - COVID-19 KW - preventive behavior KW - self-efficacy KW - prevention KW - behavior KW - modeling KW - student KW - communication N2 - 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. UR - https://www.jmir.org/2021/3/e23218 UR - http://dx.doi.org/10.2196/23218 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651707 ID - info:doi/10.2196/23218 ER - TY - JOUR AU - Shao, Ruosi AU - Shi, Zhen AU - Zhang, Di PY - 2021/3/16 TI - Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach JO - J Med Internet Res SP - e27015 VL - 23 IS - 3 KW - COVID-19 KW - pandemic KW - emotion regulation KW - emotional exhaustion KW - multilevel approach KW - well-being KW - emotion KW - mental health KW - social media KW - perspective KW - strategy KW - effective KW - modeling KW - buffer N2 - 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; ?=.24; P<.001) and interpersonal-level (B=0.35; ?=.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; ?=?.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. UR - https://www.jmir.org/2021/3/e27015 UR - http://dx.doi.org/10.2196/27015 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661753 ID - info:doi/10.2196/27015 ER - TY - JOUR AU - Benis, Arriel AU - Khodos, Anna AU - Ran, Sivan AU - Levner, Eugene AU - Ashkenazi, Shai PY - 2021/3/16 TI - Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study JO - J Med Internet Res SP - e25977 VL - 23 IS - 3 KW - influenza KW - vaccines KW - vaccination KW - social media KW - online social networking KW - health literacy KW - eHealth KW - information dissemination KW - access to information KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2021/3/e25977 UR - http://dx.doi.org/10.2196/25977 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651709 ID - info:doi/10.2196/25977 ER - TY - JOUR AU - Denis, Fabrice AU - Fontanet, Arnaud AU - Le Douarin, Yann-Mael AU - Le Goff, Florian AU - Jeanneau, Stephan AU - Lescure, François-Xavier PY - 2021/3/12 TI - A Self-Assessment Web-Based App to Assess Trends of the COVID-19 Pandemic in France: Observational Study JO - J Med Internet Res SP - e26182 VL - 23 IS - 3 KW - app KW - big data KW - COVID-19 KW - diagnosis KW - diagnostic test KW - digital health KW - France KW - mobile phone KW - observational KW - participatory app KW - self-assessment KW - surveillance KW - trend KW - web-based app N2 - 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 [?]=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 UR - https://www.jmir.org/2021/3/e26182 UR - http://dx.doi.org/10.2196/26182 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709945 ID - info:doi/10.2196/26182 ER - TY - JOUR AU - Martino, Florentine AU - Brooks, Ruby AU - Browne, Jennifer AU - Carah, Nicholas AU - Zorbas, Christina AU - Corben, Kirstan AU - Saleeba, Emma AU - Martin, Jane AU - Peeters, Anna AU - Backholer, Kathryn PY - 2021/3/12 TI - The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study JO - JMIR Public Health Surveill SP - e25202 VL - 7 IS - 3 KW - alcohol KW - food and beverage KW - COVID-19 KW - marketing KW - social media N2 - Background: Emerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and ?comfort eating? as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how ?Big Food? and ?Big Alcohol? are capitalizing on the COVID-19 pandemic to market their products and brands. Objective: We aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia. Methods: We conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia. Results: Nearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice. Conclusions: This is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. ?COVID-washing? by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to ?build back better? in a post-COVID-19 world. UR - https://publichealth.jmir.org/2021/3/e25202 UR - http://dx.doi.org/10.2196/25202 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709935 ID - info:doi/10.2196/25202 ER - TY - JOUR AU - Mussetti, Alberto AU - Salas, Queralt Maria AU - Condom, Maria AU - Antonio, Maite AU - Ochoa, Cristian AU - Ivan, Iulia AU - Jimenez Ruiz-De la Torre, David AU - Sanz Linares, Gabriela AU - Ansoleaga, Belen AU - Patiño-Gutierrez, Beatriz AU - Jimenez-Prat, Laura AU - Parody, Rocio AU - Sureda-Balari, Ana PY - 2021/3/12 TI - Use of Telehealth for Domiciliary Follow-up After Hematopoietic Cell Transplantation During the COVID-19 Pandemic: Prospective Pilot Study JO - JMIR Form Res SP - e26121 VL - 5 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - hematology KW - hematopoietic cell transplantation KW - telemedicine KW - mortality KW - surveillance KW - monitoring KW - stem cell KW - transplant KW - app KW - medical device N2 - Background: Patients who have recently received a hematopoietic cell transplant (HCT) are at higher risk of acute complications in the first weeks after discharge, especially during the COVID-19 pandemic. Objective: The aim of this study was to test the use of a telehealth platform for the follow-up of HCT patients during the first two weeks after discharge. Methods: In total, 21 patients who received autologous or allogeneic HCT for hematological malignancies were screened from April 30, 2020, to July 15, 2020. The telehealth platform assisted in the daily collection of vital signs as well as physical and psychological symptoms for two weeks after hospital discharge. The required medical devices (oximeter and blood pressure monitor) were given to patients and a dedicated smartphone app was developed to collect this data. The data were reviewed daily through web-based software by a hematologist specializing in HCT. Results: Only 12 of 21 patients were able to join and complete the study. Technological barriers were the most frequent limiting factor in this study. Among the 12 patients who completed the study, adherence to data reporting was high. The patients? experience of using such a system was considered good. In two cases, the system enabled the early recognition of acute complications. Conclusions: This pilot study showed that telehealth systems can be applied in the early posttransplant setting, with evident advantages for physicians and patients for both medical and psychological aspects. Technological issues still represent a challenge for the applicability of such a system, especially for older adult patients. Easier-to-use technologies could help to expand the use of telehealth systems in this setting in the future. UR - https://formative.jmir.org/2021/3/e26121 UR - http://dx.doi.org/10.2196/26121 UR - http://www.ncbi.nlm.nih.gov/pubmed/33600351 ID - info:doi/10.2196/26121 ER - TY - JOUR AU - Slavik, E. Catherine AU - Buttle, Charlotte AU - Sturrock, L. Shelby AU - Darlington, Connor J. AU - Yiannakoulias, Niko PY - 2021/3/11 TI - Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis JO - J Med Internet Res SP - e24883 VL - 23 IS - 3 KW - COVID-19 KW - coronavirus KW - pandemic KW - public health KW - Twitter KW - social media KW - engagement KW - risk communication KW - infodemiology KW - content analysis N2 - 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. UR - https://www.jmir.org/2021/3/e24883 UR - http://dx.doi.org/10.2196/24883 UR - http://www.ncbi.nlm.nih.gov/pubmed/33651705 ID - info:doi/10.2196/24883 ER - TY - JOUR AU - Ostermann, Thomas AU - Gampe, Julia AU - Röer, Philipp Jan AU - Radtke, Theda PY - 2021/3/11 TI - Antecedents of Individuals? Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study JO - J Med Internet Res SP - e24804 VL - 23 IS - 3 KW - COVID-19 KW - public health KW - medical investigations KW - surgery KW - hospitalization, medical practices N2 - 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 (?=?.12, 95% CI ?.20 to ?.05) and hygiene in hospitals (?=.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. UR - https://www.jmir.org/2021/3/e24804 UR - http://dx.doi.org/10.2196/24804 UR - http://www.ncbi.nlm.nih.gov/pubmed/33617458 ID - info:doi/10.2196/24804 ER - TY - JOUR AU - R Niakan Kalhori, Sharareh AU - Bahaadinbeigy, Kambiz AU - Deldar, Kolsoum AU - Gholamzadeh, Marsa AU - Hajesmaeel-Gohari, Sadrieh AU - Ayyoubzadeh, Mohammad Seyed PY - 2021/3/10 TI - Digital Health Solutions to Control the COVID-19 Pandemic in Countries With High Disease Prevalence: Literature Review JO - J Med Internet Res SP - e19473 VL - 23 IS - 3 KW - COVID-19 KW - digital health KW - information technology KW - telemedicine KW - electronic health N2 - 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. UR - https://www.jmir.org/2021/3/e19473 UR - http://dx.doi.org/10.2196/19473 UR - http://www.ncbi.nlm.nih.gov/pubmed/33600344 ID - info:doi/10.2196/19473 ER - TY - JOUR AU - Mansbach, E. William AU - Mace, A. Ryan AU - Tanner, A. Melissa PY - 2021/3/10 TI - A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study JO - JMIR Aging SP - e26340 VL - 4 IS - 1 KW - nursing homes KW - long-term care KW - COVID-19 KW - depression KW - stress KW - coping KW - burden KW - mental health KW - elderly KW - older adults KW - risk KW - telehealth KW - self-assessment KW - scale KW - mood N2 - 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 ?=.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. UR - https://aging.jmir.org/2021/1/e26340 UR - http://dx.doi.org/10.2196/26340 UR - http://www.ncbi.nlm.nih.gov/pubmed/33640866 ID - info:doi/10.2196/26340 ER - TY - JOUR AU - Zhang, Chun Ke AU - Fang, Yuan AU - Cao, He AU - Chen, Hongbiao AU - Hu, Tian AU - Chen, Yaqi AU - Zhou, Xiaofeng AU - Wang, Zixin PY - 2021/3/9 TI - Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey JO - J Med Internet Res SP - e24673 VL - 23 IS - 3 KW - COVID-19 KW - vaccination KW - behavioral intention KW - perception KW - social media influence KW - personal preventive behaviors KW - factory workers KW - China KW - social media KW - vaccine KW - behavior KW - intention KW - risk N2 - 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. UR - https://www.jmir.org/2021/3/e24673 UR - http://dx.doi.org/10.2196/24673 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646966 ID - info:doi/10.2196/24673 ER - TY - JOUR AU - Hutchings, Rhys Owen AU - Dearing, Cassandra AU - Jagers, Dianna AU - Shaw, Jane Miranda AU - Raffan, Freya AU - Jones, Aaron AU - Taggart, Richard AU - Sinclair, Tim AU - Anderson, Teresa AU - Ritchie, Graham Angus PY - 2021/3/9 TI - Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study JO - J Med Internet Res SP - e21064 VL - 23 IS - 3 KW - COVID-19 KW - digital health KW - health KW - informatics KW - remote monitoring KW - telehealth KW - virtual health care N2 - Background: Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. Objective: This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. Methods: This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. Results: During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Conclusions: Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers. UR - https://www.jmir.org/2021/3/e21064 UR - http://dx.doi.org/10.2196/21064 UR - http://www.ncbi.nlm.nih.gov/pubmed/33687341 ID - info:doi/10.2196/21064 ER - TY - JOUR AU - Zhan, Zhu AU - Yang, Xin AU - Du, Hu AU - Zhang, Chuanlai AU - Song, Yuyan AU - Ran, Xiaoyun AU - Zhang, An AU - Yang, Mei PY - 2021/3/9 TI - Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis JO - JMIR Public Health Surveill SP - e24843 VL - 7 IS - 3 KW - acute respiratory distress syndrome KW - ARDS KW - Chongqing KW - COVID-19 KW - critically ill KW - intensive care unit KW - outcome KW - characteristic KW - mortality KW - epidemiology KW - improvement N2 - 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. UR - https://publichealth.jmir.org/2021/3/e24843 UR - http://dx.doi.org/10.2196/24843 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630743 ID - info:doi/10.2196/24843 ER - TY - JOUR AU - Guzzi, H. Pietro AU - Tradigo, Giuseppe AU - Veltri, Pierangelo PY - 2021/3/9 TI - Regional Resource Assessment During the COVID-19 Pandemic in Italy: Modeling Study JO - JMIR Med Inform SP - e18933 VL - 9 IS - 3 KW - COVID-19 KW - data analysis KW - ICU KW - management KW - intensive care unit KW - pandemic KW - outbreak KW - infectious disease KW - resource KW - planning N2 - 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. UR - https://medinform.jmir.org/2021/3/e18933 UR - http://dx.doi.org/10.2196/18933 UR - http://www.ncbi.nlm.nih.gov/pubmed/33629957 ID - info:doi/10.2196/18933 ER - TY - JOUR AU - Mira, Joaquin Jose AU - Cobos, Angel AU - Martínez García, Olga AU - Bueno Domínguez, José María AU - Astier-Peña, Pilar María AU - Pérez Pérez, Pastora AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Perez-Jover, Virtudes AU - Fernandez, Cesar AU - Vicente, Asuncion María AU - Lahera-Martin, Matilde AU - Silvestre Busto, Carmen AU - Lorenzo Martínez, Susana AU - Sanchez Martinez, Ascension AU - Martin-Delgado, Jimmy AU - Mula, Aurora AU - Marco-Gomez, Barbara AU - Abad Bouzan, Cristina AU - Aibar-Remon, Carlos AU - Aranaz-Andres, Jesus AU - PY - 2021/3/9 TI - An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study JO - JMIR Form Res SP - e27107 VL - 5 IS - 3 KW - SARS-CoV-2 virus KW - COVID-19 outbreak KW - medical staff KW - acute stress KW - moral injury KW - posttraumatic stress KW - COVID-19 N2 - 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 ? and McDonald ?. 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 ?). 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. UR - https://formative.jmir.org/2021/3/e27107 UR - http://dx.doi.org/10.2196/27107 UR - http://www.ncbi.nlm.nih.gov/pubmed/33687343 ID - info:doi/10.2196/27107 ER - TY - JOUR AU - Lewis, Matthew AU - Palmer, J. Victoria AU - Kotevski, Aneta AU - Densley, Konstancja AU - O'Donnell, L. Meaghan AU - Johnson, Caroline AU - Wohlgezogen, Franz AU - Gray, Kathleen AU - Robins-Browne, Kate AU - Burchill, Luke PY - 2021/3/9 TI - 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 JO - JMIR Res Protoc SP - e26168 VL - 10 IS - 3 KW - mental health KW - mobile applications KW - COVID-19 KW - health personnel KW - experience-based co-design KW - impact KW - evaluation KW - digital interventions KW - app KW - intervention KW - health care worker KW - design KW - delivery KW - support N2 - 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 UR - https://www.researchprotocols.org/2021/3/e26168 UR - http://dx.doi.org/10.2196/26168 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635823 ID - info:doi/10.2196/26168 ER - TY - JOUR AU - Abd-Alrazaq, Alaa AU - Schneider, Jens AU - Mifsud, Borbala AU - Alam, Tanvir AU - Househ, Mowafa AU - Hamdi, Mounir AU - Shah, Zubair PY - 2021/3/8 TI - A Comprehensive Overview of the COVID-19 Literature: Machine Learning?Based Bibliometric Analysis JO - J Med Internet Res SP - e23703 VL - 23 IS - 3 KW - novel coronavirus disease KW - COVID-19 KW - SARS-CoV-2 KW - 2019-nCoV KW - bibliometric analysis KW - literature KW - machine learning KW - research KW - review N2 - 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. UR - https://www.jmir.org/2021/3/e23703 UR - http://dx.doi.org/10.2196/23703 UR - http://www.ncbi.nlm.nih.gov/pubmed/33600346 ID - info:doi/10.2196/23703 ER - TY - JOUR AU - Bowman, Leigh AU - Kwok, On Kin AU - Redd, Rozlyn AU - Yi, Yuanyuan AU - Ward, Helen AU - Wei, In Wan AU - Atchison, Christina AU - Wong, Yeung-Shan Samuel PY - 2021/3/8 TI - 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 JO - J Med Internet Res SP - e23231 VL - 23 IS - 3 KW - COVID-19 KW - novel coronavirus KW - pandemic KW - behavioural response KW - risk perceptions KW - anxiety KW - comparative KW - Hong Kong KW - United Kingdom N2 - 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. UR - https://www.jmir.org/2021/3/e23231 UR - http://dx.doi.org/10.2196/23231 UR - http://www.ncbi.nlm.nih.gov/pubmed/33539309 ID - info:doi/10.2196/23231 ER - TY - JOUR AU - Okpara, S. Kelechi AU - Hecht, Jennifer AU - Wohlfeiler, Dan AU - Prior, Matthew AU - Klausner, D. Jeffrey PY - 2021/3/5 TI - A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study JO - JMIR Form Res SP - e23843 VL - 5 IS - 3 KW - patient-led digital contact notification KW - COVID-19 KW - digital contact tracing KW - contact notification website N2 - 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. UR - https://formative.jmir.org/2021/3/e23843 UR - http://dx.doi.org/10.2196/23843 UR - http://www.ncbi.nlm.nih.gov/pubmed/33621189 ID - info:doi/10.2196/23843 ER - TY - JOUR AU - Silsand, Line AU - Severinsen, Gro-Hilde AU - Berntsen, Gro PY - 2021/3/5 TI - Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team JO - JMIR Form Res SP - e25220 VL - 5 IS - 3 KW - person-centered care KW - rapid digitalization KW - health care KW - videoconferencing KW - persons with complex, long-term needs KW - COVID-19 N2 - 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. UR - https://formative.jmir.org/2021/3/e25220 UR - http://dx.doi.org/10.2196/25220 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646965 ID - info:doi/10.2196/25220 ER - TY - JOUR AU - Seto, Emily AU - Challa, Priyanka AU - Ware, Patrick PY - 2021/3/4 TI - Adoption of COVID-19 Contact Tracing Apps: A Balance Between Privacy and Effectiveness JO - J Med Internet Res SP - e25726 VL - 23 IS - 3 KW - mobile apps KW - COVID-19 KW - contact tracing KW - exposure notification KW - privacy KW - effectiveness KW - app KW - surveillance KW - tracing KW - transmission KW - security KW - digital health UR - https://www.jmir.org/2021/3/e25726 UR - http://dx.doi.org/10.2196/25726 UR - http://www.ncbi.nlm.nih.gov/pubmed/33617459 ID - info:doi/10.2196/25726 ER - TY - JOUR AU - Cerqueira-Silva, Thiago AU - Carreiro, Roberto AU - Nunes, Victor AU - Passos, Louran AU - Canedo, F. Bernardo AU - Andrade, Sofia AU - Ramos, P. Pablo Ivan AU - Khouri, Ricardo AU - Santos, Souza Carolina Barbosa AU - Nascimento, Santos Jedson Dos AU - Paste, Angélica Aurea AU - Paiva Filho, Mattos Ivan De AU - Santini-Oliveira, Marília AU - Cruz, Álvaro AU - Barral-Netto, Manoel AU - Boaventura, Viviane PY - 2021/3/4 TI - Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study JO - JMIR Public Health Surveill SP - e24795 VL - 7 IS - 3 KW - medical education KW - surveillance KW - COVID-19 KW - education KW - telehealth KW - training KW - impact KW - medical student KW - triage KW - epidemiology KW - monitoring N2 - 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. UR - https://publichealth.jmir.org/2021/3/e24795 UR - http://dx.doi.org/10.2196/24795 UR - http://www.ncbi.nlm.nih.gov/pubmed/33630746 ID - info:doi/10.2196/24795 ER - TY - JOUR AU - Kurizky, Patricia AU - Nóbrega, T. Otávio AU - Soares, Munhoz Alexandre Anderson De Sousa AU - Aires, Barbosa Rodrigo AU - Albuquerque, De Cleandro Pires AU - Nicola, Moraes André AU - Albuquerque, Patrícia AU - Teixeira-Carvalho, Andréa AU - Naves, Ansaneli Luciana AU - Fontes, Wagner AU - Luz, Souza Isabelle AU - Felicori, Liza AU - Gomides, Monteiro Ana Paulo AU - Mendonça-Silva, Lane Dayde AU - Espindola, Salmen Laila AU - Martins-Filho, Assis Olindo AU - de Lima, Barbosa Sheila Maria AU - Mota, Henrique Licia Maria AU - Gomes, Martins Ciro PY - 2021/3/4 TI - Molecular and Cellular Biomarkers of COVID-19 Prognosis: Protocol for the Prospective Cohort TARGET Study JO - JMIR Res Protoc SP - e24211 VL - 10 IS - 3 KW - COVID-19 KW - TARGET KW - cytokine profile KW - neutrophil function KW - thromboelastometry KW - neutralizing antibodies KW - metabolomics KW - proteomics KW - biomarker KW - prognosis KW - design KW - cohort KW - virus KW - immunology KW - immune system KW - genetics N2 - 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 UR - https://www.researchprotocols.org/2021/3/e24211 UR - http://dx.doi.org/10.2196/24211 UR - http://www.ncbi.nlm.nih.gov/pubmed/33661132 ID - info:doi/10.2196/24211 ER - TY - JOUR AU - Iwalokun, Abiodun Bamidele AU - Olalekan, Adesola AU - Adenipekun, Eyitayo AU - Ojo, Olabisi AU - Iwalokun, Olusola Senapon AU - Mutiu, Bamidele AU - Orija, Oluseyi AU - Adegbola, Richard AU - Salako, Babatunde AU - Akinloye, Oluyemi PY - 2021/3/4 TI - 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 JO - JMIR Res Protoc SP - e21242 VL - 10 IS - 3 KW - SARS-COV-2 infection KW - COVID-19 KW - lymphopenia KW - immunopathogenesis KW - Nigeria N2 - 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 UR - https://www.researchprotocols.org/2021/3/e21242 UR - http://dx.doi.org/10.2196/21242 UR - http://www.ncbi.nlm.nih.gov/pubmed/33621190 ID - info:doi/10.2196/21242 ER - TY - JOUR AU - Jiang, Xinchan AU - Yao, Jiaqi AU - You, Hoi-Sze Joyce PY - 2021/3/3 TI - Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis JO - J Med Internet Res SP - e26516 VL - 23 IS - 3 KW - telemonitoring KW - mobile health KW - smartphone KW - heart failure KW - COVID-19 KW - health care avoidance KW - cost-effectiveness N2 - 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. UR - https://www.jmir.org/2021/3/e26516 UR - http://dx.doi.org/10.2196/26516 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656440 ID - info:doi/10.2196/26516 ER - TY - JOUR AU - Fu, Zhiying AU - Jiang, Min AU - Wang, Kun AU - Li, Jian PY - 2021/3/2 TI - Minimizing the Impact of the COVID-19 Epidemic on Oncology Clinical Trials: Retrospective Study of Beijing Cancer Hospital JO - J Med Internet Res SP - e26799 VL - 23 IS - 3 KW - COVID-19 KW - clinical trials KW - management strategy KW - information technology N2 - Background: In view of repeated COVID-19 outbreaks in most countries, clinical trials will continue to be conducted under outbreak prevention and control measures for the next few years. It is very significant to explore an optimal clinical trial management model during the outbreak period to provide reference and insight for other clinical trial centers worldwide. Objective: The aim of this study was to explore the management strategies used to minimize the impact of the COVID-19 epidemic on oncology clinical trials. Methods: We implemented a remote management model to maintain clinical trials conducted at Beijing Cancer Hospital, which realized remote project approval, remote initiation, remote visits, remote administration and remote monitoring to get through two COVID-19 outbreaks in the capital city from February to April and June to July 2020. The effectiveness of measures was evaluated as differences in rates of protocol compliance, participants lost to follow-up, participant withdrawal, disease progression, participant mortality, and detection of monitoring problems. Results: During the late of the first outbreak, modifications were made in trial processing, participant management and quality control, which allowed the hospital to ensure the smooth conduct of 572 trials, with a protocol compliance rate of 85.24% for 3718 participants across both outbreaks. No COVID-19 infections were recorded among participants or trial staff, and no major procedural errors occurred between February and July 2020. These measures led to significantly higher rates of protocol compliance and significantly lower rates of loss to follow-up or withdrawal after the second outbreak than after the first, without affecting rates of disease progression or mortality. The hospital provided trial sponsors with a remote monitoring system in a timely manner, and 3820 trial issues were identified. Conclusions: When public health emergencies occur, an optimal clinical trial model combining on-site and remote management could guarantee the health care and treatment needs of clinical trial participants, in which remote management plays a key role. UR - https://www.jmir.org/2021/3/e26799 UR - http://dx.doi.org/10.2196/26799 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591924 ID - info:doi/10.2196/26799 ER - TY - JOUR AU - Liu, Taoran AU - Tsang, Winghei AU - Xie, Yifei AU - Tian, Kang AU - Huang, Fengqiu AU - Chen, Yanhui AU - Lau, Oiying AU - Feng, Guanrui AU - Du, Jianhao AU - Chu, Bojia AU - Shi, Tingyu AU - Zhao, Junjie AU - Cai, Yiming AU - Hu, Xueyan AU - Akinwunmi, Babatunde AU - Huang, Jian AU - Zhang, P. Casper J. AU - Ming, Wai-Kit PY - 2021/3/2 TI - Preferences for Artificial Intelligence Clinicians Before and During the COVID-19 Pandemic: Discrete Choice Experiment and Propensity Score Matching Study JO - J Med Internet Res SP - e26997 VL - 23 IS - 3 KW - propensity score matching KW - discrete latent traits KW - patients? preferences KW - artificial intelligence KW - COVID-19 KW - preference KW - discrete choice KW - choice KW - traditional medicine KW - public health KW - resource KW - patient KW - diagnosis KW - accuracy N2 - Background: Artificial intelligence (AI) methods can potentially be used to relieve the pressure that the COVID-19 pandemic has exerted on public health. In cases of medical resource shortages caused by the pandemic, changes in people?s preferences for AI clinicians and traditional clinicians are worth exploring. Objective: We aimed to quantify and compare people?s preferences for AI clinicians and traditional clinicians before and during the COVID-19 pandemic, and to assess whether people?s preferences were affected by the pressure of pandemic. Methods: We used the propensity score matching method to match two different groups of respondents with similar demographic characteristics. Respondents were recruited in 2017 and 2020. A total of 2048 respondents (2017: n=1520; 2020: n=528) completed the questionnaire and were included in the analysis. Multinomial logit models and latent class models were used to assess people?s preferences for different diagnosis methods. Results: In total, 84.7% (1115/1317) of respondents in the 2017 group and 91.3% (482/528) of respondents in the 2020 group were confident that AI diagnosis methods would outperform human clinician diagnosis methods in the future. Both groups of matched respondents believed that the most important attribute of diagnosis was accuracy, and they preferred to receive combined diagnoses from both AI and human clinicians (2017: odds ratio [OR] 1.645, 95% CI 1.535-1.763; P<.001; 2020: OR 1.513, 95% CI 1.413-1.621; P<.001; reference: clinician diagnoses). The latent class model identified three classes with different attribute priorities. In class 1, preferences for combined diagnoses and accuracy remained constant in 2017 and 2020, and high accuracy (eg, 100% accuracy in 2017: OR 1.357, 95% CI 1.164-1.581) was preferred. In class 2, the matched data from 2017 were similar to those from 2020; combined diagnoses from both AI and human clinicians (2017: OR 1.204, 95% CI 1.039-1.394; P=.011; 2020: OR 2.009, 95% CI 1.826-2.211; P<.001; reference: clinician diagnoses) and an outpatient waiting time of 20 minutes (2017: OR 1.349, 95% CI 1.065-1.708; P<.001; 2020: OR 1.488, 95% CI 1.287-1.721; P<.001; reference: 0 minutes) were consistently preferred. In class 3, the respondents in the 2017 and 2020 groups preferred different diagnosis methods; respondents in the 2017 group preferred clinician diagnoses, whereas respondents in the 2020 group preferred AI diagnoses. In the latent class, which was stratified according to sex, all male and female respondents in the 2017 and 2020 groups believed that accuracy was the most important attribute of diagnosis. Conclusions: Individuals? preferences for receiving clinical diagnoses from AI and human clinicians were generally unaffected by the pandemic. Respondents believed that accuracy and expense were the most important attributes of diagnosis. These findings can be used to guide policies that are relevant to the development of AI-based health care. UR - https://www.jmir.org/2021/3/e26997 UR - http://dx.doi.org/10.2196/26997 UR - http://www.ncbi.nlm.nih.gov/pubmed/33556034 ID - info:doi/10.2196/26997 ER - TY - JOUR AU - Strudwick, Gillian AU - Sockalingam, Sanjeev AU - Kassam, Iman AU - Sequeira, Lydia AU - Bonato, Sarah AU - Youssef, Alaa AU - Mehta, Rohan AU - Green, Nadia AU - Agic, Branka AU - Soklaridis, Sophie AU - Impey, Danielle AU - Wiljer, David AU - Crawford, Allison PY - 2021/3/2 TI - Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review JO - JMIR Ment Health SP - e26550 VL - 8 IS - 3 KW - digital health KW - psychiatry KW - mental health KW - informatics KW - pandemic KW - COVID-19 KW - telemedicine KW - eHealth KW - public health KW - virtual care KW - mobile apps KW - population health N2 - Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada?s guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. UR - https://mental.jmir.org/2021/3/e26550 UR - http://dx.doi.org/10.2196/26550 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650985 ID - info:doi/10.2196/26550 ER - TY - JOUR AU - Blom, G. Annelies AU - Wenz, Alexander AU - Cornesse, Carina AU - Rettig, Tobias AU - Fikel, Marina AU - Friedel, Sabine AU - Möhring, Katja AU - Naumann, Elias AU - Reifenscheid, Maximiliane AU - Krieger, Ulrich PY - 2021/3/2 TI - Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study JO - J Med Internet Res SP - e23362 VL - 23 IS - 3 KW - digital health KW - mobile health KW - smartphone KW - mobile phone KW - app KW - digital technology KW - contact tracing KW - coronavirus KW - COVID-19 KW - survey N2 - 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. UR - https://www.jmir.org/2021/3/e23362 UR - http://dx.doi.org/10.2196/23362 UR - http://www.ncbi.nlm.nih.gov/pubmed/33577466 ID - info:doi/10.2196/23362 ER - TY - JOUR AU - Baral, David Stefan AU - Rucinski, Blair Katherine AU - Twahirwa Rwema, Olivier Jean AU - Rao, Amrita AU - Prata Menezes, Neia AU - Diouf, Daouda AU - Kamarulzaman, Adeeba AU - Phaswana-Mafuya, Nancy AU - Mishra, Sharmistha PY - 2021/3/2 TI - The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment JO - JMIR Public Health Surveill SP - e24696 VL - 7 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - influenza KW - descriptive epidemiology KW - epidemiology KW - assessment KW - relationship KW - flu KW - virus KW - burden KW - global health KW - public health KW - transmission KW - pattern N2 - Background: SARS-CoV-2 and influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission. Objective: With a descriptive epidemiological framing, we assessed whether recent historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across regions of the world. Methods: Weekly surveillance data reported by the World Health Organization from January 2017 to December 2019 for influenza and from January 1, 2020 through October 31, 2020, for COVID-19 were used to assess seasonal and temporal trends for influenza and COVID-19 cases across the seven World Bank regions. Results: In regions with more pronounced influenza seasonality, COVID-19 epidemics have largely followed trends similar to those seen for influenza from 2017 to 2019. COVID-19 epidemics in countries across Europe, Central Asia, and North America have been marked by a first peak during the spring, followed by significant reductions in COVID-19 cases in the summer months and a second wave in the fall. In Latin America and the Caribbean, COVID-19 epidemics in several countries peaked in the summer, corresponding to months with the highest influenza activity in the region. Countries from regions with less pronounced influenza activity, including South Asia and sub-Saharan Africa, showed more heterogeneity in COVID-19 epidemics seen to date. However, similarities in COVID-19 and influenza trends were evident within select countries irrespective of region. Conclusions: Ecological consistency in COVID-19 trends seen to date with influenza trends suggests the potential for shared individual, structural, and environmental determinants of transmission. Using a descriptive epidemiological framework to assess shared regional trends for rapidly emerging respiratory pathogens with better studied respiratory infections may provide further insights into the differential impacts of nonpharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage epidemiologic patterns in the relative burden of past respiratory pathogens as prior information. UR - https://publichealth.jmir.org/2021/3/e24696 UR - http://dx.doi.org/10.2196/24696 UR - http://www.ncbi.nlm.nih.gov/pubmed/33522974 ID - info:doi/10.2196/24696 ER - TY - JOUR AU - Almalki, Manal AU - Giannicchi, Anna PY - 2021/3/2 TI - Health Apps for Combating COVID-19: Descriptive Review and Taxonomy JO - JMIR Mhealth Uhealth SP - e24322 VL - 9 IS - 3 KW - app KW - COVID-19 KW - corona KW - self-care KW - personal tracking KW - review KW - mHealth KW - track KW - surveillance KW - awareness KW - exposure KW - consumer health informatics N2 - 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. UR - https://mhealth.jmir.org/2021/3/e24322 UR - http://dx.doi.org/10.2196/24322 UR - http://www.ncbi.nlm.nih.gov/pubmed/33626017 ID - info:doi/10.2196/24322 ER - TY - JOUR AU - Hsing, C. Julianna AU - Ma, Jasmin AU - Barrero-Castillero, Alejandra AU - Jani, G. Shilpa AU - Pulendran, Palam Uma AU - Lin, Bea-Jane AU - Thomas-Uribe, Monika AU - Wang, Jason C. PY - 2021/2/26 TI - Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media?Based Survey Study JO - J Med Internet Res SP - e23720 VL - 23 IS - 2 KW - COVID-19 pandemic KW - health belief model KW - behavior change KW - preventative health behaviors KW - handwashing KW - social distancing KW - international KW - online survey KW - social media KW - cross-sectional study N2 - 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 (?23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing (?23=309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (odds ratio [OR]United States 1.58, 95% CI 1.21-2.07; ORMexico 1.5, 95% CI 1.21-1.96; ORHong Kong 2.48, 95% CI 1.80-3.44; ORTaiwan 2.30, 95% CI 2.21-2.39) and social distancing practices (ORUnited States 1.77, 95% CI 1.24-2.49; ORMexico 1.77, 95% CI 1.40-2.25; ORHong Kong 3.25, 95% CI 2.32-4.62; ORTaiwan 2.58, 95% CI 2.47-2.68) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the United States, Mexico, and Taiwan. Conclusions: Social media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context. UR - https://www.jmir.org/2021/2/e23720 UR - http://dx.doi.org/10.2196/23720 UR - http://www.ncbi.nlm.nih.gov/pubmed/33571103 ID - info:doi/10.2196/23720 ER - TY - JOUR AU - Lim, Min Hooi AU - Teo, Hai Chin AU - Ng, Jenn Chirk AU - Chiew, Kian Thiam AU - Ng, Leik Wei AU - Abdullah, Adina AU - Abdul Hadi, Haireen AU - Liew, Sun Chee AU - Chan, Seng Chee PY - 2021/2/26 TI - An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study JO - JMIR Med Inform SP - e23427 VL - 9 IS - 2 KW - COVID-19 KW - coronavirus disease KW - home monitoring KW - symptom monitoring KW - system KW - teleconsultation KW - development KW - eHealth KW - digital health KW - mHealth KW - health services research KW - telesurveillance KW - infectious disease KW - app N2 - 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. UR - https://medinform.jmir.org/2021/2/e23427 UR - http://dx.doi.org/10.2196/23427 UR - http://www.ncbi.nlm.nih.gov/pubmed/33600345 ID - info:doi/10.2196/23427 ER - TY - JOUR AU - Elhadi, Muhammed AU - Msherghi, Ahmed AU - Elhadi, Ahmed AU - Ashini, Aimen AU - Alsoufi, Ahmed AU - Bin Alshiteewi, Fatimah AU - Elmabrouk, Amna AU - Alsuyihili, Ali AU - Elgherwi, Alsafa AU - Elkhafeefi, Fatimah AU - Abdulrazik, Sarah AU - Tarek, Ahmed PY - 2021/2/26 TI - Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis JO - JMIR Med Inform SP - e23335 VL - 9 IS - 2 KW - COVID-19 KW - cross-sectional study KW - resource-limited countries KW - SARS-CoV-2 KW - telehealth KW - telemedicine KW - transitional countries KW - usability N2 - 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. UR - https://medinform.jmir.org/2021/2/e23335 UR - http://dx.doi.org/10.2196/23335 UR - http://www.ncbi.nlm.nih.gov/pubmed/33606654 ID - info:doi/10.2196/23335 ER - TY - JOUR AU - Cabral, Pereira Bernardo AU - Braga, Luiza AU - Mota, Fabio PY - 2021/2/26 TI - 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 JO - JMIR Public Health Surveill SP - e22483 VL - 7 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - vaccine KW - treatment KW - survey KW - public health KW - drug KW - clinical trial N2 - 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. UR - https://publichealth.jmir.org/2021/2/e22483 UR - http://dx.doi.org/10.2196/22483 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635275 ID - info:doi/10.2196/22483 ER - TY - JOUR AU - Lee, Minjung AU - You, Myoungsoon PY - 2021/2/25 TI - Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea JO - J Med Internet Res SP - e24165 VL - 23 IS - 2 KW - COVID-19 KW - coronavirus KW - preventive behaviors KW - text message KW - mobile phone KW - alert KW - prevention KW - behavior KW - public health KW - survey N2 - 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 (?=.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 (?=.078, P=.01) and canceled or postponed social gatherings (?=.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. UR - https://www.jmir.org/2021/2/e24165 UR - http://dx.doi.org/10.2196/24165 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544691 ID - info:doi/10.2196/24165 ER - TY - JOUR AU - Borobia, M. Alberto AU - García-García, Irene AU - Díaz-García, Lucía AU - Rodríguez-Mariblanca, Amelia AU - Martínez de Soto, Lucía AU - Monserrat Villatoro, Jaime AU - Seco Meseguer, Enrique AU - González, J. Juan AU - Frías Iniesta, Jesús AU - Ramírez García, Elena AU - Arribas, Ramón Jose AU - Carcas-Sansuán, J. Antonio PY - 2021/2/25 TI - Health Care Workers? Reasons for Choosing Between Two Different COVID-19 Prophylaxis Trials in an Acute Pandemic Context: Single-Center Questionnaire Study JO - J Med Internet Res SP - e23441 VL - 23 IS - 2 KW - clinical trials KW - COVID-19 KW - health care worker KW - motivation KW - personnel KW - pre-exposure KW - professional practice KW - prophylaxis KW - SARS-CoV-2 KW - volunteers, web-based survey KW - workplace safety N2 - Background: In April 2020, two independent clinical trials to assess SARS-CoV-2 prophylaxis strategies among health care workers were initiated at our hospital: MeCOVID (melatonin vs placebo) and EPICOS (tenofovir disoproxil/emtricitabine vs hydroxychloroquine vs combination therapy vs placebo). Objective: This study aimed to evaluate the reasons why health care workers chose to participate in the MeCOVID and EPICOS trials, as well as why they chose one over the other. Methods: Both trials were offered to health care workers through an internal news bulletin. After an initial screening visit, all subjects were asked to respond to a web-based survey. Results: In the first month, 206 health care workers were screened and 160 were randomized. The survey participation was high at 73.3%. Health care workers cited ?to contribute to scientific knowledge? (n=80, 53.0%), followed by ?to avoid SARS-CoV-2 infection? (n=33, 21.9%) and ?the interest to be tested for SARS-CoV-2? (n=28, 18.5%), as their primary reasons to participate in the trials. We observed significant differences in the expected personal benefits across physicians and nurses (P=.01). The vast majority of volunteers (n=202, 98.0%) selected the MeCOVID trial, their primary reason being their concern regarding adverse reactions to treatments in the EPICOS trial (n=102, 69.4%). Conclusions: Health care workers? reasons to participate in prophylaxis trials in an acute pandemic context appear to be driven largely by their desire to contribute to science and to gain health benefits. Safety outweighed efficacy when choosing between the two clinical trials. UR - https://www.jmir.org/2021/2/e23441 UR - http://dx.doi.org/10.2196/23441 UR - http://www.ncbi.nlm.nih.gov/pubmed/33556032 ID - info:doi/10.2196/23441 ER - TY - JOUR AU - Paludneviciene, Raylene AU - Knight, Tracy AU - Firl, Gideon AU - Luttrell, Kaela AU - Takayama, Kota AU - Kushalnagar, Poorna PY - 2021/2/25 TI - 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 JO - J Med Internet Res SP - e21103 VL - 23 IS - 2 KW - COVID-19 KW - coronavirus KW - physical distancing KW - asymptomatic individual KW - social media KW - deaf KW - hard of hearing KW - sign language KW - perception KW - misinformation N2 - 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. UR - https://www.jmir.org/2021/2/e21103 UR - http://dx.doi.org/10.2196/21103 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560996 ID - info:doi/10.2196/21103 ER - TY - JOUR AU - Cha, Meeyoung AU - Cha, Chiyoung AU - Singh, Karandeep AU - Lima, Gabriel AU - Ahn, Yong-Yeol AU - Kulshrestha, Juhi AU - Varol, Onur PY - 2021/2/13 TI - Prevalence of Misinformation and Factchecks on the COVID-19 Pandemic in 35 Countries: Observational Infodemiology Study JO - JMIR Hum Factors SP - e23279 VL - 8 IS - 1 KW - COVID-19 KW - coronavirus KW - infodemic KW - infodemiology KW - misinformation KW - vulnerability KW - LMIC countries N2 - 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 ?=?0.72; P<.001). We also found that fact checks spread to a lesser degree than their respective false claims, following a sublinear trend (?=.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. UR - https://humanfactors.jmir.org/2021/1/e23279 UR - http://dx.doi.org/10.2196/23279 UR - http://www.ncbi.nlm.nih.gov/pubmed/33395395 ID - info:doi/10.2196/23279 ER - TY - JOUR AU - Elhadi, Muhammed AU - Elhadi, Ahmed AU - Bouhuwaish, Ahmad AU - Bin Alshiteewi, Fatimah AU - Elmabrouk, Amna AU - Alsuyihili, Ali AU - Alhashimi, Ayiman AU - Khel, Samer AU - Elgherwi, Alsafa AU - Alsoufi, Ahmed AU - Albakoush, Ahmed AU - Abdulmalik, Abdulmuez PY - 2021/2/25 TI - Telemedicine Awareness, Knowledge, Attitude, and Skills of Health Care Workers in a Low-Resource Country During the COVID-19 Pandemic: Cross-sectional Study JO - J Med Internet Res SP - e20812 VL - 23 IS - 2 KW - attitude KW - awareness KW - coronavirus KW - COVID-19 KW - knowledge KW - pandemic KW - skills KW - telemedicine N2 - 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 (?23=14.5; P<.001) and attitude (?23=13.5; P=.001) scores than those without professional computer skills. We observed significant differences in the mean computer skill scores of the groups (?23=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. UR - https://www.jmir.org/2021/2/e20812 UR - http://dx.doi.org/10.2196/20812 UR - http://www.ncbi.nlm.nih.gov/pubmed/33600350 ID - info:doi/10.2196/20812 ER - TY - JOUR AU - Zheng, Chengda AU - Xue, Jia AU - Sun, Yumin AU - Zhu, Tingshao PY - 2021/2/23 TI - Public Opinions and Concerns Regarding the Canadian Prime Minister?s Daily COVID-19 Briefing: Longitudinal Study of YouTube Comments Using Machine Learning Techniques JO - J Med Internet Res SP - e23957 VL - 23 IS - 2 KW - Canada KW - PM Trudeau KW - YouTube KW - machine learning KW - big data KW - infodemiology KW - infodemic KW - public concerns KW - communication KW - concern KW - social media KW - video N2 - 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. UR - https://www.jmir.org/2021/2/e23957 UR - http://dx.doi.org/10.2196/23957 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544690 ID - info:doi/10.2196/23957 ER - TY - JOUR AU - Anyanwu, C. Emeka AU - Ward, Parker R. AU - Shah, Atman AU - Arora, Vineet AU - Umscheid, A. Craig PY - 2021/2/23 TI - A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience JO - JMIR Mhealth Uhealth SP - e24452 VL - 9 IS - 2 KW - adoption KW - communication KW - COVID-19 KW - hospital KW - inpatient KW - mHealth KW - mobile app KW - telemedicine N2 - Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number?related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team?s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. UR - https://mhealth.jmir.org/2021/2/e24452 UR - http://dx.doi.org/10.2196/24452 UR - http://www.ncbi.nlm.nih.gov/pubmed/33513562 ID - info:doi/10.2196/24452 ER - TY - JOUR AU - Abbasi-Kangevari, Mohsen AU - Kolahi, Ali-Asghar AU - Ghamari, Seyyed-Hadi AU - Hassanian-Moghaddam, Hossein PY - 2021/2/23 TI - Public Knowledge, Attitudes, and Practices Related to COVID-19 in Iran: Questionnaire Study JO - JMIR Public Health Surveill SP - e21415 VL - 7 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - attitudes KW - coronavirus KW - knowledge KW - perceptions KW - practices KW - Iran N2 - 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. UR - https://publichealth.jmir.org/2021/2/e21415 UR - http://dx.doi.org/10.2196/21415 UR - http://www.ncbi.nlm.nih.gov/pubmed/33620326 ID - info:doi/10.2196/21415 ER - TY - JOUR AU - Liu, Taoran AU - Tsang, Winghei AU - Huang, Fengqiu AU - Lau, Ying Oi AU - Chen, Yanhui AU - Sheng, Jie AU - Guo, Yiwei AU - Akinwunmi, Babatunde AU - Zhang, JP Casper AU - Ming, Wai-Kit PY - 2021/2/23 TI - Patients? Preferences for Artificial Intelligence Applications Versus Clinicians in Disease Diagnosis During the SARS-CoV-2 Pandemic in China: Discrete Choice Experiment JO - J Med Internet Res SP - e22841 VL - 23 IS - 2 KW - discrete choice experiment KW - artificial intelligence KW - patient preference KW - multinomial logit analysis KW - questionnaire KW - latent-class conditional logit KW - app KW - human clinicians KW - diagnosis KW - COVID-19 KW - China N2 - Background: Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19. Objective: This study aims to visualize and measure patients? heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future. Methods: A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables? coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes. Results: A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis ?accuracy? attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes. Conclusions: Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People?s preferences for the ?accuracy? and ?diagnostic expenses? attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration. UR - https://www.jmir.org/2021/2/e22841 UR - http://dx.doi.org/10.2196/22841 UR - http://www.ncbi.nlm.nih.gov/pubmed/33493130 ID - info:doi/10.2196/22841 ER - TY - JOUR AU - Sang, Shengtian AU - Sun, Ran AU - Coquet, Jean AU - Carmichael, Harris AU - Seto, Tina AU - Hernandez-Boussard, Tina PY - 2021/2/22 TI - Learning From Past Respiratory Infections to Predict COVID-19 Outcomes: Retrospective Study JO - J Med Internet Res SP - e23026 VL - 23 IS - 2 KW - COVID-19 KW - invasive mechanical ventilation KW - all-cause mortality KW - machine learning KW - artificial intelligence KW - respiratory KW - infection KW - outcome KW - data KW - feasibility KW - framework N2 - 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. UR - https://www.jmir.org/2021/2/e23026 UR - http://dx.doi.org/10.2196/23026 UR - http://www.ncbi.nlm.nih.gov/pubmed/33534724 ID - info:doi/10.2196/23026 ER - TY - JOUR AU - Parikh, Soham AU - Davoudi, Anahita AU - Yu, Shun AU - Giraldo, Carolina AU - Schriver, Emily AU - Mowery, Danielle PY - 2021/2/22 TI - Lexicon Development for COVID-19-related Concepts Using Open-source Word Embedding Sources: An Intrinsic and Extrinsic Evaluation JO - JMIR Med Inform SP - e21679 VL - 9 IS - 2 KW - natural language processing KW - word embedding KW - COVID-19 KW - intrinsic KW - open-source KW - computation KW - model KW - prediction KW - semantic KW - syntactic KW - pattern N2 - Background: Scientists are developing new computational methods and prediction models to better clinically understand COVID-19 prevalence, treatment efficacy, and patient outcomes. These efforts could be improved by leveraging documented COVID-19?related symptoms, findings, and disorders from clinical text sources in an electronic health record. Word embeddings can identify terms related to these clinical concepts from both the biomedical and nonbiomedical domains, and are being shared with the open-source community at large. However, it?s unclear how useful openly available word embeddings are for developing lexicons for COVID-19?related concepts. Objective: Given an initial lexicon of COVID-19?related terms, this study aims to characterize the returned terms by similarity across various open-source word embeddings and determine common semantic and syntactic patterns between the COVID-19 queried terms and returned terms specific to the word embedding source. Methods: We compared seven openly available word embedding sources. Using a series of COVID-19?related terms for associated symptoms, findings, and disorders, we conducted an interannotator agreement study to determine how accurately the most similar returned terms could be classified according to semantic types by three annotators. We conducted a qualitative study of COVID-19 queried terms and their returned terms to detect informative patterns for constructing lexicons. We demonstrated the utility of applying such learned synonyms to discharge summaries by reporting the proportion of patients identified by concept among three patient cohorts: pneumonia (n=6410), acute respiratory distress syndrome (n=8647), and COVID-19 (n=2397). Results: We observed high pairwise interannotator agreement (Cohen kappa) for symptoms (0.86-0.99), findings (0.93-0.99), and disorders (0.93-0.99). Word embedding sources generated based on characters tend to return more synonyms (mean count of 7.2 synonyms) compared to token-based embedding sources (mean counts range from 2.0 to 3.4). Word embedding sources queried using a qualifier term (eg, dry cough or muscle pain) more often returned qualifiers of the similar semantic type (eg, ?dry? returns consistency qualifiers like ?wet? and ?runny?) compared to a single term (eg, cough or pain) queries. A higher proportion of patients had documented fever (0.61-0.84), cough (0.41-0.55), shortness of breath (0.40-0.59), and hypoxia (0.51-0.56) retrieved than other clinical features. Terms for dry cough returned a higher proportion of patients with COVID-19 (0.07) than the pneumonia (0.05) and acute respiratory distress syndrome (0.03) populations. Conclusions: Word embeddings are valuable technology for learning related terms, including synonyms. When leveraging openly available word embedding sources, choices made for the construction of the word embeddings can significantly influence the words learned. UR - https://medinform.jmir.org/2021/2/e21679 UR - http://dx.doi.org/10.2196/21679 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544689 ID - info:doi/10.2196/21679 ER - TY - JOUR AU - Dai, Wanfa AU - Ke, Pei-Feng AU - Li, Zhen-Zhen AU - Zhuang, Qi-Zhen AU - Huang, Wei AU - Wang, Yi AU - Xiong, Yujuan AU - Huang, Xian-Zhang PY - 2021/2/22 TI - Establishing Classifiers With Clinical Laboratory Indicators to Distinguish COVID-19 From Community-Acquired Pneumonia: Retrospective Cohort Study JO - J Med Internet Res SP - e23390 VL - 23 IS - 2 KW - COVID-19 KW - clinical laboratory indicators KW - community-acquired pneumonia KW - classifier KW - classification algorithm N2 - 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. UR - https://www.jmir.org/2021/2/e23390 UR - http://dx.doi.org/10.2196/23390 UR - http://www.ncbi.nlm.nih.gov/pubmed/33534722 ID - info:doi/10.2196/23390 ER - TY - JOUR AU - Hirten, P. Robert AU - Danieletto, Matteo AU - Tomalin, Lewis AU - Choi, Hyewon Katie AU - Zweig, Micol AU - Golden, Eddye AU - Kaur, Sparshdeep AU - Helmus, Drew AU - Biello, Anthony AU - Pyzik, Renata AU - Charney, Alexander AU - Miotto, Riccardo AU - Glicksberg, S. Benjamin AU - Levin, Matthew AU - Nabeel, Ismail AU - Aberg, Judith AU - Reich, David AU - Charney, Dennis AU - Bottinger, P. Erwin AU - Keefer, Laurie AU - Suarez-Farinas, Mayte AU - Nadkarni, N. Girish AU - Fayad, A. Zahi PY - 2021/2/22 TI - Use of Physiological Data From a Wearable Device to Identify SARS-CoV-2 Infection and Symptoms and Predict COVID-19 Diagnosis: Observational Study JO - J Med Internet Res SP - e26107 VL - 23 IS - 2 KW - wearable device KW - COVID-19 KW - identification KW - prediction KW - heart rate variability KW - physiological KW - wearable KW - app KW - data KW - infectious disease KW - symptom KW - diagnosis KW - observational N2 - 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. UR - https://www.jmir.org/2021/2/e26107 UR - http://dx.doi.org/10.2196/26107 UR - http://www.ncbi.nlm.nih.gov/pubmed/33529156 ID - info:doi/10.2196/26107 ER - TY - JOUR AU - Wong, Zheng Mark Yu AU - Gunasekeran, Visva Dinesh AU - Nusinovici, Simon AU - Sabanayagam, Charumathi AU - Yeo, Keong Khung AU - Cheng, Ching-Yu AU - Tham, Yih-Chung PY - 2021/2/19 TI - Telehealth Demand Trends During the COVID-19 Pandemic in the Top 50 Most Affected Countries: Infodemiological Evaluation JO - JMIR Public Health Surveill SP - e24445 VL - 7 IS - 2 KW - COVID-19 KW - infodemiology KW - telehealth KW - telemedicine KW - internet N2 - 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. UR - http://publichealth.jmir.org/2021/2/e24445/ UR - http://dx.doi.org/10.2196/24445 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605883 ID - info:doi/10.2196/24445 ER - TY - JOUR AU - Krishnamurti, Tamar AU - Davis, L. Alexander AU - Quinn, Beth AU - Castillo, F. Anabel AU - Martin, L. Kelly AU - Simhan, N. Hyagriv PY - 2021/2/19 TI - Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study JO - J Med Internet Res SP - e22790 VL - 23 IS - 2 KW - COVID-19 KW - social isolation, sheltering-in-place KW - intimate partner violence KW - domestic violence KW - pregnancy KW - telemedicine KW - telehealth N2 - Background: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. Objective: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. Methods: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. Results: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. Conclusions: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider. UR - http://www.jmir.org/2021/2/e22790/ UR - http://dx.doi.org/10.2196/22790 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605898 ID - info:doi/10.2196/22790 ER - TY - JOUR AU - de Lusignan, Simon AU - Lopez Bernal, Jamie AU - Byford, Rachel AU - Amirthalingam, Gayatri AU - Ferreira, Filipa AU - Akinyemi, Oluwafunmi AU - Andrews, Nick AU - Campbell, Helen AU - Dabrera, Gavin AU - Deeks, Alexandra AU - Elliot, J. Alex AU - Krajenbrink, Else AU - Liyanage, Harshana AU - McGagh, Dylan AU - Okusi, Cecilia AU - Parimalanathan, Vaishnavi AU - Ramsay, Mary AU - Smith, Gillian AU - Tripathy, Manasa AU - Williams, John AU - Victor, William AU - Zambon, Maria AU - Howsam, Gary AU - Nicholson, David Brian AU - Tzortziou Brown, Victoria AU - Butler, C. Christopher AU - Joy, Mark AU - Hobbs, Richard F. D. PY - 2021/2/19 TI - 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 JO - JMIR Public Health Surveill SP - e24341 VL - 7 IS - 2 KW - COVID-19 KW - general practice KW - influenza KW - computerized medical record systems KW - sentinel surveillance KW - coronavirus infections KW - records as topic KW - serology KW - virology N2 - 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. UR - http://publichealth.jmir.org/2021/2/e24341/ UR - http://dx.doi.org/10.2196/24341 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605892 ID - info:doi/10.2196/24341 ER - TY - JOUR AU - Nishimura, Yoshito AU - Ochi, Kanako AU - Tokumasu, Kazuki AU - Obika, Mikako AU - Hagiya, Hideharu AU - Kataoka, Hitomi AU - Otsuka, Fumio PY - 2021/2/18 TI - Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study JO - J Med Internet Res SP - e25232 VL - 23 IS - 2 KW - COVID-19 KW - online education KW - depression KW - pandemic KW - anxiety KW - medical student N2 - 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. UR - http://www.jmir.org/2021/2/e25232/ UR - http://dx.doi.org/10.2196/25232 UR - http://www.ncbi.nlm.nih.gov/pubmed/33556033 ID - info:doi/10.2196/25232 ER - TY - JOUR AU - Ali, H. Shahmir AU - Imbruce, M. Valerie AU - Russo, G. Rienna AU - Kaplan, Samuel AU - Stevenson, Kaye AU - Mezzacca, Adjoian Tamar AU - Foster, Victoria AU - Radee, Ashley AU - Chong, Stella AU - Tsui, Felice AU - Kranick, Julie AU - Yi, S. Stella PY - 2021/2/18 TI - Evaluating Closures of Fresh Fruit and Vegetable Vendors During the COVID-19 Pandemic: Methodology and Preliminary Results Using Omnidirectional Street View Imagery JO - JMIR Form Res SP - e23870 VL - 5 IS - 2 KW - built environment KW - Google Street View KW - food retail environment KW - COVID-19 KW - geographic surveillance KW - food KW - longitudinal KW - supply chain KW - economy KW - demand KW - service KW - vendor KW - surveillance N2 - 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. UR - http://formative.jmir.org/2021/2/e23870/ UR - http://dx.doi.org/10.2196/23870 UR - http://www.ncbi.nlm.nih.gov/pubmed/33539310 ID - info:doi/10.2196/23870 ER - TY - JOUR AU - Sasikumar, Smriti AU - Sulaiman, Omer Hafsa AU - Bedi, Simran AU - Nozdrin, Mikhail AU - Rundell, Caroline AU - Zaman, Sadia PY - 2021/2/18 TI - 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? JO - J Med Internet Res SP - e23168 VL - 23 IS - 2 KW - COVID-19 KW - social media KW - mass media KW - information quality UR - https://www.jmir.org/2021/2/e23168 UR - http://dx.doi.org/10.2196/23168 UR - http://www.ncbi.nlm.nih.gov/pubmed/33599623 ID - info:doi/10.2196/23168 ER - TY - JOUR AU - Kaveladze, Benjamin AU - Chang, Katherine AU - Siev, Jedidiah AU - Schueller, M. Stephen PY - 2021/2/17 TI - Impact of the COVID-19 Pandemic on Online Obsessive-Compulsive Disorder Support Community Members: Survey Study JO - JMIR Ment Health SP - e26715 VL - 8 IS - 2 KW - obsessive-compulsive disorder KW - COVID-19 pandemic KW - online support communities KW - mental health N2 - Background: People with obsessive-compulsive disorder (OCD) have faced unique challenges during the COVID-19 pandemic. Research from the first two months of the pandemic suggests that a small proportion of people with OCD experienced worsening in their OCD symptoms since the pandemic began, whereas the rest experienced either no change or an improvement in their symptoms. However, as society-level factors relating to the pandemic have evolved, the effects of the pandemic on people with OCD have likely changed as well, in complex and population-specific ways. Therefore, this study contributes to a growing body of knowledge on the impact of the COVID-19 pandemic on people and demonstrates how differences across studies might emerge when studying specific populations at specific timepoints. Objective: This study aimed to assess how members of online OCD support communities felt the COVID-19 pandemic had affected their OCD symptoms, around 3 months after the pandemic began. Methods: We recruited participants from online OCD support communities for our brief survey. Participants indicated how much they felt their OCD symptoms had changed since the pandemic began and how much they felt that having OCD was making it harder to deal with the pandemic. Results: We collected survey data from June through August 2020 and received a total of 196 responses, some of which were partial responses. Among the nonmissing data, 65.9% (108/164) of the participants were from the United States and 90.5% (152/168) had been subjected to a stay-at-home order. In all, 92.9% (182/196) of the participants said they experienced worsening of their OCD symptoms since the pandemic began, although the extent to which their symptoms worsened differed across dimensions of OCD; notably, symmetry and completeness symptoms were less likely to have worsened than others. Moreover, 95.5% (171/179) of the participants felt that having OCD made it difficult to deal with the pandemic. Conclusions: Our study of online OCD support community members found a much higher rate of OCD symptom worsening than did other studies on people with OCD conducted during the current COVID-19 pandemic. Factors such as quarantine length, location, overlapping society-level challenges, and differing measurement and sampling choices may help to explain this difference across studies. UR - http://mental.jmir.org/2021/2/e26715/ UR - http://dx.doi.org/10.2196/26715 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595449 ID - info:doi/10.2196/26715 ER - TY - JOUR AU - Haldeman, Scott AU - Nordin, Margareta AU - Tavares, Patricia AU - Mullerpatan, Rajani AU - Kopansky-Giles, Deborah AU - Setlhare, Vincent AU - Chou, Roger AU - Hurwitz, Eric AU - Treanor, Caroline AU - Hartvigsen, Jan AU - Schneider, Michael AU - Gay, Ralph AU - Moss, Jean AU - Haldeman, Joan AU - Gryfe, David AU - Wilkey, Adam AU - Brown, Richard AU - Outerbridge, Geoff AU - Eberspaecher, Stefan AU - Carroll, Linda AU - Engelbrecht, Reginald AU - Graham, Kait AU - Cashion, Nathan AU - Ince, Stefanie AU - Moon, Erin PY - 2021/2/17 TI - Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative JO - JMIR Public Health Surveill SP - e25484 VL - 7 IS - 2 KW - COVID-19 KW - spinal disorders KW - evidence-based care KW - physical distancing care KW - clinical guides KW - low- and middle-income communities KW - telehealth KW - telemedicine KW - evidence-based KW - spine KW - guide KW - management N2 - Background: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient?s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping.These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication. UR - http://publichealth.jmir.org/2021/2/e25484/ UR - http://dx.doi.org/10.2196/25484 UR - http://www.ncbi.nlm.nih.gov/pubmed/33471778 ID - info:doi/10.2196/25484 ER - TY - JOUR AU - Sadik, Neha AU - Salman, Reem PY - 2021/2/17 TI - Defining Telemedicine and Engaging Future Medical Practitioners. Comment on ?Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey? JO - J Med Internet Res SP - e23363 VL - 23 IS - 2 KW - telemedicine KW - coronavirus KW - COVID-19 KW - medical education UR - https://www.jmir.org/2021/2/e23363 UR - http://dx.doi.org/10.2196/23363 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595454 ID - info:doi/10.2196/23363 ER - TY - JOUR AU - Grimes, Lee Hannah AU - Uppal, Ramnik PY - 2021/2/17 TI - Remote Examination and Screening for Domestic Abuse. Comment on ?Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges? JO - J Med Internet Res SP - e23295 VL - 23 IS - 2 KW - spouse abuse KW - domestic abuse KW - apps KW - patient information KW - antenatal care KW - COVID-19 UR - https://www.jmir.org/2021/2/e23295 UR - http://dx.doi.org/10.2196/23295 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595438 ID - info:doi/10.2196/23295 ER - TY - JOUR AU - Kurita, Junko AU - Sugishita, Yoshiyuki AU - Sugawara, Tamie AU - Ohkusa, Yasushi PY - 2021/2/15 TI - Evaluating Apple Inc Mobility Trend Data Related to the COVID-19 Outbreak in Japan: Statistical Analysis JO - JMIR Public Health Surveill SP - e20335 VL - 7 IS - 2 KW - peak KW - COVID-19 KW - effective reproduction number KW - mobility trend data KW - Apple KW - countermeasure N2 - 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. UR - http://publichealth.jmir.org/2021/2/e20335/ UR - http://dx.doi.org/10.2196/20335 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481755 ID - info:doi/10.2196/20335 ER - TY - JOUR AU - Basch, H. Corey AU - Fera, Joseph AU - Pierce, Isabela AU - Basch, E. Charles PY - 2021/2/12 TI - Promoting Mask Use on TikTok: Descriptive, Cross-sectional Study JO - JMIR Public Health Surveill SP - e26392 VL - 7 IS - 2 KW - TikTok KW - COVID-19 KW - social media KW - infodemiology KW - infoveillance KW - mask use KW - prevention KW - promotion KW - communication KW - public health KW - cross-sectional KW - content analysis KW - transmission N2 - 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. UR - http://publichealth.jmir.org/2021/2/e26392/ UR - http://dx.doi.org/10.2196/26392 UR - http://www.ncbi.nlm.nih.gov/pubmed/33523823 ID - info:doi/10.2196/26392 ER - TY - JOUR AU - Yin, Fulian AU - Shao, Xueying AU - Ji, Meiqi AU - Wu, Jianhong PY - 2021/2/12 TI - Quantifying the Influence of Delay in Opinion Transmission of COVID-19 Information Propagation: Modeling Study JO - J Med Internet Res SP - e25734 VL - 23 IS - 2 KW - COVID-19 KW - delay transmission KW - dynamic model KW - Sina Microblog KW - social media KW - communication KW - online health information KW - health information KW - public health KW - opinion KW - strategy KW - model KW - information transmission KW - delay KW - infodemiology KW - infoveillance N2 - 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. UR - http://www.jmir.org/2021/2/e25734/ UR - http://dx.doi.org/10.2196/25734 UR - http://www.ncbi.nlm.nih.gov/pubmed/33529153 ID - info:doi/10.2196/25734 ER - TY - JOUR AU - Mongkhon, Pajaree AU - Ruengorn, Chidchanok AU - Awiphan, Ratanaporn AU - Thavorn, Kednapa AU - Hutton, Brian AU - Wongpakaran, Nahathai AU - Wongpakaran, Tinakon AU - Nochaiwong, Surapon PY - 2021/2/12 TI - Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study JO - J Med Internet Res SP - e25363 VL - 23 IS - 2 KW - coronavirus KW - COVID-19 KW - insomnia KW - mental health KW - social media KW - depression KW - anxiety KW - stress KW - psychosocial problem N2 - 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. UR - http://www.jmir.org/2021/2/e25363/ UR - http://dx.doi.org/10.2196/25363 UR - http://www.ncbi.nlm.nih.gov/pubmed/33523828 ID - info:doi/10.2196/25363 ER - TY - JOUR AU - Wong, Chun Frankie Ho AU - Liu, Tianyin AU - Leung, Yi Dara Kiu AU - Zhang, Y. Anna AU - Au, Hong Walker Siu AU - Kwok, Wai Wai AU - Shum, Y. Angie K. AU - Wong, Yan Gloria Hoi AU - Lum, Yat-Sang Terry PY - 2021/2/11 TI - 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 JO - J Med Internet Res SP - e26570 VL - 23 IS - 2 KW - COVID-19 KW - anxiety KW - social media KW - infodemic KW - Hong Kong N2 - 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. UR - http://www.jmir.org/2021/2/e26570/ UR - http://dx.doi.org/10.2196/26570 UR - http://www.ncbi.nlm.nih.gov/pubmed/33523825 ID - info:doi/10.2196/26570 ER - TY - JOUR AU - Quiroz, Carlos Juan AU - Feng, You-Zhen AU - Cheng, Zhong-Yuan AU - Rezazadegan, Dana AU - Chen, Ping-Kang AU - Lin, Qi-Ting AU - Qian, Long AU - Liu, Xiao-Fang AU - Berkovsky, Shlomo AU - Coiera, Enrico AU - Song, Lei AU - Qiu, Xiaoming AU - Liu, Sidong AU - Cai, Xiang-Ran PY - 2021/2/11 TI - Development and Validation of a Machine Learning Approach for Automated Severity Assessment of COVID-19 Based on Clinical and Imaging Data: Retrospective Study JO - JMIR Med Inform SP - e24572 VL - 9 IS - 2 KW - algorithm KW - clinical data KW - clinical features KW - COVID-19 KW - CT scans KW - development KW - imaging KW - imbalanced data KW - machine learning KW - oversampling KW - severity assessment KW - validation N2 - Background: COVID-19 has overwhelmed health systems worldwide. It is important to identify severe cases as early as possible, such that resources can be mobilized and treatment can be escalated. Objective: This study aims to develop a machine learning approach for automated severity assessment of COVID-19 based on clinical and imaging data. Methods: Clinical data?including demographics, signs, symptoms, comorbidities, and blood test results?and chest computed tomography scans of 346 patients from 2 hospitals in the Hubei Province, China, were used to develop machine learning models for automated severity assessment in diagnosed COVID-19 cases. We compared the predictive power of the clinical and imaging data from multiple machine learning models and further explored the use of four oversampling methods to address the imbalanced classification issue. Features with the highest predictive power were identified using the Shapley Additive Explanations framework. Results: Imaging features had the strongest impact on the model output, while a combination of clinical and imaging features yielded the best performance overall. The identified predictive features were consistent with those reported previously. Although oversampling yielded mixed results, it achieved the best model performance in our study. Logistic regression models differentiating between mild and severe cases achieved the best performance for clinical features (area under the curve [AUC] 0.848; sensitivity 0.455; specificity 0.906), imaging features (AUC 0.926; sensitivity 0.818; specificity 0.901), and a combination of clinical and imaging features (AUC 0.950; sensitivity 0.764; specificity 0.919). The synthetic minority oversampling method further improved the performance of the model using combined features (AUC 0.960; sensitivity 0.845; specificity 0.929). Conclusions: Clinical and imaging features can be used for automated severity assessment of COVID-19 and can potentially help triage patients with COVID-19 and prioritize care delivery to those at a higher risk of severe disease. UR - http://medinform.jmir.org/2021/2/e24572/ UR - http://dx.doi.org/10.2196/24572 UR - http://www.ncbi.nlm.nih.gov/pubmed/33534723 ID - info:doi/10.2196/24572 ER - TY - JOUR AU - Wang, Qian AU - Song, Bo AU - Di, Jiangli AU - Yang, Xue AU - Wu, Anise AU - Lau, Joseph AU - Xin, Meiqi AU - Wang, Linhong AU - Mo, Kit-Han Phoenix PY - 2021/2/11 TI - Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study JO - JMIR Ment Health SP - e24162 VL - 8 IS - 2 KW - pregnant women KW - COVID-19 KW - depression KW - anxiety KW - help-seeking KW - mental health services KW - social support KW - trust KW - intention KW - mental health KW - pregnancy KW - survey N2 - Background: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. Objective: We aimed to identify factors that are associated with pregnant women?s intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. Methods: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ?10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ?5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. Results: More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19?related lockdowns in participants? cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants? intentions to seek help from mental health services. Conclusions: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers. UR - http://mental.jmir.org/2021/2/e24162/ UR - http://dx.doi.org/10.2196/24162 UR - http://www.ncbi.nlm.nih.gov/pubmed/33570500 ID - info:doi/10.2196/24162 ER - TY - JOUR AU - Bolourani, Siavash AU - Brenner, Max AU - Wang, Ping AU - McGinn, Thomas AU - Hirsch, S. Jamie AU - Barnaby, Douglas AU - Zanos, P. Theodoros AU - PY - 2021/2/10 TI - A Machine Learning Prediction Model of Respiratory Failure Within 48 Hours of Patient Admission for COVID-19: Model Development and Validation JO - J Med Internet Res SP - e24246 VL - 23 IS - 2 KW - artificial intelligence KW - prognostic KW - model KW - pandemic KW - severe acute respiratory syndrome coronavirus 2 KW - modeling KW - development KW - validation KW - COVID-19 KW - machine learning N2 - 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. UR - http://www.jmir.org/2021/2/e24246/ UR - http://dx.doi.org/10.2196/24246 UR - http://www.ncbi.nlm.nih.gov/pubmed/33476281 ID - info:doi/10.2196/24246 ER - TY - JOUR AU - Liu, Guihua AU - Wang, Shuo AU - Liao, Jinhua AU - Ou, Ping AU - Huang, Longsheng AU - Xie, Namei AU - He, Yingshuang AU - Lin, Jinling AU - He, Hong-Gu AU - Hu, Rongfang PY - 2021/2/10 TI - The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study JO - JMIR Ment Health SP - e23917 VL - 8 IS - 2 KW - coronavirus disease 2019 KW - autism spectrum disorder KW - parenting training KW - psychological well-being KW - social media KW - WeChat KW - COVID-19 KW - autism KW - parenting KW - mental health KW - well-being KW - anxiety KW - depression KW - stress N2 - Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 UR - https://mental.jmir.org/2021/2/e23917 UR - http://dx.doi.org/10.2196/23917 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481751 ID - info:doi/10.2196/23917 ER - TY - JOUR AU - Albahli, Saleh AU - Yar, Hassan Ghulam Nabi Ahmad PY - 2021/2/10 TI - Fast and Accurate Detection of COVID-19 Along With 14 Other Chest Pathologies Using a Multi-Level Classification: Algorithm Development and Validation Study JO - J Med Internet Res SP - e23693 VL - 23 IS - 2 KW - COVID-19 KW - chest x-ray KW - convolutional neural network KW - data augmentation KW - biomedical imaging KW - automatic detection N2 - 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. UR - http://www.jmir.org/2021/2/e23693/ UR - http://dx.doi.org/10.2196/23693 UR - http://www.ncbi.nlm.nih.gov/pubmed/33529154 ID - info:doi/10.2196/23693 ER - TY - JOUR AU - Ferry, R. Olivia AU - Moloney, C. Emma AU - Spratt, T. Owen AU - Whiting, M. Gerald F. AU - Bennett, J. Cameron PY - 2021/2/10 TI - A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study JO - J Med Internet Res SP - e25518 VL - 23 IS - 2 KW - COVID-19 KW - efficacy KW - hospital KW - innovation KW - model KW - remote care KW - safety KW - telemedicine KW - virtual health care KW - virtual ward N2 - 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. UR - http://www.jmir.org/2021/2/e25518/ UR - http://dx.doi.org/10.2196/25518 UR - http://www.ncbi.nlm.nih.gov/pubmed/33529157 ID - info:doi/10.2196/25518 ER - TY - JOUR AU - Jang, Hyeju AU - Rempel, Emily AU - Roth, David AU - Carenini, Giuseppe AU - Janjua, Zafar Naveed PY - 2021/2/10 TI - Tracking COVID-19 Discourse on Twitter in North America: Infodemiology Study Using Topic Modeling and Aspect-Based Sentiment Analysis JO - J Med Internet Res SP - e25431 VL - 23 IS - 2 KW - COVID-19 KW - Twitter KW - topic modeling KW - aspect-based sentiment analysis KW - racism KW - anti-Asians KW - Canada KW - North America KW - sentiment analysis KW - social media KW - discourse KW - reaction KW - public health N2 - 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. UR - http://www.jmir.org/2021/2/e25431/ UR - http://dx.doi.org/10.2196/25431 UR - http://www.ncbi.nlm.nih.gov/pubmed/33497352 ID - info:doi/10.2196/25431 ER - TY - JOUR AU - Lin, Yu-Hsuan AU - Chen, Chung-Yen AU - Wu, Shiow-Ing PY - 2021/2/10 TI - Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review JO - J Med Internet Res SP - e25118 VL - 23 IS - 2 KW - COVID-19 KW - mental health KW - Newcastle-Ottawa Scale KW - review KW - data collection KW - survey KW - surveillance KW - literature KW - research N2 - Background: The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. Objective: This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. Methods: We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. Results: Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis. Conclusions: The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies. UR - http://www.jmir.org/2021/2/e25118/ UR - http://dx.doi.org/10.2196/25118 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481754 ID - info:doi/10.2196/25118 ER - TY - JOUR AU - de Melo, Tiago AU - Figueiredo, S. Carlos M. PY - 2021/2/10 TI - Comparing News Articles and Tweets About COVID-19 in Brazil: Sentiment Analysis and Topic Modeling Approach JO - JMIR Public Health Surveill SP - e24585 VL - 7 IS - 2 KW - COVID-19 KW - Twitter KW - infodemiology KW - news KW - sentiment analysis KW - social media KW - Brazil KW - monitoring KW - topic modeling KW - entity recognition KW - text analysis N2 - 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. UR - http://publichealth.jmir.org/2021/2/e24585/ UR - http://dx.doi.org/10.2196/24585 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480853 ID - info:doi/10.2196/24585 ER - TY - JOUR AU - Oehmke, B. Theresa AU - Post, A. Lori AU - Moss, B. Charles AU - Issa, Z. Tariq AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, F. James PY - 2021/2/9 TI - Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis JO - J Med Internet Res SP - e26081 VL - 23 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - SARS-CoV-2 surveillance KW - second wave KW - wave two KW - wave 2 KW - global COVID-19 surveillance KW - COVID-19 metropolitan areas KW - COVID-19 cities KW - US public health surveillance KW - US COVID-19 KW - US surveillance metrics KW - dynamic panel data KW - generalized method of the moments KW - US econometrics KW - US SARS-CoV-2 KW - US COVID-19 surveillance system KW - US COVID-19 transmission speed KW - US COVID-19 transmission acceleration KW - COVID-19 transmission deceleration KW - COVID-19 transmission jerk KW - COVID-19 7-day lag KW - Arellano-Bond estimator KW - generalized method of moments KW - GMM KW - New York City KW - Los Angeles KW - Chicago KW - Dallas KW - Houston KW - Washington, DC KW - Miami KW - Philadelphia KW - Atlanta KW - Phoenix KW - Boston KW - San Francisco KW - Riverside KW - Detroit KW - Seattle KW - Minneapolis KW - San Diego KW - Tampa KW - Denver KW - St Louis KW - Baltimore KW - Charlotte KW - Orlando KW - San Antonio KW - Portland N2 - 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. UR - https://www.jmir.org/2021/2/e26081 UR - http://dx.doi.org/10.2196/26081 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481757 ID - info:doi/10.2196/26081 ER - TY - JOUR AU - Saleh, Nagui Sameh AU - Lehmann, U. Christoph AU - Medford, J. Richard PY - 2021/2/9 TI - Early Crowdfunding Response to the COVID-19 Pandemic: Cross-sectional Study JO - J Med Internet Res SP - e25429 VL - 23 IS - 2 KW - crowdfunding KW - fundraising KW - GoFundMe KW - COVID-19 KW - coronavirus KW - pandemic KW - natural disasters KW - disaster relief KW - fundraise KW - disaster KW - cross-sectional KW - crowdfund KW - crowdsource KW - economy KW - social media KW - community KW - distress N2 - Background: As the number of COVID-19 cases increased precipitously in the United States, policy makers and health officials marshalled their pandemic responses. As the economic impacts multiplied, anecdotal reports noted the increased use of web-based crowdfunding to defray these costs. Objective: We examined the web-based crowdfunding response in the early stage of the COVID-19 pandemic in the United States to understand the incidence of initiation of COVID-19?related campaigns and compare them to non?COVID-19?related campaigns. Methods: On May 16, 2020, we extracted all available data available on US campaigns that contained narratives and were created between January 1 and May 10, 2020, on GoFundMe. We identified the subset of COVID-19?related campaigns using keywords relevant to the COVID-19 pandemic. We explored the incidence of COVID-19?related campaigns by geography, by category, and over time, and we compared the characteristics of the campaigns to those of non?COVID-19?related campaigns after March 11, when the pandemic was declared. We then used a natural language processing algorithm to cluster campaigns by narrative content using overlapping keywords. Results: We found that there was a substantial increase in overall GoFundMe web-based crowdfunding campaigns in March, largely attributable to COVID-19?related campaigns. However, as the COVID-19 pandemic persisted and progressed, the number of campaigns per COVID-19 case declined more than tenfold across all states. The states with the earliest disease burden had the fewest campaigns per case, indicating a lack of a case-dependent response. COVID-19?related campaigns raised more money, had a longer narrative description, and were more likely to be shared on Facebook than other campaigns in the study period. Conclusions: Web-based crowdfunding appears to be a stopgap for only a minority of campaigners. The novelty of an emergency likely impacts both campaign initiation and crowdfunding success, as it reflects the affective response of a community. Crowdfunding activity likely serves as an early signal for emerging needs and societal sentiment for communities in acute distress that could be used by governments and aid organizations to guide disaster relief and policy. UR - http://www.jmir.org/2021/2/e25429/ UR - http://dx.doi.org/10.2196/25429 UR - http://www.ncbi.nlm.nih.gov/pubmed/33523826 ID - info:doi/10.2196/25429 ER - TY - JOUR AU - Elkhodr, Mahmoud AU - Mubin, Omar AU - Iftikhar, Zainab AU - Masood, Maleeha AU - Alsinglawi, Belal AU - Shahid, Suleman AU - Alnajjar, Fady PY - 2021/2/9 TI - Technology, Privacy, and User Opinions of COVID-19 Mobile Apps for Contact Tracing: Systematic Search and Content Analysis JO - J Med Internet Res SP - e23467 VL - 23 IS - 2 KW - contact tracing KW - COVID-19 KW - digital contact tracing apps N2 - Background: Many countries across the globe have released their own COVID-19 contact tracing apps. This has resulted in the proliferation of several apps that used a variety of technologies. With the absence of a standardized approach used by the authorities, policy makers, and developers, many of these apps were unique. Therefore, they varied by function and the underlying technology used for contact tracing and infection reporting. Objective: The goal of this study was to analyze most of the COVID-19 contact tracing apps in use today. Beyond investigating the privacy features, design, and implications of these apps, this research examined the underlying technologies used in contact tracing apps. It also attempted to provide some insights into their level of penetration and to gauge their public reception. This research also investigated the data collection, reporting, retention, and destruction procedures used by each of the apps under review. Methods: This research study evaluated 13 apps corresponding to 10 countries based on the underlying technology used. The inclusion criteria ensured that most COVID-19-declared epicenters (ie, countries) were included in the sample, such as Italy. The evaluated apps also included countries that did relatively well in controlling the outbreak of COVID-19, such as Singapore. Informational and unofficial contact tracing apps were excluded from this study. A total of 30,000 reviews corresponding to the 13 apps were scraped from app store webpages and analyzed. Results: This study identified seven distinct technologies used by COVID-19 tracing apps and 13 distinct apps. The United States was reported to have released the most contact tracing apps, followed by Italy. Bluetooth was the most frequently used underlying technology, employed by seven apps, whereas three apps used GPS. The Norwegian, Singaporean, Georgian, and New Zealand apps were among those that collected the most personal information from users, whereas some apps, such as the Swiss app and the Italian (Immuni) app, did not collect any user information. The observed minimum amount of time implemented for most of the apps with regard to data destruction was 14 days, while the Georgian app retained records for 3 years. No significant battery drainage issue was reported for most of the apps. Interestingly, only about 2% of the reviewers expressed concerns about their privacy across all apps. The number and frequency of technical issues reported on the Apple App Store were significantly more than those reported on Google Play; the highest was with the New Zealand app, with 27% of the reviewers reporting technical difficulties (ie, 10% out of 27% scraped reviews reported that the app did not work). The Norwegian, Swiss, and US (PathCheck) apps had the least reported technical issues, sitting at just below 10%. In terms of usability, many apps, such as those from Singapore, Australia, and Switzerland, did not provide the users with an option to sign out from their apps. Conclusions: This article highlighted the fact that COVID-19 contact tracing apps are still facing many obstacles toward their widespread and public acceptance. The main challenges are related to the technical, usability, and privacy issues or to the requirements reported by some users. UR - http://www.jmir.org/2021/2/e23467/ UR - http://dx.doi.org/10.2196/23467 UR - http://www.ncbi.nlm.nih.gov/pubmed/33493125 ID - info:doi/10.2196/23467 ER - TY - JOUR AU - Bernardo, Theresa AU - Sobkowich, Edward Kurtis AU - Forrest, Othmer Russell AU - Stewart, Silva Luke AU - D'Agostino, Marcelo AU - Perez Gutierrez, Enrique AU - Gillis, Daniel PY - 2021/2/9 TI - Collaborating in the Time of COVID-19: The Scope and Scale of Innovative Responses to a Global Pandemic JO - JMIR Public Health Surveill SP - e25935 VL - 7 IS - 2 KW - crowdsourcing KW - artificial intelligence KW - collaboration KW - personal protective equipment KW - big data KW - AI KW - COVID-19 KW - innovation KW - information sharing KW - communication KW - teamwork KW - knowledge KW - dissemination UR - http://publichealth.jmir.org/2021/2/e25935/ UR - http://dx.doi.org/10.2196/25935 UR - http://www.ncbi.nlm.nih.gov/pubmed/33503001 ID - info:doi/10.2196/25935 ER - TY - JOUR AU - Hull, D. Thomas AU - Levine, Jacob AU - Bantilan, Niels AU - Desai, N. Angel AU - Majumder, S. Maimuna PY - 2021/2/9 TI - Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages JO - JMIR Form Res SP - e26190 VL - 5 IS - 2 KW - digital phenotyping KW - COVID-19 KW - telehealth KW - digital mental health KW - natural language processing KW - machine learning KW - mental health KW - phenotyping KW - burden KW - treatment KW - symptom N2 - 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. UR - http://formative.jmir.org/2021/2/e26190/ UR - http://dx.doi.org/10.2196/26190 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502999 ID - info:doi/10.2196/26190 ER - TY - JOUR AU - Mayer, Angel Miguel AU - Vidal-Alaball, Josep AU - Puigdellívol-Sánchez, Anna AU - Marín Gomez, X. Francesc AU - Leis, Angela AU - Mendioroz Peña, Jacobo PY - 2021/2/8 TI - Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study JO - JMIR Public Health Surveill SP - e25452 VL - 7 IS - 2 KW - COVID-19 KW - risk factors KW - primary health care KW - angiotensin-converting enzyme inhibitors KW - angiotensin II type 2 receptor blockers KW - risk KW - characteristic KW - retrospective KW - observational KW - Spain KW - mortality N2 - 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. UR - http://publichealth.jmir.org/2021/2/e25452/ UR - http://dx.doi.org/10.2196/25452 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496668 ID - info:doi/10.2196/25452 ER - TY - JOUR AU - Xiu, Xiaolei AU - Wang, Anran AU - Qian, Qing AU - Wu, Sizhu PY - 2021/2/8 TI - The US Public?s Perception of the Threat of COVID-19 During the Rapid Spread of the COVID-19 Outbreak: Cross-Sectional Survey Study JO - J Med Internet Res SP - e23400 VL - 23 IS - 2 KW - COVID-19 KW - perceived threat of disease KW - environment KW - behavior KW - America N2 - Background: The rapid spread of the COVID-19 pandemic in the United States has made people uncertain about their perceptions of the threat of COVID-19 and COVID-19 response measures. To mount an effective response to this epidemic, it is necessary to understand the public's perceptions, behaviors, and attitudes. Objective: We aimed to test the hypothesis that people?s perceptions of the threat of COVID-19 influence their attitudes and behaviors. Methods: This study used an open dataset of web-based questionnaires about COVID-19. The questionnaires were provided by Nexoid United Kingdom. We selected the results of a questionnaire on COVID-19?related behaviors, attitudes, and perceptions among the US public. The questionnaire was conducted from March 29 to April 20, 2020. A total of 24,547 people who lived in the United States took part in the survey. Results: In this study, the average self-assessed probability of contracting COVID-19 was 33.2%, and 49.9% (12,244/24,547) of the respondents thought that their chances of contracting COVID-19 were less than 30%. The self-assessed probability of contracting COVID-19 among women was 1.35 times that of males. A 5% increase in perceived infection risk was significantly associated with being 1.02 times (OR 1.02, 95% CI 1.02-1.02; P<.001) more likely to report having close contact with >10 people, and being 1.01 times (OR 1.01, 95% CI 1.01-1.01; P<.001) more likely to report that cohabitants disagreed with taking steps to reduce the risk of contracting COVID-19. However, there was no significant association between participants who lived with more than 5 cohabitants or less than 5 cohabitants (P=.85). Generally, participants who lived in states with 1001-10,000 COVID-19 cases, were aged 20-40 years, were obese, smoked, drank alcohol, never used drugs, and had no underlying medical conditions were more likely to be in close contact with >10 people. Most participants (21,017/24,547, 85.6%) agreed with washing their hands and maintaining social distancing, but only 20.2% (4958/24,547) of participants often wore masks. Additionally, male participants and participants aged <20 years typically disagreed with washing their hands, maintaining social distancing, and wearing masks. Conclusions: This survey is the first attempt to describe the determinants of the US public?s perception of the threat of COVID-19 on a large scale. The self-assessed probability of contracting COVID-19 differed significantly based on the respondents? genders, states of residence, ages, body mass indices, smoking habits, alcohol consumption habits, drug use habits, underlying medical conditions, environments, and behaviors. These findings can be used as references by public health policy makers and health care workers who want to identify populations that need to be educated on COVID-19 prevention and health. UR - http://www.jmir.org/2021/2/e23400/ UR - http://dx.doi.org/10.2196/23400 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481753 ID - info:doi/10.2196/23400 ER - TY - JOUR AU - Chen, Qiang AU - Min, Chen AU - Zhang, Wei AU - Ma, Xiaoyue AU - Evans, Richard PY - 2021/2/4 TI - Factors Driving Citizen Engagement With Government TikTok Accounts During the COVID-19 Pandemic: Model Development and Analysis JO - J Med Internet Res SP - e21463 VL - 23 IS - 2 KW - government social media KW - citizen engagement KW - public health crisis KW - TikTok KW - emotion valence KW - dialogic loop KW - COVID-19 N2 - Background: During the COVID-19 pandemic, growth in citizen engagement with social media platforms has enabled public health departments to accelerate and improve health information dissemination, developing transparency and trust between governments and citizens. In light of these benefits, it is imperative to learn the antecedents and underlying mechanisms for this to maintain and enhance engagement. Objective: The aim of this study is to determine the factors and influencing mechanisms related to citizen engagement with the TikTok account of the National Health Commission of China during the COVID-19 pandemic. Methods: Using a web crawler, 355 short videos were collected from the Healthy China account on TikTok (with more than 3 million followers throughout China), covering the period from January 21, 2020, to April 25, 2020. The title and video length, as well as the number of likes, shares, and comments were collected for each video. After classifying them using content analysis, a series of negative binomial regression analyses were completed. Results: Among the 355 videos, 154 (43.4%) related to guidance for clinicians, patients, and ordinary citizens, followed by information concerning the government?s handling of the pandemic (n=100, 28.2%), the latest news about COVID-19 (n=61, 17.2%), and appreciation toward frontline emergency services (n=40, 11.3%). Video length, titles, dialogic loop, and content type all influenced the level of citizen engagement. Specifically, video length was negatively associated with the number of likes (incidence rate ratio [IRR]=0.19, P<.001) and comments (IRR=0.39, P<.001). Title length was positively related to the number of shares (IRR=24.25, P=.01), likes (IRR=8.50, P=.03), and comments (IRR=7.85, P=.02). Dialogic loop negatively predicted the number of shares (IRR=0.56, P=.03). In comparison to appreciative information, information about the government?s handling of the situation (IRR=5.16, P<.001) and guidelines information (IRR=7.31, P<.001) were positively correlated with the number of shares, while the latest news was negatively related to the number of likes received (IRR=0.46, P=.004). More importantly, the relationship between predictors and citizen engagement was moderated by the emotional valence of video titles. Longer videos with positive titles received a higher number of likes (IRR=21.72, P=.04) and comments (IRR=10.14, P=.047). Furthermore, for short videos related to government handling of the pandemic (IRR=14.48, P=.04) and guidance for stakeholders (IRR=7.59, P=.04), positive titles received a greater number of shares. Videos related to the latest news (IRR=66.69, P=.04) received more likes if the video title displayed higher levels of positive emotion. Conclusions: During the COVID-19 pandemic, videos were frequently published on government social media platforms. Video length, title, dialogic loop, and content type significantly influenced the level of citizen engagement. These relationships were moderated by the emotional valence of the video?s title. Our findings have implications for maintaining and enhancing citizen engagement via government social media. UR - http://www.jmir.org/2021/2/e21463/ UR - http://dx.doi.org/10.2196/21463 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481756 ID - info:doi/10.2196/21463 ER - TY - JOUR AU - Bacsu, Juanita-Dawne AU - O'Connell, E. Megan AU - Cammer, Allison AU - Azizi, Mahsa AU - Grewal, Karl AU - Poole, Lisa AU - Green, Shoshana AU - Sivananthan, Saskia AU - Spiteri, J. Raymond PY - 2021/2/3 TI - Using Twitter to Understand the COVID-19 Experiences of People With Dementia: Infodemiology Study JO - J Med Internet Res SP - e26254 VL - 23 IS - 2 KW - Twitter KW - social media KW - dementia KW - COVID-19 KW - health policy KW - experience KW - support KW - disorder KW - theme KW - collaborate KW - quality of life N2 - Background: The COVID-19 pandemic is affecting people with dementia in numerous ways. Nevertheless, there is a paucity of research on the COVID-19 impact on people with dementia and their care partners. Objective: Using Twitter, the purpose of this study is to understand the experiences of COVID-19 for people with dementia and their care partners. Methods: We collected tweets on COVID-19 and dementia using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: From the 5063 tweets analyzed with line-by-line coding, we identified 4 main themes including (1) separation and loss; (2) COVID-19 confusion, despair, and abandonment; (3) stress and exhaustion exacerbation; and (4) unpaid sacrifices by formal care providers. Conclusions: There is an imminent need for governments to rethink using a one-size-fits-all response to COVID-19 policy and use a collaborative approach to support people with dementia. Collaboration and more evidence-informed research are essential to reducing COVID-19 mortality and improving the quality of life for people with dementia and their care partners. UR - https://www.jmir.org/2021/2/e26254 UR - http://dx.doi.org/10.2196/26254 UR - http://www.ncbi.nlm.nih.gov/pubmed/33468449 ID - info:doi/10.2196/26254 ER - TY - JOUR AU - Post, Ann Lori AU - Benishay, T. Elana AU - Moss, B. Charles AU - Murphy, Leo Robert AU - Achenbach, J. Chad AU - Ison, G. Michael AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - White, Janine AU - Chaudhury, S. Azraa AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, Francis James PY - 2021/2/3 TI - Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis JO - J Med Internet Res SP - e25799 VL - 23 IS - 2 KW - SARS-CoV-2 surveillance KW - second wave KW - wave two KW - global COVID-19 surveillance KW - Central Asia public health surveillance KW - Central Asia COVID-19 KW - Central Asia surveillance metrics KW - dynamic panel data KW - generalized method of moments KW - Central Asia econometrics KW - Central Asia SARS-CoV-2 KW - Central Asia COVID-19 surveillance system KW - Central Asia COVID-19 transmission speed KW - Central Asia COVID transmission acceleration KW - COVID-19 transmission deceleration KW - COVID-19 transmission jerk KW - COVID-19 7-day lag KW - SARS-CoV-2 KW - Arellano-Bond estimator, generalized method of moments KW - GMM KW - Armenia KW - Azerbaijan KW - Cyprus KW - Faeroe Islands KW - Georgia KW - Gibraltar KW - Kazakhstan KW - Kosovo KW - Kyrgyzstan KW - Macedonia KW - Russia KW - Tajikistan Turkey KW - Turkmenistan KW - Uzbekistan KW - COVID-19 KW - surveillance KW - longitudinal KW - trend KW - trend analysis KW - monitoring KW - public health KW - infectious disease KW - transmission KW - risk KW - management KW - policy KW - prevention N2 - 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. UR - https://www.jmir.org/2021/2/e25799 UR - http://dx.doi.org/10.2196/25799 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475513 ID - info:doi/10.2196/25799 ER - TY - JOUR AU - McCarthy, Hannah AU - Potts, W. Henry W. AU - Fisher, Abigail PY - 2021/2/3 TI - Physical Activity Behavior Before, During, and After COVID-19 Restrictions: Longitudinal Smartphone-Tracking Study of Adults in the United Kingdom JO - J Med Internet Res SP - e23701 VL - 23 IS - 2 KW - physical activity KW - mobile apps KW - apps KW - fitness trackers KW - mHealth KW - COVID-19 KW - behavior KW - tracking KW - smartphone KW - pattern N2 - Background: The COVID-19 pandemic led to the implementation of worldwide restrictive measures to reduce social contact and viral spread. These measures have been reported to have a negative effect on physical activity (PA). Studies of PA during the pandemic have primarily used self-reported data. The single academic study that used tracked data did not report on demographics. Objective: This study aimed to explore patterns of smartphone-tracked activity before, during, and immediately after lockdown in the United Kingdom, and examine differences by sociodemographic characteristics and prior levels of PA. Methods: Tracked longitudinal weekly minutes of PA were captured using the BetterPoints smartphone app between January and June 2020. Data were plotted by week, demographics, and activity levels at baseline. Nonparametric tests of difference were used to assess mean and median weekly minutes of activity at significant points before and during the lockdown, and as the lockdown was eased. Changes over time by demographics (age, gender, Index of Multiple Deprivation, baseline activity levels) were examined using generalized estimating equations (GEEs). Results: There were 5395 users with a mean age of 41 years (SD 12) and 61% (n=3274) were female. At baseline, 26% (n=1422) of users were inactive, 23% (n=1240) were fairly active, and 51% (n=2733) were active. There was a relatively even spread across deprivation deciles (31% [n=1693] in the least deprived deciles and 23% in the most [n=1261]). We found significant changes in PA from the week before the first case of COVID-19 was announced (baseline) to the week that social distancing restrictions were relaxed (Friedman test: ?22=2331, P<.001). By the first full week of lockdown, the median change in PA was 57 minutes less than baseline. This represents a 37% reduction in weekly minutes of PA. Overall, 63% of people decreased their level of activity between baseline and the first week of COVID-19 restrictions. Younger people showed more PA before lockdown but the least PA after lockdown. In contrast, those aged >65 years appeared to remain more active throughout and increased their activity levels as soon as lockdown was eased. Levels of PA among those classed as active at baseline showed a larger drop compared with those considered to be fairly active or inactive. Socioeconomic group and gender did not appear to be associated with changes in PA. Conclusions: Our tracked PA data suggests a significant drop in PA during the United Kingdom?s COVID-19 lockdown. Significant differences by age group and prior PA levels suggests that the government?s response to COVID-19 needs to be sensitive to these individual differences and the government should react accordingly. Specifically, it should consider the impact on younger age groups, encourage everyone to increase their PA, and not assume that people will recover prior levels of PA on their own. UR - https://www.jmir.org/2021/2/e23701 UR - http://dx.doi.org/10.2196/23701 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347421 ID - info:doi/10.2196/23701 ER - TY - JOUR AU - Faro, M. Jamie AU - Mattocks, M. Kristin AU - Nagawa, S. Catherine AU - Lemon, C. Stephenie AU - Wang, Bo AU - Cutrona, L. Sarah AU - Sadasivam, S. Rajani PY - 2021/2/3 TI - Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Cancer SP - e25317 VL - 7 IS - 1 KW - cancer KW - COVID-19 KW - digital KW - physical activity KW - support KW - technology N2 - Background: COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as ?survivors?) are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures. Objective: We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors? physical activity and social health during and after COVID-19, along with the role of digital health in such strategies. Methods: A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men?s Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre?COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores ?3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes. Results: Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6%]), 67.2% (n=41) reported decreased physical activity and 67.2% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6% (n=15) and 26.2% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits). Conclusions: Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic. UR - http://cancer.jmir.org/2021/1/e25317/ UR - http://dx.doi.org/10.2196/25317 UR - http://www.ncbi.nlm.nih.gov/pubmed/33471776 ID - info:doi/10.2196/25317 ER - TY - JOUR AU - Geronikolou, Styliani AU - Chrousos, George PY - 2021/2/3 TI - COVID-19?Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results JO - JMIR Form Res SP - e21156 VL - 5 IS - 2 KW - COVID-19 KW - social media KW - misinformation KW - infodemics KW - infodemiology KW - infoveillance KW - fear KW - meta-analysis N2 - 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. UR - https://formative.jmir.org/2021/2/e21156 UR - http://dx.doi.org/10.2196/21156 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400681 ID - info:doi/10.2196/21156 ER - TY - JOUR AU - Jalilian Khave, Laya AU - Vahidi, Mohammad AU - Shirini, Dorsa AU - Sanadgol, Ghazal AU - Ashrafi, Farzad AU - Arab-Ahmadi, Mehran AU - Fatemi, Alireza AU - Shabani Barzegar, Minoosh AU - Hassanzadeh, Taha AU - Rezaei, Behandokht AU - Zali, Alireza AU - Ommi, Davood AU - Nohesara, Shabnam AU - Jalili Khoshnood, Reza AU - Abdi, Saeed AU - Pirsalehi, Ali AU - Masarat, Ehsan AU - Shokoohi, Mostafa AU - Karamouzian, Mohammad PY - 2021/2/2 TI - Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study) JO - JMIR Res Protoc SP - e23316 VL - 10 IS - 2 KW - cohort studies KW - COVID-19 KW - health care delivery KW - Iran KW - medical education KW - telemedicine N2 - 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 UR - https://www.researchprotocols.org/2021/2/e23316 UR - http://dx.doi.org/10.2196/23316 UR - http://www.ncbi.nlm.nih.gov/pubmed/33471777 ID - info:doi/10.2196/23316 ER - TY - JOUR AU - Post, Ann Lori AU - Lin, S. Jasmine AU - Moss, B. Charles AU - Murphy, Leo Robert AU - Ison, G. Michael AU - Achenbach, J. Chad AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - White, Janine AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, Francis James PY - 2021/2/1 TI - SARS-CoV-2 Wave Two Surveillance in East Asia and the Pacific: Longitudinal Trend Analysis JO - J Med Internet Res SP - e25454 VL - 23 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - SARS-CoV-2 surveillance KW - second wave KW - wave two KW - wave 2 KW - global COVID-19 surveillance KW - Asia Pacific public health surveillance KW - Asia Pacific COVID-19 KW - Asian Pacific SARS-CoV-2 KW - Asia Pacific surveillance metrics KW - dynamic panel data KW - generalized method of the moments KW - Asian Pacific econometrics KW - East Asian Pacific COVID-19 surveillance system KW - Pacific Asian COVID-19 transmission speed KW - Asian Pacific COVID-19 transmission acceleration KW - COVID-19 transmission deceleration KW - COVID-19 transmission jerk KW - COVID-19 7-day lag KW - Arellano-Bond estimator KW - generalized method of moments KW - GMM KW - Australia KW - Brunei KW - Cambodia KW - China KW - Fiji KW - French Polynesia KW - Guam KW - Indonesia KW - Japan KW - Kiribati KW - Laos KW - Malaysia KW - Mongolia KW - Myanmar KW - New Caledonia KW - Philippines N2 - 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. UR - https://www.jmir.org/2021/2/e25454 UR - http://dx.doi.org/10.2196/25454 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464207 ID - info:doi/10.2196/25454 ER - TY - JOUR AU - Reeves, Jeffery J. AU - Ayers, W. John AU - Longhurst, A. Christopher PY - 2021/2/1 TI - Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm JO - J Med Internet Res SP - e24785 VL - 23 IS - 2 KW - telehealth KW - patient safety KW - COVID-19 KW - coronavirus KW - informatics KW - safety KW - harm KW - risk KW - access KW - efficiency KW - virtual care UR - https://www.jmir.org/2021/2/e24785 UR - http://dx.doi.org/10.2196/24785 UR - http://www.ncbi.nlm.nih.gov/pubmed/33477104 ID - info:doi/10.2196/24785 ER - TY - JOUR AU - Phiri, Peter AU - Delanerolle, Gayathri AU - Al-Sudani, Ayaat AU - Rathod, Shanaya PY - 2021/2/1 TI - COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause JO - JMIR Public Health Surveill SP - e22581 VL - 7 IS - 2 KW - BAME KW - COVID-19 KW - ethnicity KW - health care professionals KW - health care worker KW - impact KW - inequalities KW - minority KW - risk UR - https://publichealth.jmir.org/2021/2/e22581 UR - http://dx.doi.org/10.2196/22581 UR - http://www.ncbi.nlm.nih.gov/pubmed/33481752 ID - info:doi/10.2196/22581 ER - TY - JOUR AU - Wu, Xiaoyan AU - Tao, Shuman AU - Zhang, Yi AU - Li, Shiyue AU - Ma, Le AU - Yu, Yizhen AU - Sun, Guilong AU - Li, Tingting AU - Tao, Fangbiao PY - 2021/1/29 TI - Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study JO - J Med Internet Res SP - e23126 VL - 23 IS - 1 KW - COVID-19 pandemic KW - college students KW - mental health problems KW - geographic location N2 - 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. UR - http://www.jmir.org/2021/1/e23126/ UR - http://dx.doi.org/10.2196/23126 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439853 ID - info:doi/10.2196/23126 ER - TY - JOUR AU - Bapaye, Amol Jay AU - Bapaye, Amol Harsh PY - 2021/1/30 TI - Demographic Factors Influencing the Impact of Coronavirus-Related Misinformation on WhatsApp: Cross-sectional Questionnaire Study JO - JMIR Public Health Surveill SP - e19858 VL - 7 IS - 1 KW - coronavirus KW - COVID-19 KW - SARS?CoV?2 KW - WhatsApp KW - social media KW - misinformation KW - infodemiology KW - infodemic KW - pandemic KW - medical informatics N2 - Background: The risks of misinformation on social networking sites is a global issue, especially in light of the COVID-19 infodemic. WhatsApp is being used as an important source of COVID-19?related information during the current pandemic. Unlike Facebook and Twitter, limited studies have investigated the role of WhatsApp as a source of communication, information, or misinformation during crisis situations. Objective: Our study aimed to evaluate the vulnerability of demographic cohorts in a developing country toward COVID-19?related misinformation shared via WhatsApp. We also aimed to identify characteristics of WhatsApp messages associated with increased credibility of misinformation. Methods: We conducted a web-based questionnaire survey and designed a scoring system based on theories supported by the existing literature. Vulnerability (K) was measured as a ratio of the respondent?s score to the maximum score. Respondents were stratified according to age and occupation, and Kmean was calculated and compared among each subgroup using single-factor analysis of variance and Hochberg GT2 tests. The questionnaire evaluated the respondents? opinion of the veracity of coronavirus-related WhatsApp messages. The responses to the false-proven messages were compared using z test between the 2 groups: coronavirus-related WhatsApp messages with an attached link and/or source and those without. Results: We analyzed 1137 responses from WhatsApp users in India. Users aged over 65 years had the highest vulnerability (Kmean=0.38, 95% CI 0.341-0.419) to misinformation. Respondents in the age group 19-25 years had significantly lower vulnerability (Kmean=0.31, 95% CI 0.301-0.319) than those aged over 25 years (P<.05). The vulnerability of users employed in elementary occupations was the highest (Kmean=0.38, 95% CI 0.356-0.404), and it was significantly higher than that of professionals and students (P<.05). Interestingly, the vulnerability of healthcare workers was not significantly different from that of other occupation groups (P>.05). We found that false CRWMs with an attached link and/or source were marked true 6 times more often than false CRWMs without an attached link or source (P<.001). Conclusions: Our study demonstrates that in a developing country, WhatsApp users aged over 65 years and those involved in elementary occupations were found to be the most vulnerable to false information disseminated via WhatsApp. Health care workers, who are otherwise considered as experts with regard to this global health care crisis, also shared this vulnerability to misinformation with other occupation groups. Our findings also indicated that the presence of an attached link and/or source falsely validating an incorrect message adds significant false credibility, making it appear true. These results indicate an emergent need to address and rectify the current usage patterns of WhatsApp users. This study also provides metrics that can be used by health care organizations and government authorities of developing countries to formulate guidelines to contain the spread of WhatsApp-related misinformation. UR - http://publichealth.jmir.org/2021/1/e19858/ UR - http://dx.doi.org/10.2196/19858 UR - http://www.ncbi.nlm.nih.gov/pubmed/33444152 ID - info:doi/10.2196/19858 ER - TY - JOUR AU - Lin, Sheng-Hsuan AU - Fu, Shih-Chen AU - Kao, Michael Chu-Lan PY - 2021/1/27 TI - Using the Novel Mortality-Prevalence Ratio to Evaluate Potentially Undocumented SARS-CoV-2 Infection: Correlational Study JO - JMIR Public Health Surveill SP - e23034 VL - 7 IS - 1 KW - COVID-19 KW - prevalence KW - mortality KW - undocumented infection KW - mortality-prevalence ratio KW - China N2 - 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 (?=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. UR - http://publichealth.jmir.org/2021/1/e23034/ UR - http://dx.doi.org/10.2196/23034 UR - http://www.ncbi.nlm.nih.gov/pubmed/33332282 ID - info:doi/10.2196/23034 ER - TY - JOUR AU - Burger, C. Zoe AU - Mehta, N. Shivani AU - Ortiz, Dayanna AU - Sor, Sekboppa AU - Kothari, Jigna AU - Lam, Yvonne AU - Meka, Meena AU - Meka, Ajay AU - Rodwell, Timothy PY - 2021/1/27 TI - Assessing COVID-19?Related Knowledge, Attitudes, and Practices Among Hispanic Primary Care Patients: Protocol for a Cross-sectional Survey Study JO - JMIR Res Protoc SP - e25265 VL - 10 IS - 1 KW - COVID-19 KW - knowledge KW - attitude KW - practices KW - Hispanic KW - California KW - protocol KW - cross-sectional KW - survey N2 - 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 UR - http://www.researchprotocols.org/2021/1/e25265/ UR - http://dx.doi.org/10.2196/25265 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406051 ID - info:doi/10.2196/25265 ER - TY - JOUR AU - James, M. Hannah AU - Papoutsi, Chrysanthi AU - Wherton, Joseph AU - Greenhalgh, Trisha AU - Shaw, E. Sara PY - 2021/1/26 TI - Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework JO - J Med Internet Res SP - e23775 VL - 23 IS - 1 KW - delivery of health care KW - remote consultation KW - telemedicine KW - videoconferencing KW - spread and scale-up KW - sustainability KW - mobile phone KW - COVID-19 KW - remote care KW - consultation KW - review N2 - Background: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use. UR - http://www.jmir.org/2021/1/e23775/ UR - http://dx.doi.org/10.2196/23775 UR - http://www.ncbi.nlm.nih.gov/pubmed/33434141 ID - info:doi/10.2196/23775 ER - TY - JOUR AU - Kamyari, Naser AU - Soltanian, Reza Ali AU - Mahjub, Hossein AU - Moghimbeigi, Abbas PY - 2021/1/26 TI - Diet, Nutrition, Obesity, and Their Implications for COVID-19 Mortality: Development of a Marginalized Two-Part Model for Semicontinuous Data JO - JMIR Public Health Surveill SP - e22717 VL - 7 IS - 1 KW - COVID-19 KW - diet KW - nutrition KW - obesity KW - marginalized two-part model KW - semicontinuous data N2 - 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. UR - http://publichealth.jmir.org/2021/1/e22717/ UR - http://dx.doi.org/10.2196/22717 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439850 ID - info:doi/10.2196/22717 ER - TY - JOUR AU - To, G. Quyen AU - Duncan, J. Mitch AU - Van Itallie, Anetta AU - Vandelanotte, Corneel PY - 2021/1/25 TI - Impact of COVID-19 on Physical Activity Among 10,000 Steps Members and Engagement With the Program in Australia: Prospective Study JO - J Med Internet Res SP - e23946 VL - 23 IS - 1 KW - exercise KW - pandemic KW - lockdown KW - eHealth KW - physical activity KW - COVID-19 KW - engagement KW - behavior N2 - Background: Physical activity is an important health behavior, due to its association with many physical and mental health conditions. During distressing events, such as the COVID-19 pandemic, there is a concern that physical activity levels may be negatively impacted. However, recent studies have shown inconsistent results. Additionally, there is a lack of studies in Australia on this topic. Objective: The aim of this study is to investigate changes in physical activity reported through the 10,000 Steps program and changes in engagement with the program during the COVID-19 pandemic. Methods: Data between January 1, 2018, and June 30, 2020, from registered members of the 10,000 Steps program, which included 3,548,825 days with step data, were used. The number of daily steps were logged manually by the members or synced automatically from their activity trackers connected to the program. Measures on program usage were the number of new registered members per day, the number of newly registered organizations per day, the number of steps logged per day, and the number of step entries per day. Key dates used for comparison were as follows: the first case with symptoms in Wuhan, China; the first case reported in Australia; the implementation of a 14-day ban for noncitizens arriving in Australia from China; the start of the lockdown in Australia; and the relaxing of restrictions by the Australian Government. Wilcoxon signed-rank tests were used to test for significant differences in number of steps between subgroups, between engagement measures in 2019 versus 2020, and before and after an event. Results: A decrease in steps was observed after the first case in Australia was reported (1.5%; P=.02) and after the start of the lockdown (3.4%; P<.001). At the time that the relaxing of restrictions started, the steps had already recovered from the lockdown. Additionally, the trends were consistent across genders and age groups. New South Wales, Australian Capital Territory, and Victoria had the greatest step reductions, with decreases of 7.0% (P<.001), 6.2% (P=.02), and 4.7% (P<.001), respectively. During the lockdown, the use of the program increased steeply. On the peak day, there were more than 9000 step entries per day, with nearly 100 million steps logged per day; in addition, more than 450 new users and more than 15 new organizations registered per day, although the numbers decreased quickly when restrictions were relaxed. On average per day, there were about 55 new registered users (P<.001), 2 new organizations (P<.001), 25.6 million steps (P<.001), and 2672 log entries (P<.001) more in 2020 compared to the same period in 2019. Conclusions: The pandemic has had negative effects on steps among Australians across age groups and genders. However, the effect was relatively small, with steps recovering quickly after the lockdown. There was a large increase in program usage during the pandemic, which might help minimize the health impact of the lockdown and confirms the important role of physical activity programs during times of distress and lockdowns. UR - http://www.jmir.org/2021/1/e23946/ UR - http://dx.doi.org/10.2196/23946 UR - http://www.ncbi.nlm.nih.gov/pubmed/33449907 ID - info:doi/10.2196/23946 ER - TY - JOUR AU - Erinoso, Olufemi AU - Wright, Ololade Kikelomo AU - Anya, Samuel AU - Kuyinu, Yetunde AU - Abdur-Razzaq, Hussein AU - Adewuya, Abiodun PY - 2021/1/25 TI - Predictors of COVID-19 Information Sources and Their Perceived Accuracy in Nigeria: Online Cross-sectional Study JO - JMIR Public Health Surveill SP - e22273 VL - 7 IS - 1 KW - COVID-19 KW - communication KW - health information KW - public health KW - infodemiology KW - infodemic KW - accuracy KW - cross-sectional KW - risk KW - information source KW - predictor KW - Nigeria N2 - Background: Effective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic. Objective: This study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources. Methods: We conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee. Results: A total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19?related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization. Conclusions: The internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic. UR - http://publichealth.jmir.org/2021/1/e22273/ UR - http://dx.doi.org/10.2196/22273 UR - http://www.ncbi.nlm.nih.gov/pubmed/33428580 ID - info:doi/10.2196/22273 ER - TY - JOUR AU - He, Zonglin AU - Chin, Yiqiao AU - Yu, Shinning AU - Huang, Jian AU - Zhang, P. Casper J. AU - Zhu, Ke AU - Azarakhsh, Nima AU - Sheng, Jie AU - He, Yi AU - Jayavanth, Pallavi AU - Liu, Qian AU - Akinwunmi, O. Babatunde AU - Ming, Wai-Kit PY - 2021/1/25 TI - The Influence of Average Temperature and Relative Humidity on New Cases of COVID-19: Time-Series Analysis JO - JMIR Public Health Surveill SP - e20495 VL - 7 IS - 1 KW - COVID-19 KW - coronavirus KW - meteorological factors KW - temperature KW - humidity KW - weather KW - transmission KW - virus KW - Asia KW - time-series KW - analysis KW - public health N2 - 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. UR - https://publichealth.jmir.org/2021/1/e20495 UR - http://dx.doi.org/10.2196/20495 UR - http://www.ncbi.nlm.nih.gov/pubmed/33232262 ID - info:doi/10.2196/20495 ER - TY - JOUR AU - Shaikhain, Ahmad Talal AU - Al-Husayni, Abdulmohsen Faisal AU - Alhejaili, Awadh Essam AU - Al-Harbi, Nawaf Maha AU - Bogari, Abdullah Anas AU - Baghlaf, Abdulaziz Bayan AU - Alzahrani, Saeed Mohammed PY - 2021/1/25 TI - COVID-19?Related Knowledge and Practices Among Health Care Workers in Saudi Arabia: Cross-sectional Questionnaire Study JO - JMIR Form Res SP - e21220 VL - 5 IS - 1 KW - COVID-19 KW - health care workers KW - infection control KW - attitude KW - knowledge KW - Saudi Arabia N2 - 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. UR - http://formative.jmir.org/2021/1/e21220/ UR - http://dx.doi.org/10.2196/21220 UR - http://www.ncbi.nlm.nih.gov/pubmed/33460390 ID - info:doi/10.2196/21220 ER - TY - JOUR AU - Singh, Aniruddha AU - Mountjoy, Natalie AU - McElroy, Doug AU - Mittal, Shilpi AU - Al Hemyari, Bashar AU - Coffey, Nicholas AU - Miller, Kristen AU - Gaines, Kenneth PY - 2021/1/22 TI - Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study JO - JMIR Cardio SP - e25074 VL - 5 IS - 1 KW - COVID-19 KW - telehealth KW - cardiology KW - internet KW - broadband KW - patient satisfaction KW - restriction KW - survey N2 - Background: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results: A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits. UR - http://cardio.jmir.org/2021/1/e25074/ UR - http://dx.doi.org/10.2196/25074 UR - http://www.ncbi.nlm.nih.gov/pubmed/33385234 ID - info:doi/10.2196/25074 ER - TY - JOUR AU - Garnier, Romain AU - Benetka, R. Jan AU - Kraemer, John AU - Bansal, Shweta PY - 2021/1/22 TI - Socioeconomic Disparities in Social Distancing During the COVID-19 Pandemic in the United States: Observational Study JO - J Med Internet Res SP - e24591 VL - 23 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - disease ecology KW - nonpharmaceutical interventions KW - mobility data KW - economic KW - disparity KW - social distancing KW - equity KW - access KW - socioeconomic KW - infectious disease KW - mobility N2 - 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. UR - http://www.jmir.org/2021/1/e24591/ UR - http://dx.doi.org/10.2196/24591 UR - http://www.ncbi.nlm.nih.gov/pubmed/33351774 ID - info:doi/10.2196/24591 ER - TY - JOUR AU - Cardemil, V. Cristina AU - Dahl, Rebecca AU - Prill, M. Mila AU - Cates, Jordan AU - Brown, Sheldon AU - Perea, Adrienne AU - Marconi, Vincent AU - Bell, LaSara AU - Rodriguez-Barradas, C. Maria AU - Rivera-Dominguez, Gilberto AU - Beenhouwer, David AU - Poteshkina, Aleksandra AU - Holodniy, Mark AU - Lucero-Obusan, Cynthia AU - Balachandran, Neha AU - Hall, J. Aron AU - Kim, Lindsay AU - Langley, Gayle PY - 2021/1/22 TI - COVID-19?Related Hospitalization Rates and Severe Outcomes Among Veterans From 5 Veterans Affairs Medical Centers: Hospital-Based Surveillance Study JO - JMIR Public Health Surveill SP - e24502 VL - 7 IS - 1 KW - veteran KW - COVID-19 KW - hospitalization KW - outcome KW - fatality KW - mortality KW - prevention KW - at-risk N2 - Background: COVID-19 has disproportionately affected older adults and certain racial and ethnic groups in the United States. Data quantifying the disease burden, as well as describing clinical outcomes during hospitalization among these groups, are needed. Objective: We aimed to describe interim COVID-19 hospitalization rates and severe clinical outcomes by age group and race and ethnicity among US veterans by using a multisite surveillance network. Methods: We implemented a multisite COVID-19 surveillance platform in 5 Veterans Affairs Medical Centers located in Atlanta, Bronx, Houston, Palo Alto, and Los Angeles, collectively serving more than 396,000 patients annually. From February 27 to July 17, 2020, we actively identified inpatient cases with COVID-19 by screening admitted patients and reviewing their laboratory test results. We then manually abstracted the patients' medical charts for demographics, underlying medical conditions, and clinical outcomes. Furthermore, we calculated hospitalization incidence and incidence rate ratios, as well as relative risk for invasive mechanical ventilation, intensive care unit admission, and case fatality rate after adjusting for age, race and ethnicity, and underlying medical conditions. Results: We identified 621 laboratory-confirmed, hospitalized COVID-19 cases. The median age of the patients was 70 years, with 65.7% (408/621) aged ?65 years and 94% (584/621) male. Most COVID-19 diagnoses were among non-Hispanic Black (325/621, 52.3%) veterans, followed by non-Hispanic White (153/621, 24.6%) and Hispanic or Latino (112/621, 18%) veterans. Hospitalization rates were the highest among veterans who were ?85 years old, Hispanic or Latino, and non-Hispanic Black (430, 317, and 298 per 100,000, respectively). Veterans aged ?85 years had a 14-fold increased rate of hospitalization compared with those aged 18-29 years (95% CI: 5.7-34.6), whereas Hispanic or Latino and Black veterans had a 4.6- and 4.2-fold increased rate of hospitalization, respectively, compared with non-Hispanic White veterans (95% CI: 3.6-5.9). Overall, 11.6% (72/621) of the patients required invasive mechanical ventilation, 26.6% (165/621) were admitted to the intensive care unit, and 16.9% (105/621) died in the hospital. The adjusted relative risk for invasive mechanical ventilation and admission to the intensive care unit did not differ by age group or race and ethnicity, but veterans aged ?65 years had a 4.5-fold increased risk of death while hospitalized with COVID-19 compared with those aged <65 years (95% CI: 2.4-8.6). Conclusions: COVID-19 surveillance at the 5 Veterans Affairs Medical Centers across the United States demonstrated higher hospitalization rates and severe outcomes among older veterans, as well as higher hospitalization rates among Hispanic or Latino and non-Hispanic Black veterans than among non-Hispanic White veterans. These findings highlight the need for targeted prevention and timely treatment for veterans, with special attention to older aged, Hispanic or Latino, and non-Hispanic Black veterans. UR - http://publichealth.jmir.org/2021/1/e24502/ UR - http://dx.doi.org/10.2196/24502 UR - http://www.ncbi.nlm.nih.gov/pubmed/33338028 ID - info:doi/10.2196/24502 ER - TY - JOUR AU - Tai, Yu-Lin AU - Chi, Hsin AU - Chiu, Nan-Chang AU - Tseng, Cheng-Yin AU - Huang, Ya-Ning AU - Lin, Chien-Yu PY - 2021/1/22 TI - 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 JO - JMIR Form Res SP - e21409 VL - 5 IS - 1 KW - coronavirus KW - COVID-19 KW - novel coronavirus KW - SARS-CoV-2 KW - mask KW - rationing KW - Taiwan KW - anxiety KW - mental health KW - observational KW - crisis KW - plan N2 - 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. UR - http://formative.jmir.org/2021/1/e21409/ UR - http://dx.doi.org/10.2196/21409 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400678 ID - info:doi/10.2196/21409 ER - TY - JOUR AU - Guimarães, Almeida Vinícius Henrique AU - de Oliveira-Leandro, Maísa AU - Cassiano, Carolina AU - Marques, Piantino Anna Laura AU - Motta, Clara AU - Freitas-Silva, Letícia Ana AU - de Sousa, Dias Marlos Aureliano AU - Silveira, Matias Luciano Alves AU - Pardi, César Thiago AU - Gazotto, Castro Fernanda AU - Silva, Vinícius Marcos AU - Rodrigues Jr, Virmondes AU - Rodrigues, Francisco Wellington AU - Oliveira, Freire Carlo Jose PY - 2021/1/21 TI - Knowledge About COVID-19 in Brazil: Cross-Sectional Web-Based Study JO - JMIR Public Health Surveill SP - e24756 VL - 7 IS - 1 KW - COVID-19 KW - coronavirus KW - perception KW - knowledge KW - Brazil KW - cross-sectional KW - online survey KW - health information N2 - 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. UR - http://publichealth.jmir.org/2021/1/e24756/ UR - http://dx.doi.org/10.2196/24756 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400684 ID - info:doi/10.2196/24756 ER - TY - JOUR AU - Jang, Soobin AU - Kim, Dongsu AU - Yi, Eunhee AU - Choi, Gunhee AU - Song, Mideok AU - Lee, Eun-Kyoung PY - 2021/1/19 TI - Telemedicine and the Use of Korean Medicine for Patients With COVID-19 in South Korea: Observational Study JO - JMIR Public Health Surveill SP - e20236 VL - 7 IS - 1 KW - telemedicine KW - telehealth KW - herbal medicine KW - Korean medicine KW - COVID-19 KW - Korea KW - pandemic KW - guideline KW - infectious disease N2 - Background: COVID-19 was first reported in Wuhan, China, in December 2019, and it has since spread worldwide. The Association of Korean Medicine (AKOM) established the COVID-19 telemedicine center of Korean medicine (KM telemedicine center) in Daegu and Seoul. Objective: The aim of this study was to describe the results of the KM telemedicine center and the clinical possibility of using herbal medicines for COVID-19. Methods: All procedures were conducted by voice call following standardized guidelines. The students in the reception group obtained informed consent from participants and they collected basic information. Subsequently, Korean Medicine doctors assessed COVID-19?related symptoms and prescribed the appropriate herbal medicine according to the KM telemedicine guidelines. The data of patients who completed the program by June 30, 2020, were analyzed. Results: From March 9 to June 30, 2020, 2324 patients participated in and completed the KM telemedicine program. Kyung-Ok-Ko (n=2285) was the most prescribed herbal medicine, and Qingfei Paidu decoction (I and II, n=2053) was the second most prescribed. All COVID-19?related symptoms (headache, chills, sputum, dry cough, sore throat, fatigue, muscle pain, rhinorrhea, nasal congestion, dyspnea, chest tightness, diarrhea, and loss of appetite) improved after treatment (P<.001). Conclusions: The KM telemedicine center has provided medical service to 10.8% of all patients with COVID-19 in South Korea (as of June 30, 2020), and it is still in operation. We hope that this study will help to establish a better health care system to overcome COVID-19. UR - http://publichealth.jmir.org/2021/1/e20236/ UR - http://dx.doi.org/10.2196/20236 UR - http://www.ncbi.nlm.nih.gov/pubmed/33342765 ID - info:doi/10.2196/20236 ER - TY - JOUR AU - Pinho, Lucena Rebeca Da Nóbrega AU - Costa, Ferreira Thais AU - Silva, Miranda Nayane AU - Barros-Areal, F. Adriana AU - Salles, Mattos André De AU - Oliveira, Pedrosa Andrea AU - Rassi, Carlos AU - Valero, Brero Caroline Elizabeth AU - Gomes, Martins Ciro AU - Mendonça-Silva, Dayde AU - Oliveira, Fernando AU - Jochims, Isadora AU - Ranulfo, Ivan AU - Neves, Seixas Juliana De Brito AU - Oliveira, Lucas AU - Dantas, Nogueira Maria AU - Rosal, Marta AU - Soares, Mayra AU - Kurizky, Patrícia AU - Peterle, Uliana Viviane AU - Faro, Furtado Yasmin AU - Gomides, Paula Ana AU - da Mota, Licia AU - Albuquerque, Cleandro AU - Simaan, Kozak Cezar AU - Amado, M. Veronica PY - 2021/1/19 TI - 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 JO - JMIR Res Protoc SP - e24298 VL - 10 IS - 1 KW - burnout syndrome KW - medical residency KW - multidisciplinary residency KW - COVID-19 KW - mental health KW - burnout KW - stress KW - anxiety KW - prospective KW - cohort KW - health care professional KW - medical student N2 - 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 UR - https://www.researchprotocols.org/2021/1/e24298 UR - http://dx.doi.org/10.2196/24298 UR - http://www.ncbi.nlm.nih.gov/pubmed/33290246 ID - info:doi/10.2196/24298 ER - TY - JOUR AU - Jiang, Hong AU - Jin, Longmei AU - Qian, Xu AU - Xiong, Xu AU - La, Xuena AU - Chen, Weiyi AU - Yang, Xiaoguang AU - Yang, Fengyun AU - Zhang, Xinwen AU - Abudukelimu, Nazhakaiti AU - Li, Xingying AU - Xie, Zhenyu AU - Zhu, Xiaoling AU - Zhang, Xiaohua AU - Zhang, Lifeng AU - Wang, Li AU - Li, Lingling AU - Li, Mu PY - 2021/1/18 TI - Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study JO - J Med Internet Res SP - e18722 VL - 23 IS - 1 KW - COVID-19 KW - mental health KW - perceived stress KW - anxiety KW - depression KW - antenatal care information KW - social media platform KW - pregnancy KW - women N2 - Background: China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a limited understanding of the novel, emerging infectious disease, pregnant women have sought ways to access timely and trusted health care information. The mental health status of pregnant women during this public health emergency, as well as how they responded to the situation and where and how they obtained antenatal care information, remain to be understood. Objective: This study aimed to evaluate the mental health status of pregnant women during the COVID-19 epidemic in China by measuring their perceived stress, anxiety, and depression levels; explore the approaches used by them to access antenatal health care information; and determine their associations with maternal mental health status. Methods: We conducted a web-based, cross-sectional survey to assess the mental health status of Chinese pregnant women by using the validated, Chinese version of Perceived Stress Scale, Self-Rating Anxiety Scale, and Edinburgh Depression Scale. We also collected information on the various approaches these women used to access antenatal care information during the early stage of the COVID-19 epidemic, from February 5 to 28, 2020. Results: A total of 1873 pregnant women from 22 provinces or regions of China participated in the survey. The prevalence of perceived stress, anxiety, and depression among these participants was 89.1% (1668/1873; 95% CI 87.6%, 90.4%), 18.1% (339/1873; 95% CI 16.4%, 19.9%), and 45.9% (859/1873; 95% CI 43.6%, 48.1%), respectively. Hospitals? official accounts on the Chinese social media platforms WeChat and Weibo were the most popular channels among these pregnant women to obtain antenatal care information during the COVID-19 outbreak. Access to antenatal care information via the hospitals? official social media accounts was found to be associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46, 95% CI 0.30-0.72; P=.001), anxiety (aOR 0.53, 95% CI 0.41-0.68; P<.001), and depression (aOR 0.73, 95% CI 0.59-0.91; P=.005). Access to health care information via hospital hotlines or SMS was found to be significantly associated with a lower risk of anxiety only (OR 0.77, 95% CI 0.60-0.98; P=.04). Conclusions: During the COVID-19 outbreak in China, pregnant women experienced high levels of perceived stress, anxiety, and depression. During such public health emergencies, mental health care services should be strengthened to reassure and support pregnant women. Specific information targeted at pregnant women, including information on how to cope in an emergency or major disease outbreak, developed and disseminated by health care institutions via social media platforms could be an effective way to mitigate mental health challenges and ensure epidemic preparedness and response in the future. UR - http://www.jmir.org/2021/1/e18722/ UR - http://dx.doi.org/10.2196/18722 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347423 ID - info:doi/10.2196/18722 ER - TY - JOUR AU - Yin, Fulian AU - Wu, Zhaoliang AU - Xia, Xinyu AU - Ji, Meiqi AU - Wang, Yanyan AU - Hu, Zhiwen PY - 2021/1/15 TI - Unfolding the Determinants of COVID-19 Vaccine Acceptance in China JO - J Med Internet Res SP - e26089 VL - 23 IS - 1 KW - COVID-19 vaccines KW - COVID-19 vaccination KW - affordability KW - efficacy KW - risk communication KW - evidence communication KW - social media KW - COVID-19 KW - vaccine KW - communication KW - risk KW - acceptance KW - China KW - opinion KW - strategy KW - promotion N2 - Background: China is at the forefront of global efforts to develop COVID-19 vaccines and has five fast-tracked candidates at the final-stage, large-scale human clinical trials testing phase. Vaccine-promoting policymaking for public engagement is a prerequisite for social mobilization. However, making an informed and judicious choice is a dilemma for the Chinese government in the vaccine promotion context. Objective: In this study, public opinions in China were analyzed via dialogues on Chinese social media, based on which Chinese netizens? views on COVID-19 vaccines and vaccination were investigated. We also aimed to develop strategies for promoting vaccination programs in China based on an in-depth understanding of the challenges in risk communication and social mobilization. Methods: We proposed a novel behavioral dynamics model, SRS/I (susceptible-reading-susceptible/immune), to analyze opinion transmission paradigms on Chinese social media. Coupled with a meta-analysis and natural language processing techniques, the emotion polarity of individual opinions was examined in their given context. Results: We collected more than 1.75 million Weibo messages about COVID-19 vaccines from January to October 2020. According to the public opinion reproduction ratio (R0), the dynamic propagation of those messages can be classified into three periods: the ferment period (R01=1.1360), the revolution period (R02=2.8278), and the transmission period (R03=3.0729). Topics on COVID-19 vaccine acceptance in China include price and side effects. From September to October, Weibo users claimed that the vaccine was overpriced, making up 18.3% (n=899) of messages; 38.1% (n=81,909) of relevant topics on Weibo received likes. On the contrary, the number of messages that considered the vaccine to be reasonably priced was twice as high but received fewer likes, accounting for 25.0% (n=53,693). In addition, we obtained 441 (47.7%) positive and 295 (31.9%) negative Weibo messages about side effects. Interestingly, inactivated vaccines instigated more heated discussions than any other vaccine type. The discussions, forwards, comments, and likes associated with topics related to inactivated vaccines accounted for 53% (n=588), 42% (n=3072), 56% (n=3671), and 49% (n=17,940), respectively, of the total activity associated with the five types of vaccines in China. Conclusions: Most Chinese netizens believe that the vaccine is less expensive than previously thought, while some claim they cannot afford it for their entire family. The findings demonstrate that Chinese individuals are inclined to be positive about side effects over time and are proud of China?s involvement with vaccine development. Nevertheless, they have a collective misunderstanding about inactivated vaccines, insisting that inactivated vaccines are safer than other vaccines. Reflecting on netizens? collective responses, the unfolding determinants of COVID-19 vaccine acceptance provide illuminating benchmarks for vaccine-promoting policies. UR - http://www.jmir.org/2021/1/e26089/ UR - http://dx.doi.org/10.2196/26089 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400682 ID - info:doi/10.2196/26089 ER - TY - JOUR AU - Greene, K. Sharon AU - McGough, F. Sarah AU - Culp, M. Gretchen AU - Graf, E. Laura AU - Lipsitch, Marc AU - Menzies, A. Nicolas AU - Kahn, Rebecca PY - 2021/1/15 TI - Nowcasting for Real-Time COVID-19 Tracking in New York City: An Evaluation Using Reportable Disease Data From Early in the Pandemic JO - JMIR Public Health Surveill SP - e25538 VL - 7 IS - 1 KW - COVID-19 KW - data quality KW - epidemiology KW - forecasting KW - infectious disease KW - morbidity and mortality trends KW - public health practice KW - surveillance N2 - 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. UR - http://publichealth.jmir.org/2021/1/e25538/ UR - http://dx.doi.org/10.2196/25538 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406053 ID - info:doi/10.2196/25538 ER - TY - JOUR AU - Post, Lori AU - Marogi, Emily AU - Moss, B. Charles AU - Murphy, Leo Robert AU - Ison, G. Michael AU - Achenbach, J. Chad AU - Resnick, Danielle AU - Singh, Lauren AU - White, Janine AU - Boctor, J. Michael AU - Welch, B. Sarah AU - Oehmke, Francis James PY - 2021/1/15 TI - SARS-CoV-2 Surveillance in the Middle East and North Africa: Longitudinal Trend Analysis JO - J Med Internet Res SP - e25830 VL - 23 IS - 1 KW - COVID-19 KW - SARS-CoV-2 surveillance KW - wave two KW - second wave KW - global COVID-19 surveillance KW - MENA public health surveillance KW - MENA COVID-19 KW - Middle East and North Africa surveillance metrics KW - dynamic panel data KW - MENA econometrics KW - MENA SARS-CoV-2 KW - Middle East and North Africa COVID-19 surveillance system KW - MENA COVID-19 transmission speed KW - MENA COVID-19 transmission acceleration KW - COVID-19 transmission deceleration KW - COVID-19 transmission jerk KW - COVID-19 7-day lag KW - SARS-CoV-2 KW - Arellano-Bond estimator KW - generalized method of moments KW - GMM KW - Bahrain KW - Iran KW - Iraq KW - Israel KW - Jordan KW - Kuwait KW - Lebanon KW - Oman KW - Qatar KW - Saudi Arabia KW - Syria KW - United Arab Emirates KW - Yemen KW - Algeria KW - Djibouti KW - Egypt KW - Libya KW - Morocco KW - Tunisia N2 - 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 (?25=859.5, P<.001). The Sargan test was not significant, failing to reject the validity of overidentifying restrictions (?2294=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. UR - http://www.jmir.org/2021/1/e25830/ UR - http://dx.doi.org/10.2196/25830 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302252 ID - info:doi/10.2196/25830 ER - TY - JOUR AU - Suppan, Mélanie AU - Stuby, Loric AU - Carrera, Emmanuel AU - Cottet, Philippe AU - Koka, Avinash AU - Assal, Frédéric AU - Savoldelli, Louis Georges AU - Suppan, Laurent PY - 2021/1/15 TI - Asynchronous Distance Learning of the National Institutes of Health Stroke Scale During the COVID-19 Pandemic (E-Learning vs Video): Randomized Controlled Trial JO - J Med Internet Res SP - e23594 VL - 23 IS - 1 KW - stroke KW - COVID-19 KW - e-learning KW - medical student KW - medical education KW - online learning KW - randomized controlled trial KW - video N2 - Background: The COVID-19 pandemic has considerably altered the regular medical education curriculum while increasing the need for health care professionals. Senior medical students are being incrementally deployed to the front line to address the shortage of certified physicians. These students, some of whom will be fast-tracked as physicians, may lack knowledge regarding the initial management of time-critical emergencies such as stroke. Objective: Our aim was to determine whether an e-learning module could improve asynchronous distance knowledge acquisition of the National Institutes of Health Stroke Scale (NIHSS) in senior medical students compared to the traditional didactic video. Methods: A randomized, data analyst?blinded web-based trial was conducted at the University of Geneva Faculty of Medicine between April and June 2020. Fifth year medical students followed a distance learning path designed to teach the NIHSS. The control group followed the traditional didactic video created by Patrick Lyden, while the e-learning group followed the updated version of a previously tested, highly interactive e-learning module. The main outcome was the score on a 50-question quiz displayed upon completion of the learning material. The difference in the proportion of correct answers for each specific NIHSS item was also assessed. Results: Out of 158 potential participants, 88 started their allocated learning path and 75 completed the trial. Participants who followed the e-learning module performed better than those who followed the video (38 correct answers, 95% CI 37-39, vs 35 correct answers, 95% CI 34-36, P<.001). Participants in the e-learning group scored better on five elements than the video group: key NIHSS concepts (P=.02), the consciousness ? global item (P<.001), the facial palsy item (P=.04), the ataxia item (P=.03), and the sensory item (P=.04). Conclusions: Compared to the traditional didactic video, a highly interactive e-learning module enhances asynchronous distance learning and NIHSS knowledge acquisition in senior medical students. UR - http://www.jmir.org/2021/1/e23594/ UR - http://dx.doi.org/10.2196/23594 UR - http://www.ncbi.nlm.nih.gov/pubmed/33428581 ID - info:doi/10.2196/23594 ER - TY - JOUR AU - Dadaczynski, Kevin AU - Okan, Orkan AU - Messer, Melanie AU - Leung, M. Angela Y. AU - Rosário, Rafaela AU - Darlington, Emily AU - Rathmann, Katharina PY - 2021/1/15 TI - Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study JO - J Med Internet Res SP - e24097 VL - 23 IS - 1 KW - digital health KW - literacy KW - infodemic KW - health information KW - behaviour KW - coronavirus KW - COVID-19 KW - university student KW - student KW - infodemiology N2 - Background: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19?related information and service environments. Objective: This study aimed to investigate university students? digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. Methods: A cross-sectional study among 14,916 university students aged ?18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. Results: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of ?information searching? and ?evaluating reliability.? Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. Conclusions: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key. UR - http://www.jmir.org/2021/1/e24097/ UR - http://dx.doi.org/10.2196/24097 UR - http://www.ncbi.nlm.nih.gov/pubmed/33395396 ID - info:doi/10.2196/24097 ER - TY - JOUR AU - Shah, Shailendra Sachin AU - Gvozdanovic, Andrew AU - Knight, Matthew AU - Gagnon, Julien PY - 2021/1/15 TI - Mobile App?Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis JO - JMIR Form Res SP - e23190 VL - 5 IS - 1 KW - mHealth KW - remote patient monitoring KW - digital health KW - COVID-19 KW - service improvement KW - cost-effectiveness KW - monitoring N2 - 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. UR - http://formative.jmir.org/2021/1/e23190/ UR - http://dx.doi.org/10.2196/23190 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400675 ID - info:doi/10.2196/23190 ER - TY - JOUR AU - Itamura, Kyohei AU - Wu, Arthur AU - Illing, Elisa AU - Ting, Jonathan AU - Higgins, Thomas PY - 2021/1/14 TI - YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis JO - JMIR Public Health Surveill SP - e24220 VL - 7 IS - 1 KW - COVID-19 KW - coronavirus KW - SARS-coV-2 KW - nasopharyngeal swab KW - viral testing KW - PCR KW - YouTube KW - infodemiology KW - digital epidemiology KW - testing KW - diagnostic KW - content analysis KW - video KW - error N2 - Background: Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates. Objective: The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures. Methods: We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique. Results: In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat?related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020). Conclusions: Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures. UR - http://publichealth.jmir.org/2021/1/e24220/ UR - http://dx.doi.org/10.2196/24220 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406478 ID - info:doi/10.2196/24220 ER - TY - JOUR AU - Tornberg, N. Haley AU - Moezinia, Carine AU - Wei, Chapman AU - Bernstein, A. Simone AU - Wei, Chaplin AU - Al-Beyati, Refka AU - Quan, Theodore AU - Diemert, J. David PY - 2021/1/14 TI - Retracted: "Assessing the Dissemination of COVID-19 Articles Across Social Media With Altmetric and PlumX Metrics: Correlational Study" JO - J Med Internet Res SP - e21408 VL - 23 IS - 1 KW - Altmetric KW - PlumX KW - social media KW - impact factor KW - COVID-19 KW - information KW - dissemination KW - citation N2 - Background: The use of social media assists in the distribution of COVID-19 information to the general public and health professionals. Alternative-level metrics (ie, altmetrics) and PlumX metrics are new bibliometrics that can assess how many times a scientific article has been shared and how much a scientific article has spread within social media platforms. Objective: Our objective was to characterize and compare the traditional bibliometrics (ie, citation count and impact factors) and new bibliometrics (ie, Altmetric Attention Score [AAS] and PlumX score) of the top 100 COVID-19 articles with the highest AASs. Methods: The top 100 articles with highest AASs were identified with Altmetric Explorer in May 2020. The AASs, journal names, and the number of mentions in various social media databases of each article were collected. Citation counts and PlumX Field-Weighted Citation Impact scores were collected from the Scopus database. Additionally, AASs, PlumX scores, and citation counts were log-transformed and adjusted by +1 for linear regression, and Spearman correlation coefficients were used to determine correlations. Results: The median AAS, PlumX score, and citation count were 4922.50, 37.92, and 24.00, respectively. The New England Journal of Medicine published the most articles (18/100, 18%). The highest number of mentions (985,429/1,022,975, 96.3%) were found on Twitter, making it the most frequently used social media platform. A positive correlation was observed between AAS and citation count (r2=0.0973; P=.002), and between PlumX score and citation count (r2=0.8911; P<.001). Conclusions: Our study demonstrated that citation count weakly correlated with AASs and strongly correlated with PlumX scores, with regard to COVID-19 articles at this point in time. Altmetric and PlumX metrics should be used to complement traditional citation counts when assessing the dissemination and impact of a COVID-19 article. UR - http://www.jmir.org/2021/1/e21408/ UR - http://dx.doi.org/10.2196/21408 UR - http://www.ncbi.nlm.nih.gov/pubmed/33406049 ID - info:doi/10.2196/21408 ER - TY - JOUR AU - Figueroa, Astrid Caroline AU - Hernandez-Ramos, Rosa AU - Boone, Elizabeth Claire AU - Gómez-Pathak, Laura AU - Yip, Vivian AU - Luo, Tiffany AU - Sierra, Valentín AU - Xu, Jing AU - Chakraborty, Bibhas AU - Darrow, Sabrina AU - Aguilera, Adrian PY - 2021/1/14 TI - A Text Messaging Intervention for Coping With Social Distancing During COVID-19 (StayWell at Home): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e23592 VL - 10 IS - 1 KW - COVID-19 KW - mental health KW - depression KW - reinforcement learning KW - microrandomized trial N2 - 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 UR - http://www.researchprotocols.org/2021/1/e23592/ UR - http://dx.doi.org/10.2196/23592 UR - http://www.ncbi.nlm.nih.gov/pubmed/33370721 ID - info:doi/10.2196/23592 ER - TY - JOUR AU - Laires, Almeida Pedro AU - Dias, Sónia AU - Gama, Ana AU - Moniz, Marta AU - Pedro, R. Ana AU - Soares, Patricia AU - Aguiar, Pedro AU - Nunes, Carla PY - 2021/1/12 TI - The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis JO - JMIR Public Health Surveill SP - e22794 VL - 7 IS - 1 KW - COVID-19 KW - risk factors KW - morbidity KW - chronic disease KW - risk KW - perception KW - outcome KW - association N2 - 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. UR - http://publichealth.jmir.org/2021/1/e22794/ UR - http://dx.doi.org/10.2196/22794 UR - http://www.ncbi.nlm.nih.gov/pubmed/33433397 ID - info:doi/10.2196/22794 ER - TY - JOUR AU - van Stekelenburg, Aart AU - Schaap, Gabi AU - Veling, Harm AU - Buijzen, Moniek PY - 2021/1/12 TI - Investigating and Improving the Accuracy of US Citizens? Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study JO - J Med Internet Res SP - e24069 VL - 23 IS - 1 KW - infodemic KW - infodemiology KW - misinformation KW - COVID-19 pandemic KW - belief accuracy KW - boosting KW - trust in scientists KW - political orientation KW - media use N2 - 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. UR - http://www.jmir.org/2021/1/e24069/ UR - http://dx.doi.org/10.2196/24069 UR - http://www.ncbi.nlm.nih.gov/pubmed/33351776 ID - info:doi/10.2196/24069 ER - TY - JOUR AU - Kawakami, Norito AU - Sasaki, Natsu AU - Kuroda, Reiko AU - Tsuno, Kanami AU - Imamura, Kotaro PY - 2021/1/12 TI - The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study JO - JMIR Ment Health SP - e23699 VL - 8 IS - 1 KW - coronavirus disease KW - digital contact tracing KW - mental health KW - working population KW - longitudinal study KW - COVID-19 KW - contact tracing KW - surveillance KW - tracking KW - anxiety KW - distress N2 - Background: Downloading a COVID-19 contact tracing app may be effective in reducing users? worry about COVID-19 and psychological distress. Objective: This 2.5-month prospective study aimed to investigate the association of downloading a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government, with worry about COVID-19 and psychological distress in a sample of employed adults in Japan. Methods: A total of 996 full-time employed respondents to an online survey conducted May 22-26, 2020 (baseline), were invited to participate in a follow-up survey August 7-12, 2020 (follow-up). A high level of worrying about COVID-19 and high psychological distress were defined by baseline and follow-up scores on a single-item scale and the Kessler 6 (K6) scale, respectively. The app was released between the two surveys, on June 17. Participants were asked at follow-up if they downloaded the app. Results: A total of 902 (90.6%) of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress at follow-up after controlling for baseline variables, but not with worry about COVID-19. Conclusions: This study provides the first evidence that using a government-issued COVID-19 contact tracing app may be beneficial for the mental health of employed adults during the COVID-19 pandemic. UR - http://mental.jmir.org/2021/1/e23699/ UR - http://dx.doi.org/10.2196/23699 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347424 ID - info:doi/10.2196/23699 ER - TY - JOUR AU - Rui, Raymond Jian AU - Yang, Keqing AU - Chen, Juan PY - 2021/1/12 TI - Information Sources, Risk Perception, and Efficacy Appraisal?s Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey JO - JMIR Hum Factors SP - e23232 VL - 8 IS - 1 KW - information source KW - perceived severity KW - perceived susceptibility KW - response efficacy KW - self-efficacy KW - health information KW - protective behavior KW - COVID-19 KW - protection KW - behavior KW - risk KW - perception KW - prediction N2 - 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. UR - http://humanfactors.jmir.org/2021/1/e23232/ UR - http://dx.doi.org/10.2196/23232 UR - http://www.ncbi.nlm.nih.gov/pubmed/33338027 ID - info:doi/10.2196/23232 ER - TY - JOUR AU - Syeda, Bareen Hafsa AU - Syed, Mahanazuddin AU - Sexton, Wayne Kevin AU - Syed, Shorabuddin AU - Begum, Salma AU - Syed, Farhanuddin AU - Prior, Fred AU - Yu Jr, Feliciano PY - 2021/1/11 TI - Role of Machine Learning Techniques to Tackle the COVID-19 Crisis: Systematic Review JO - JMIR Med Inform SP - e23811 VL - 9 IS - 1 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - artificial intelligence KW - machine learning KW - deep learning KW - systematic review KW - epidemiology KW - pandemic KW - neural network N2 - Background: SARS-CoV-2, the novel coronavirus responsible for COVID-19, has caused havoc worldwide, with patients presenting a spectrum of complications that have pushed health care experts to explore new technological solutions and treatment plans. Artificial Intelligence (AI)?based technologies have played a substantial role in solving complex problems, and several organizations have been swift to adopt and customize these technologies in response to the challenges posed by the COVID-19 pandemic. Objective: The objective of this study was to conduct a systematic review of the literature on the role of AI as a comprehensive and decisive technology to fight the COVID-19 crisis in the fields of epidemiology, diagnosis, and disease progression. Methods: A systematic search of PubMed, Web of Science, and CINAHL databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify all potentially relevant studies published and made available online between December 1, 2019, and June 27, 2020. The search syntax was built using keywords specific to COVID-19 and AI. Results: The search strategy resulted in 419 articles published and made available online during the aforementioned period. Of these, 130 publications were selected for further analyses. These publications were classified into 3 themes based on AI applications employed to combat the COVID-19 crisis: Computational Epidemiology, Early Detection and Diagnosis, and Disease Progression. Of the 130 studies, 71 (54.6%) focused on predicting the COVID-19 outbreak, the impact of containment policies, and potential drug discoveries, which were classified under the Computational Epidemiology theme. Next, 40 of 130 (30.8%) studies that applied AI techniques to detect COVID-19 by using patients? radiological images or laboratory test results were classified under the Early Detection and Diagnosis theme. Finally, 19 of the 130 studies (14.6%) that focused on predicting disease progression, outcomes (ie, recovery and mortality), length of hospital stay, and number of days spent in the intensive care unit for patients with COVID-19 were classified under the Disease Progression theme. Conclusions: In this systematic review, we assembled studies in the current COVID-19 literature that utilized AI-based methods to provide insights into different COVID-19 themes. Our findings highlight important variables, data types, and available COVID-19 resources that can assist in facilitating clinical and translational research. UR - http://medinform.jmir.org/2021/1/e23811/ UR - http://dx.doi.org/10.2196/23811 UR - http://www.ncbi.nlm.nih.gov/pubmed/33326405 ID - info:doi/10.2196/23811 ER - TY - JOUR AU - van den Broek-Altenburg, M. Eline AU - Atherly, J. Adam AU - Diehl, A. Sean AU - Gleason, M. Kelsey AU - Hart, C. Victoria AU - MacLean, D. Charles AU - Barkhuff, A. Daniel AU - Levine, A. Mark AU - Carney, K. Jan PY - 2021/1/11 TI - Jobs, Housing, and Mask Wearing: Cross-Sectional Study of Risk Factors for COVID-19 JO - JMIR Public Health Surveill SP - e24320 VL - 7 IS - 1 KW - COVID-19 KW - risk of infection KW - community exposure KW - self-protecting behavior KW - mask wearing KW - infection fatality rate KW - infection KW - self-protecting KW - mask KW - fatality rate KW - exposure KW - virus KW - SARS-CoV-2 N2 - 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. UR - http://publichealth.jmir.org/2021/1/e24320/ UR - http://dx.doi.org/10.2196/24320 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315576 ID - info:doi/10.2196/24320 ER - TY - JOUR AU - Garg, Alpana AU - Goyal, Sachin AU - Thati, Rohit AU - Thati, Neelima PY - 2021/1/8 TI - Implementation of Telemedicine in a Tertiary Hospital?Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study JO - JMIR Public Health Surveill SP - e21327 VL - 7 IS - 1 KW - telemedicine KW - telehealth KW - COVID-19 KW - Detroit KW - ambulatory care KW - primary care KW - internal medicine KW - pandemic N2 - Background: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital?based outpatient clinic in one of the worst-hit areas in the world. Objective: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. Methods: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. Results: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. Conclusions: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice. UR - http://publichealth.jmir.org/2021/1/e21327/ UR - http://dx.doi.org/10.2196/21327 UR - http://www.ncbi.nlm.nih.gov/pubmed/33400680 ID - info:doi/10.2196/21327 ER - TY - JOUR AU - Maytin, Lauren AU - Maytin, Jason AU - Agarwal, Priya AU - Krenitsky, Anna AU - Krenitsky, JoAnn AU - Epstein, S. Robert PY - 2021/1/8 TI - Attitudes and Perceptions Toward COVID-19 Digital Surveillance: Survey of Young Adults in the United States JO - JMIR Form Res SP - e23000 VL - 5 IS - 1 KW - attitude KW - perception KW - young adult KW - COVID-19 KW - digital surveillance KW - population health technologies KW - surveillance KW - population KW - survey KW - adolescent N2 - 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. UR - http://formative.jmir.org/2021/1/e23000/ UR - http://dx.doi.org/10.2196/23000 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347420 ID - info:doi/10.2196/23000 ER - TY - JOUR AU - von Wyl, Viktor AU - Höglinger, Marc AU - Sieber, Chloé AU - Kaufmann, Marco AU - Moser, André AU - Serra-Burriel, Miquel AU - Ballouz, Tala AU - Menges, Dominik AU - Frei, Anja AU - Puhan, Alan Milo PY - 2021/1/6 TI - Drivers of Acceptance of COVID-19 Proximity Tracing Apps in Switzerland: Panel Survey Analysis JO - JMIR Public Health Surveill SP - e25701 VL - 7 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - digital proximity tracing KW - digital contact tracing KW - mHealth KW - tracing KW - compliance KW - acceptance KW - uptake KW - usability KW - communication N2 - Background: Digital proximity tracing apps have been released to mitigate the transmission of SARS-CoV-2, the virus known to cause COVID-19. However, it remains unclear how the acceptance and uptake of these apps can be improved. Objective: This study aimed to investigate the coverage of the SwissCovid app and the reasons for its nonuse in Switzerland during a period of increasing incidence of COVID-19 cases. Methods: We collected data between September 28 and October 8, 2020, via a nationwide online panel survey (COVID-19 Social Monitor, N=1511). We examined sociodemographic and behavioral factors associated with app use by using multivariable logistic regression, whereas reasons for app nonuse were analyzed descriptively. Results: Overall, 46.5% (703/1511) of the survey participants reported they used the SwissCovid app, which was an increase from 43.9% (662/1508) reported in the previous study wave conducted in July 2020. A higher monthly household income (ie, income >CHF 10,000 or >US $11,000 vs income ?CHF 6000 or 3 hours on reading COVID-19 news per day. Women with excessive media use (>3 hours) were more likely to be previously pregnant (P=.03), have no physical activity (P=.003), have inadequate dietary diversity (P=.03), and have poor sleep quality (P<.001). The prevalence of miscarriage was 16.0% (n=73; 95% CI 12.6%-19.4%). Compared with women who spent 0.5-2 hours (25/247, 10.1%) on reading COVID-19 news per day, miscarriage prevalence in women who spent <0.5 hours (5/23, 21.7%), 2-3 hours (26/132, 19.7%), and >3 hours (17/54, 31.5%) was higher (P<.001). Miscarriage prevalence was also higher in pregnant women with poor sleep quality (39/174, 22.4% vs 34/282, 12.1%; P=.003) and a high education level (66/368, 17.9% vs 7/88, 8.0%; P=.02). In the multivariable model, poor sleep quality (adjusted RR 2.06, 95% CI 1.24-3.44; P=.006), 2-3 hours of media use daily (adjusted RR 1.74, 95% CI 1.02-2.97; P=.04), and >3 hours of media use daily (adjusted RR 2.56, 95% CI 1.43-4.59; P=.002) were associated with miscarriage. In the sensitivity analysis, results were still stable. Conclusions: Pregnant women with excessive media use were more likely to have no physical activity, inadequate dietary diversity, and poor sleep quality. Excessive media use and poor sleep quality were associated with a higher risk of miscarriage. Our findings highlight the importance of healthy lifestyles during the COVID-19 pandemic. UR - https://publichealth.jmir.org/2021/1/e25241 UR - http://dx.doi.org/10.2196/25241 UR - http://www.ncbi.nlm.nih.gov/pubmed/33293263 ID - info:doi/10.2196/25241 ER - TY - JOUR AU - Gao, Yankun AU - Xie, Zidian AU - Li, Dongmei PY - 2021/1/5 TI - Electronic Cigarette Users' Perspective on the COVID-19 Pandemic: Observational Study Using Twitter Data JO - JMIR Public Health Surveill SP - e24859 VL - 7 IS - 1 KW - COVID-19 KW - Twitter KW - infodemiology KW - Electronic cigarette KW - perspective KW - observational KW - social media KW - vulnerable KW - sentiment analysis KW - topic modeling KW - concern N2 - Background: Previous studies have shown that electronic cigarette (e-cigarette) users might be more vulnerable to COVID-19 infection and could develop more severe symptoms if they contract the disease owing to their impaired immune responses to viral infections. Social media platforms such as Twitter have been widely used by individuals worldwide to express their responses to the current COVID-19 pandemic. Objective: In this study, we aimed to examine the longitudinal changes in the attitudes of Twitter users who used e-cigarettes toward the COVID-19 pandemic, as well as compare differences in attitudes between e-cigarette users and nonusers based on Twitter data. Methods: The study dataset containing COVID-19?related Twitter posts (tweets) posted between March 5 and April 3, 2020, was collected using a Twitter streaming application programming interface with COVID-19?related keywords. Twitter users were classified into two groups: Ecig group, including users who did not have commercial accounts but posted e-cigarette?related tweets between May 2019 and August 2019, and non-Ecig group, including users who did not post any e-cigarette?related tweets. Sentiment analysis was performed to compare sentiment scores towards the COVID-19 pandemic between both groups and determine whether the sentiment expressed was positive, negative, or neutral. Topic modeling was performed to compare the main topics discussed between the groups. Results: The US COVID-19 dataset consisted of 4,500,248 COVID-19?related tweets collected from 187,399 unique Twitter users in the Ecig group and 11,479,773 COVID-19?related tweets collected from 2,511,659 unique Twitter users in the non-Ecig group. Sentiment analysis showed that Ecig group users had more negative sentiment scores than non-Ecig group users. Results from topic modeling indicated that Ecig group users had more concerns about deaths due to COVID-19, whereas non-Ecig group users cared more about the government?s responses to the COVID-19 pandemic. Conclusions: Our findings show that Twitter users who tweeted about e-cigarettes had more concerns about the COVID-19 pandemic. These findings can inform public health practitioners to use social media platforms such as Twitter for timely monitoring of public responses to the COVID-19 pandemic and educating and encouraging current e-cigarette users to quit vaping to minimize the risks associated with COVID-19. UR - http://publichealth.jmir.org/2021/1/e24859/ UR - http://dx.doi.org/10.2196/24859 UR - http://www.ncbi.nlm.nih.gov/pubmed/33347422 ID - info:doi/10.2196/24859 ER - TY - JOUR AU - Chen, Ying AU - Zhou, Rui AU - Chen, Boyan AU - Chen, Hao AU - Li, Ying AU - Chen, Zhi AU - Zhu, Haihong AU - Wang, Hongmei PY - 2020/12/31 TI - Knowledge, Perceived Beliefs, and Preventive Behaviors Related to COVID-19 Among Chinese Older Adults: Cross-Sectional Web-Based Survey JO - J Med Internet Res SP - e23729 VL - 22 IS - 12 KW - COVID-19 KW - knowledge KW - perceived beliefs KW - behaviors KW - elderly KW - China N2 - 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 (?=0.198, P<.001), perceived susceptibility (?=0.263, P=.03), perceived benefits (?=0.643, P<.001), and self-efficacy in preventing COVID-19 (?=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. UR - https://www.jmir.org/2020/12/e23729 UR - http://dx.doi.org/10.2196/23729 UR - http://www.ncbi.nlm.nih.gov/pubmed/33293262 ID - info:doi/10.2196/23729 ER - TY - JOUR AU - Zimba, Rebecca AU - Kulkarni, Sarah AU - Berry, Amanda AU - You, William AU - Mirzayi, Chloe AU - Westmoreland, Drew AU - Parcesepe, Angela AU - Waldron, Levi AU - Rane, Madhura AU - Kochhar, Shivani AU - Robertson, McKaylee AU - Maroko, Andrew AU - Grov, Christian AU - Nash, Denis PY - 2020/12/31 TI - SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment JO - JMIR Public Health Surveill SP - e25546 VL - 6 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - discrete choice experiment KW - implementation science KW - engagement KW - testing KW - cohort study KW - stated preference study KW - pandemic N2 - 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. UR - http://publichealth.jmir.org/2020/4/e25546/ UR - http://dx.doi.org/10.2196/25546 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315584 ID - info:doi/10.2196/25546 ER - TY - JOUR AU - Petracca, Francesco AU - Ciani, Oriana AU - Cucciniello, Maria AU - Tarricone, Rosanna PY - 2020/12/30 TI - Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters JO - J Med Internet Res SP - e21815 VL - 22 IS - 12 KW - mobile apps KW - coronavirus KW - COVID-19 KW - digital health KW - mHealth KW - organizational context KW - public health KW - telemedicine UR - http://www.jmir.org/2020/12/e21815/ UR - http://dx.doi.org/10.2196/21815 UR - http://www.ncbi.nlm.nih.gov/pubmed/33351777 ID - info:doi/10.2196/21815 ER - TY - JOUR AU - Richardson, G. Chris AU - Slemon, Allie AU - Gadermann, Anne AU - McAuliffe, Corey AU - Thomson, Kimberly AU - Daly, Zachary AU - Salway, Travis AU - Currie, M. Leanne AU - David, Anita AU - Jenkins, Emily PY - 2020/12/30 TI - Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic?Related Stress Among the General Population in Canada: Cross-Sectional Survey Study JO - J Med Internet Res SP - e24868 VL - 22 IS - 12 KW - virtual health KW - digital health KW - virtual mental health KW - mental health KW - public health KW - COVID-19 KW - coping KW - stress KW - implementation KW - utilization N2 - Background: The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. Objective: The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. Methods: Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. Results: Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping ?not well? with COVID-19?related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. Conclusions: Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use. UR - http://www.jmir.org/2020/12/e24868/ UR - http://dx.doi.org/10.2196/24868 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315583 ID - info:doi/10.2196/24868 ER - TY - JOUR AU - Burnett, Dayle AU - Eapen, Valsamma AU - Lin, Ping-I PY - 2020/12/30 TI - Time Trends of the Public?s Attention Toward Suicide During the COVID-19 Pandemic: Retrospective, Longitudinal Time-Series Study JO - JMIR Public Health Surveill SP - e24694 VL - 6 IS - 4 KW - COVID-19 KW - suicide KW - infodemiology KW - infoveillance KW - Google Trends KW - time trend KW - school closure KW - attention KW - mental health KW - crisis KW - time series N2 - Background: The COVID-19 pandemic has overwhelmed health care systems around the world. Emerging evidence has suggested that substantially few patients seek help for suicidality at clinical settings during the COVID-19 pandemic, which has elicited concerns of an imminent mental health crisis as the course of the pandemic continues to unfold. Clarifying the relationship between the public?s attention to knowledge about suicide and the public?s attention to knowledge about the COVID-19 pandemic may provide insight into developing prevention strategies for a putative surge of suicide in relation to the impact of the COVID-19 pandemic. Objective: The goal of this retrospective, longitudinal time-series study is to understand the relationship between temporal trends of interest for the search term ?suicide? and those of COVID-19?related terms, such as ?social distancing,? ?school closure,? and ?lockdown.? Methods: We used the Google Trends platform to collect data on daily interest levels for search terms related to suicide, several other mental health-related issues, and COVID-19 over the period between February 14, 2020 and May 13, 2020. A correlational analysis was performed to determine the association between the search term ??suicide?? and COVID-19?related search terms in 16 countries. The Mann-Kendall test was used to examine significant differences between interest levels for the search term ?suicide? before and after school closure. Results: We found that interest levels for the search term ?suicide? statistically significantly inversely correlated with interest levels for the search terms ?COVID-19? or ?coronavirus? in nearly all countries between February 14, 2020 and May 13, 2020. Additionally, search interest for the term ??suicide?? significantly and negatively correlated with that of many COVID-19?related search terms, and search interest varied between countries. The Mann-Kendall test was used to examine significant differences between search interest levels for the term ?suicide? before and after school closure. The Netherlands (P=.19), New Zealand (P=.003), the United Kingdom (P=.006), and the United States (P=.049) showed significant negative trends in interest levels for suicide in the 2-week period preceding school closures. In contrast, interest levels for suicide had a significant positive trend in Canada (P<.001) and the United States (P=.002) after school closures. Conclusions: The public?s attention to suicide might inversely correlate with the public?s attention to COVID-19?related issues. Additionally, several anticontagion policies, such as school closure, might have led to a turning point for mental health crises, because the attention to suicidality increased after restrictions were implemented. Our results suggest that an increased risk of suicidal ideation may ensue due to the ongoing anticontagion policies. Timely intervention strategies for suicides should therefore be an integral part of efforts to flatten the epidemic curve. UR - http://publichealth.jmir.org/2020/4/e24694/ UR - http://dx.doi.org/10.2196/24694 UR - http://www.ncbi.nlm.nih.gov/pubmed/33326407 ID - info:doi/10.2196/24694 ER - TY - JOUR AU - Obeidat, Lina AU - Masarwa, Nader AU - AlWarawreh, Amjad AU - El-Naji, Waddah PY - 2020/12/29 TI - Dental Treatments During the COVID-19 Pandemic in Three Hospitals in Jordan: Retrospective Study JO - Interact J Med Res SP - e24371 VL - 9 IS - 4 KW - COVID-19 KW - dental treatments KW - Jordan KW - lockdown KW - pandemic N2 - Background: Cases of COVID-19 first emerged in December 2019. Since then, the virus has spread rapidly worldwide, with daily increases in the numbers of infections and deaths. COVID-19 spreads via airborne transmission, which renders dental treatment a potential source of virus transmission. Dental treatments require the use of handpieces, ultrasonic devices, or air?water syringes, which generate considerable amounts of aerosols. Jordan, being one of the affected countries, instituted preventive lockdown measures on March 17, 2020. Emergency dental treatments were only allowed in dental clinics of the Royal Medical Services of Jordan Armed Forces and Ministry of Health, and were prohibited in other sectors such as private clinics and universities. Objective: The aim of this study is to investigate the dental treatments performed in three military hospitals during the 44-day lockdown period in Jordan. The investigation explores the impact of COVID-19 on the number of patients and types of performed dental treatments. Methods: Data such as number of patients, patients? age and gender, and performed dental treatments were collected retrospectively from the hospital records and were analyzed. Results: Our results showed a 90% (17,591 to 1689) decrease in patient visits during the lockdown period compared to regular days. The total number of treatments (n=1689) during the lockdown period varied between endodontic cases (n=877, 51.9%), extraction and other surgical cases (n=374, 22.1%), restorative cases (n=142, 8.4%), orthodontic treatments (n=4, 0.2%), and other procedures (n=292, 17.3%). The differences in gender and age group among all clinics were statistically significant (P<.001 and P=.02, respectively). Conclusions: The COVID-19 pandemic had a significant effect on the number of patients seeking dental treatments. It also affected the types of treatments performed. Endodontic treatment accounted for almost 50% of patient load during the lockdown compared to approximately 20% during regular days. UR - http://www.i-jmr.org/2020/4/e24371/ UR - http://dx.doi.org/10.2196/24371 UR - http://www.ncbi.nlm.nih.gov/pubmed/33325372 ID - info:doi/10.2196/24371 ER - TY - JOUR AU - Pramukti, Iqbal AU - Strong, Carol AU - Sitthimongkol, Yajai AU - Setiawan, Agus AU - Pandin, Rumambo Moses Glorino AU - Yen, Cheng-Fang AU - Lin, Chung-Ying AU - Griffiths, D. Mark AU - Ko, Nai-Ying PY - 2020/12/24 TI - Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students JO - J Med Internet Res SP - e24487 VL - 22 IS - 12 KW - anxiety KW - COVID-19 KW - cross-country KW - suicidal thoughts KW - university students N2 - Background: The COVID-19 pandemic has negatively affected the mental health of university students. Objective: This study examined the psychological responses toward COVID-19 among university students from 3 countries?Indonesia, Taiwan, and Thailand. Methods: We used a web-based, cross-sectional survey to recruit 1985 university students from 5 public universities (2 in Indonesia, 1 in Thailand, and 1 in Taiwan) via popular social media platforms such as Facebook, LINE, WhatsApp, and broadcast. All students (n=938 in Indonesia, n=734 in Thailand, and n=313 in Taiwan) answered questions concerning their anxiety, suicidal thoughts (or sadness), confidence in pandemic control, risk perception of susceptibility to infection, perceived support, resources for fighting infection, and sources of information in the context of the COVID-19 pandemic. Results: Among the 3 student groups, Thai students had the highest levels of anxiety but the lowest levels of confidence in pandemic control and available resources for fighting COVID-19. Factors associated with higher anxiety differed across countries. Less perceived satisfactory support was associated with more suicidal thoughts among Indonesian students. On the other hand, Taiwanese students were more negatively affected by information gathered from the internet and from medical staff than were Indonesian or Thai students. Conclusions: Our findings suggest that health care providers in Thailand may need to pay special attention to Thai university students given that high levels of anxiety were observed in this study population. In addition, health care providers should establish a good support system for university students, as the results of this study indicate a negative association between support and suicidal thoughts. UR - http://www.jmir.org/2020/12/e24487/ UR - http://dx.doi.org/10.2196/24487 UR - http://www.ncbi.nlm.nih.gov/pubmed/33296867 ID - info:doi/10.2196/24487 ER - TY - JOUR AU - Wang, Xiaofeng AU - Ren, Rui AU - Kattan, W. Michael AU - Jehi, Lara AU - Cheng, Zhenshun AU - Fang, Kuangnan PY - 2020/12/23 TI - Public Health Interventions? Effect on Hospital Use in Patients With COVID-19: Comparative Study JO - JMIR Public Health Surveill SP - e25174 VL - 6 IS - 4 KW - COVID-19 KW - public health KW - intervention KW - hospital KW - use KW - prediction KW - comparative KW - United States KW - China KW - implementation KW - observational N2 - 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. UR - http://publichealth.jmir.org/2020/4/e25174/ UR - http://dx.doi.org/10.2196/25174 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315585 ID - info:doi/10.2196/25174 ER - TY - JOUR AU - Zeng, Kylie AU - Bernardo, N. Stephanie AU - Havins, E. Weldon PY - 2020/12/23 TI - The Use of Digital Tools to Mitigate the COVID-19 Pandemic: Comparative Retrospective Study of Six Countries JO - JMIR Public Health Surveill SP - e24598 VL - 6 IS - 4 KW - COVID-19 KW - digital tool KW - policy KW - proposal KW - digital health KW - precaution KW - spread KW - contact tracing KW - public health N2 - 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. UR - http://publichealth.jmir.org/2020/4/e24598/ UR - http://dx.doi.org/10.2196/24598 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302255 ID - info:doi/10.2196/24598 ER - TY - JOUR AU - McKee, L. Kevin AU - Crandell, C. Ian AU - Hanlon, L. Alexandra PY - 2020/12/23 TI - County-Level Social Distancing and Policy Impact in the United States: A Dynamical Systems Model JO - JMIR Public Health Surveill SP - e23902 VL - 6 IS - 4 KW - pandemic KW - SARS-CoV-2 KW - infection control KW - COVID-19 KW - social distancing KW - lockdown KW - nonpharmaceutical interventions KW - public health KW - intervention KW - model KW - infectious disease KW - policy N2 - 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. UR - http://publichealth.jmir.org/2020/4/e23902/ UR - http://dx.doi.org/10.2196/23902 UR - http://www.ncbi.nlm.nih.gov/pubmed/33296866 ID - info:doi/10.2196/23902 ER - TY - JOUR AU - Hansen, Gregory AU - Cyr, Amelie PY - 2020/12/23 TI - Canada?s Decentralized ?Human-Driven? Approach During the Early COVID-19 Pandemic JO - JMIR Public Health Surveill SP - e20343 VL - 6 IS - 4 KW - COVID-19 KW - coronavirus infection KW - public health UR - http://publichealth.jmir.org/2020/4/e20343/ UR - http://dx.doi.org/10.2196/20343 UR - http://www.ncbi.nlm.nih.gov/pubmed/33315582 ID - info:doi/10.2196/20343 ER - TY - JOUR AU - Gupta, Bhawna AU - Sharma, Vyom AU - Kumar, Narinder AU - Mahajan, Akanksha PY - 2020/12/22 TI - Anxiety and Sleep Disturbances Among Health Care Workers During the COVID-19 Pandemic in India: Cross-Sectional Online Survey JO - JMIR Public Health Surveill SP - e24206 VL - 6 IS - 4 KW - occupational epidemiology KW - anxiety KW - GAD-7 KW - sleep quality KW - health care worker KW - pandemic KW - COVID-19 KW - online survey KW - sleep KW - mental health, personal protective equipment N2 - Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the global medical community and has resulted in an unprecedented psychological impact on health care workers, who were already working under stressful conditions. Objective: In this study, we aimed to evaluate and measure the effects of the COVID-19 pandemic on the anxiety levels and sleep quality among health care workers in India, as well as to determine how the unavailability of personal protective equipment affects their willingness to provide patient-related care. Methods: We conducted an online cross-sectional study using piloted, structured questionnaires with self-reported responses from 368 volunteer male and female health care workers in India. Study participants were identified through social networking platforms such as Facebook and WhatsApp. The survey evaluated the participants? degree of signs and symptoms of anxiety and sleep quality based on the 7-item Generalized Anxiety Disorder (GAD-7) scale and single-item Sleep Quality Scale, respectively. Information on the availability of personal protective equipment was collected based on responses to relevant survey questions. Results: The majority of health care workers (126/368, 34.2%) were in the age group 45-60 years, and 52.2% (192/368) were doctors. Severe anxiety (ie, GAD-7 score >10) was observed among 7.3% (27/368) health care workers, whereas moderate, mild, and minimal anxiety was observed among 12.5% (46/368), 29.3% (108/368), and 50.8% (187/368) health care workers, respectively. Moreover, 31.5% (116/368) of the health care workers had poor-to-fair sleep quality (ie, scores <6). Univariate analysis showed female gender and inadequate availability of personal protective equipment was significantly associated with higher anxiety levels (P=.01 for both). Sleep disturbance was significantly associated with age <30 years (P=.04) and inadequate personal protective equipment (P<.001). Multivariable analysis showed that poorer quality of sleep was associated with higher anxiety levels (P<.001). Conclusions: The COVID-19 pandemic has potentially caused significant levels of anxiety and sleep disturbances among health care workers, particularly associated with the female gender, younger age group, and inadequate availability of personal protective equipment. These factors put health care workers at constant risk of contracting the infection themselves or transmitting it to their families. Early identification of at-risk health care workers and implementation of situation-tailored mitigation measures could help alleviate the risk of long-term, serious psychological sequelae as well as reduce current anxiety levels among health care workers. UR - https://publichealth.jmir.org/2020/4/e24206 UR - http://dx.doi.org/10.2196/24206 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284784 ID - info:doi/10.2196/24206 ER - TY - JOUR AU - Ebrahim, Senan AU - Ashworth, Henry AU - Noah, Cray AU - Kadambi, Adesh AU - Toumi, Asmae AU - Chhatwal, Jagpreet PY - 2020/12/21 TI - Reduction of COVID-19 Incidence and Nonpharmacologic Interventions: Analysis Using a US County?Level Policy Data Set JO - J Med Internet Res SP - e24614 VL - 22 IS - 12 KW - communicable diseases KW - COVID-19 KW - data set KW - pandemic KW - policy KW - public health KW - data KW - intervention KW - effectiveness KW - incidence KW - time series N2 - Background: Worldwide, nonpharmacologic interventions (NPIs) have been the main tool used to mitigate the COVID-19 pandemic. This includes social distancing measures (closing businesses, closing schools, and quarantining symptomatic persons) and contacttracing (tracking and following exposed individuals). While preliminary research across the globe has shown these policies to be effective, there is currently a lack of information on the effectiveness of NPIs in the United States. Objective: The purpose of this study was to create a granular NPI data set at the county level and then analyze the relationship between NPI policies and changes in reported COVID-19 cases. Methods: Using a standardized crowdsourcing methodology, we collected time-series data on 7 key NPIs for 1320 US counties. Results: This open-source data set is the largest and most comprehensive collection of county NPI policy data and meets the need for higher-resolution COVID-19 policy data. Our analysis revealed a wide variation in county-level policies both within and among states (P<.001). We identified a correlation between workplace closures and lower growth rates of COVID-19 cases (P=.004). We found weak correlations between shelter-in-place enforcement and measures of Democratic local voter proportion (R=0.21) and elected leadership (R=0.22). Conclusions: This study is the first large-scale NPI analysis at the county level demonstrating a correlation between NPIs and decreased rates of COVID-19. Future work using this data set will explore the relationship between county-level policies and COVID-19 transmission to optimize real-time policy formulation. UR - http://www.jmir.org/2020/12/e24614/ UR - http://dx.doi.org/10.2196/24614 UR - http://www.ncbi.nlm.nih.gov/pubmed/33302253 ID - info:doi/10.2196/24614 ER - TY - JOUR AU - Jimenez, Jimenez Alberto AU - Estevez-Reboredo, M. Rosa AU - Santed, A. Miguel AU - Ramos, Victoria PY - 2020/12/18 TI - COVID-19 Symptom-Related Google Searches and Local COVID-19 Incidence in Spain: Correlational Study JO - J Med Internet Res SP - e23518 VL - 22 IS - 12 KW - behavioral epidemiology KW - big data KW - smart data KW - tracking KW - nowcasting KW - forecast KW - predict KW - infosurveillance KW - infodemiology KW - COVID-19 N2 - 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. UR - http://www.jmir.org/2020/12/e23518/ UR - http://dx.doi.org/10.2196/23518 UR - http://www.ncbi.nlm.nih.gov/pubmed/33156803 ID - info:doi/10.2196/23518 ER - TY - JOUR AU - Utamura, Motoaki AU - Koizumi, Makoto AU - Kirikami, Seiichi PY - 2020/12/16 TI - An Epidemiological Model Considering Isolation to Predict COVID-19 Trends in Tokyo, Japan: Numerical Analysis JO - JMIR Public Health Surveill SP - e23624 VL - 6 IS - 4 KW - coronavirus KW - COVID-19 KW - epidemiological model KW - prediction KW - Tokyo KW - delay differential equation KW - SIR model KW - model KW - epidemiology KW - isolation KW - trend N2 - 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 ?=1.43?0 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. UR - http://publichealth.jmir.org/2020/4/e23624/ UR - http://dx.doi.org/10.2196/23624 UR - http://www.ncbi.nlm.nih.gov/pubmed/33259325 ID - info:doi/10.2196/23624 ER - TY - JOUR AU - Ngoc Cong Duong, Khanh AU - Nguyen Le Bao, Tien AU - Thi Lan Nguyen, Phuong AU - Vo Van, Thanh AU - Phung Lam, Toi AU - Pham Gia, Anh AU - Anuratpanich, Luerat AU - Vo Van, Bay PY - 2020/12/15 TI - Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study JO - JMIR Form Res SP - e24776 VL - 4 IS - 12 KW - COVID-19 KW - mental health KW - psychological distress KW - depression KW - anxiety KW - Vietnam KW - psychology KW - distress KW - lockdown KW - survey N2 - Background: The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. Objective: This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. Methods: We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. Results: A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor?s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=?7.84, 95% CI ?14.58 to ?1.11). Conclusions: The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. UR - http://formative.jmir.org/2020/12/e24776/ UR - http://dx.doi.org/10.2196/24776 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284778 ID - info:doi/10.2196/24776 ER - TY - JOUR AU - Abd-Alrazaq, Alaa AU - Alajlani, Mohannad AU - Alhuwail, Dari AU - Schneider, Jens AU - Al-Kuwari, Saif AU - Shah, Zubair AU - Hamdi, Mounir AU - Househ, Mowafa PY - 2020/12/15 TI - Artificial Intelligence in the Fight Against COVID-19: Scoping Review JO - J Med Internet Res SP - e20756 VL - 22 IS - 12 KW - artificial intelligence KW - machine learning KW - deep learning KW - natural language processing KW - coronavirus KW - COVID-19 KW - 2019-nCoV KW - SARS-CoV-2 N2 - Background: In December 2019, COVID-19 broke out in Wuhan, China, leading to national and international disruptions in health care, business, education, transportation, and nearly every aspect of our daily lives. Artificial intelligence (AI) has been leveraged amid the COVID-19 pandemic; however, little is known about its use for supporting public health efforts. Objective: This scoping review aims to explore how AI technology is being used during the COVID-19 pandemic, as reported in the literature. Thus, it is the first review that describes and summarizes features of the identified AI techniques and data sets used for their development and validation. Methods: A scoping review was conducted following the guidelines of PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). We searched the most commonly used electronic databases (eg, MEDLINE, EMBASE, and PsycInfo) between April 10 and 12, 2020. These terms were selected based on the target intervention (ie, AI) and the target disease (ie, COVID-19). Two reviewers independently conducted study selection and data extraction. A narrative approach was used to synthesize the extracted data. Results: We considered 82 studies out of the 435 retrieved studies. The most common use of AI was diagnosing COVID-19 cases based on various indicators. AI was also employed in drug and vaccine discovery or repurposing and for assessing their safety. Further, the included studies used AI for forecasting the epidemic development of COVID-19 and predicting its potential hosts and reservoirs. Researchers used AI for patient outcome?related tasks such as assessing the severity of COVID-19, predicting mortality risk, its associated factors, and the length of hospital stay. AI was used for infodemiology to raise awareness to use water, sanitation, and hygiene. The most prominent AI technique used was convolutional neural network, followed by support vector machine. Conclusions: The included studies showed that AI has the potential to fight against COVID-19. However, many of the proposed methods are not yet clinically accepted. Thus, the most rewarding research will be on methods promising value beyond COVID-19. More efforts are needed for developing standardized reporting protocols or guidelines for studies on AI. UR - http://www.jmir.org/2020/12/e20756/ UR - http://dx.doi.org/10.2196/20756 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284779 ID - info:doi/10.2196/20756 ER - TY - JOUR AU - Urbach, Dietmar AU - Awiszus, Friedemann AU - Leiß, Sven AU - Venton, Tamsin AU - Specht, De Alexander Vincent AU - Apfelbacher, Christian PY - 2020/12/14 TI - Associations of Medications With Lower Odds of Typical COVID-19 Symptoms: Cross-Sectional Symptom Surveillance Study JO - JMIR Public Health Surveill SP - e22521 VL - 6 IS - 4 KW - COVID-19 KW - SARS-CoV-2 KW - statins KW - antihypertensives KW - surveillance KW - hydroxymethyl-glutaryl-coenzyme A reductase inhibitors KW - online survey N2 - Background: As the COVID-19 pandemic continues to spread across the globe, the search for an effective medication to treat the symptoms of COVID-19 continues as well. It would be desirable to identify a medication that is already in use for another condition and whose side effect profile and safety data are already known and approved. Objective: The objective of this study was to evaluate the effect of different medications on typical COVID-19 symptoms by using data from an online surveillance survey. Methods: Between early April and late-July 2020, a total of 3654 individuals in Lower Saxony, Germany, participated in an online symptom-tracking survey conducted through the app covid-nein-danke.de. The questionnaire comprised items on typical COVID-19 symptoms, age range, gender, employment in patient-facing healthcare, housing status, postal code, previous illnesses, permanent medication, vaccination status, results of reverse transcription polymerase chain reaction (RT-PCR) and antibody tests for COVID-19 diagnosis, and consequent COVID-19 treatment if applicable. Odds ratio estimates with corresponding 95% CIs were computed for each medication and symptom by using logistic regression models. Results: Data analysis suggested a statistically significant inverse relationship between typical COVID-19 symptoms self-reported by the participants and self-reported statin therapy and, to a lesser extent, antihypertensive therapy. When COVID-19 diagnosis was based on restrictive symptom criteria (ie, presence of 4 out of 7 symptoms) or a positive RT-PCR test, a statistically significant association was found solely for statins (odds ratio 0.28, 95% CI 0.1-0.78). Conclusions: Individuals taking statin medication are more likely to have asymptomatic COVID-19, in which case they may be at an increased risk of transmitting the disease unknowingly. We suggest that the results of this study be incorporated into symptoms-based surveillance and decision-making protocols in regard to COVID-19 management. Whether statin therapy has a beneficial effect in combating COVID-19 cannot be deduced based on our findings and should be investigated by further study. Trial Registration: German Clinical Trials Register DRKS00022185; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022185; World Health Organization International Clinical Trials Registry Platform U1111-1252-6946 UR - http://publichealth.jmir.org/2020/4/e22521/ UR - http://dx.doi.org/10.2196/22521 UR - http://www.ncbi.nlm.nih.gov/pubmed/33197879 ID - info:doi/10.2196/22521 ER - TY - JOUR AU - Valdez, Danny AU - ten Thij, Marijn AU - Bathina, Krishna AU - Rutter, A. Lauren AU - Bollen, Johan PY - 2020/12/14 TI - Social Media Insights Into US Mental Health During the COVID-19 Pandemic: Longitudinal Analysis of Twitter Data JO - J Med Internet Res SP - e21418 VL - 22 IS - 12 KW - social media KW - analytics KW - infodemiology KW - infoveillance KW - COVID-19 KW - United States KW - mental health KW - informatics KW - sentiment analysis KW - Twitter N2 - Background: The COVID-19 pandemic led to unprecedented mitigation efforts that disrupted the daily lives of millions. Beyond the general health repercussions of the pandemic itself, these measures also present a challenge to the world?s mental health and health care systems. Considering that traditional survey methods are time-consuming and expensive, we need timely and proactive data sources to respond to the rapidly evolving effects of health policy on our population?s mental health. Many people in the United States now use social media platforms such as Twitter to express the most minute details of their daily lives and social relations. This behavior is expected to increase during the COVID-19 pandemic, rendering social media data a rich field to understand personal well-being. Objective: This study aims to answer three research questions: (1) What themes emerge from a corpus of US tweets about COVID-19? (2) To what extent did social media use increase during the onset of the COVID-19 pandemic? and (3) Does sentiment change in response to the COVID-19 pandemic? Methods: We analyzed 86,581,237 public domain English language US tweets collected from an open-access public repository in three steps. First, we characterized the evolution of hashtags over time using latent Dirichlet allocation (LDA) topic modeling. Second, we increased the granularity of this analysis by downloading Twitter timelines of a large cohort of individuals (n=354,738) in 20 major US cities to assess changes in social media use. Finally, using this timeline data, we examined collective shifts in public mood in relation to evolving pandemic news cycles by analyzing the average daily sentiment of all timeline tweets with the Valence Aware Dictionary and Sentiment Reasoner (VADER) tool. Results: LDA topics generated in the early months of the data set corresponded to major COVID-19?specific events. However, as state and municipal governments began issuing stay-at-home orders, latent themes shifted toward US-related lifestyle changes rather than global pandemic-related events. Social media volume also increased significantly, peaking during stay-at-home mandates. Finally, VADER sentiment analysis scores of user timelines were initially high and stable but decreased significantly, and continuously, by late March. Conclusions: Our findings underscore the negative effects of the pandemic on overall population sentiment. Increased use rates suggest that, for some, social media may be a coping mechanism to combat feelings of isolation related to long-term social distancing. However, in light of the documented negative effect of heavy social media use on mental health, social media may further exacerbate negative feelings in the long-term for many individuals. Thus, considering the overburdened US mental health care structure, these findings have important implications for ongoing mitigation efforts. UR - http://www.jmir.org/2020/12/e21418/ UR - http://dx.doi.org/10.2196/21418 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284783 ID - info:doi/10.2196/21418 ER - TY - JOUR AU - Grow, André AU - Perrotta, Daniela AU - Del Fava, Emanuele AU - Cimentada, Jorge AU - Rampazzo, Francesco AU - Gil-Clavel, Sofia AU - Zagheni, Emilio PY - 2020/12/14 TI - Addressing Public Health Emergencies via Facebook Surveys: Advantages, Challenges, and Practical Considerations JO - J Med Internet Res SP - e20653 VL - 22 IS - 12 KW - Facebook KW - web-based surveys KW - public health emergency KW - COVID-19 UR - http://www.jmir.org/2020/12/e20653/ UR - http://dx.doi.org/10.2196/20653 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284782 ID - info:doi/10.2196/20653 ER - TY - JOUR AU - Guérard-Poirier, Natasha AU - Beniey, Michèle AU - Meloche-Dumas, Léamarie AU - Lebel-Guay, Florence AU - Misheva, Bojana AU - Abbas, Myriam AU - Dhane, Malek AU - Elraheb, Myriam AU - Dubrowski, Adam AU - Patocskai, Erica PY - 2020/12/14 TI - An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e21273 VL - 9 IS - 12 KW - distance learning KW - COVID-19 KW - surgical pedagogy KW - learning platform KW - subcuticular sutures KW - advanced sutures KW - medical education KW - peer learning KW - surgery KW - medical student KW - web-based learning KW - web-based tool KW - gamification KW - video N2 - Background: Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training. Objective: Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students? ability to identify and perform the correct technique. We will also assess the students? satisfaction with regard to GEN. Methods: We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students? ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students? acceptance of the intervention. Results: The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet. Conclusions: Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative. Trial Registration: ClinicalTrials.gov NCT04425499; https://clinicaltrials.gov/ct2/show/NCT04425499 International Registered Report Identifier (IRRID): PRR1-10.2196/21273 UR - http://www.researchprotocols.org/2020/12/e21273/ UR - http://dx.doi.org/10.2196/21273 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284780 ID - info:doi/10.2196/21273 ER - TY - JOUR AU - Jeong, Hun Gwang AU - Lee, Jeong Hyo AU - Lee, Jinhee AU - Lee, Young Jun AU - Lee, Hwa Keum AU - Han, Joo Young AU - Yoon, Sojung AU - Ryu, Seohyun AU - Kim, Kyung Da AU - Park, Bae Myung AU - Yang, Won Jae AU - Effenberger, Maria AU - Eisenhut, Michael AU - Hong, Hwi Sung AU - Kronbichler, Andreas AU - Ghayda, Abou Ramy AU - Shin, Il Jae PY - 2020/12/10 TI - Effective Control of COVID-19 in South Korea: Cross-Sectional Study of Epidemiological Data JO - J Med Internet Res SP - e22103 VL - 22 IS - 12 KW - COVID-19 KW - Korea KW - strategies KW - epidemiological characteristics N2 - 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. UR - http://www.jmir.org/2020/12/e22103/ UR - http://dx.doi.org/10.2196/22103 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151893 ID - info:doi/10.2196/22103 ER - TY - JOUR AU - Saliba-Gustafsson, A. Erika AU - Miller-Kuhlmann, Rebecca AU - Kling, R. Samantha M. AU - Garvert, W. Donn AU - Brown-Johnson, G. Cati AU - Lestoquoy, Sophia Anna AU - Verano, Mae-Richelle AU - Yang, Laurice AU - Falco-Walter, Jessica AU - Shaw, G. Jonathan AU - Asch, M. Steven AU - Gold, A. Carl AU - Winget, Marcy PY - 2020/12/9 TI - Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation JO - J Med Internet Res SP - e24328 VL - 22 IS - 12 KW - teleneurology KW - telemedicine KW - telehealth KW - ambulatory neurology KW - video visits KW - COVID-19 KW - implementation KW - outcomes KW - video KW - neurology KW - mixed methods KW - acceptability KW - sustainability N2 - Background: Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology?s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. Objective: To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. Methods: Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. Results: Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient?s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. Conclusions: Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike. UR - http://www.jmir.org/2020/12/e24328/ UR - http://dx.doi.org/10.2196/24328 UR - http://www.ncbi.nlm.nih.gov/pubmed/33245699 ID - info:doi/10.2196/24328 ER - TY - JOUR AU - Alshalan, Raghad AU - Al-Khalifa, Hend AU - Alsaeed, Duaa AU - Al-Baity, Heyam AU - Alshalan, Shahad PY - 2020/12/8 TI - Detection of Hate Speech in COVID-19?Related Tweets in the Arab Region: Deep Learning and Topic Modeling Approach JO - J Med Internet Res SP - e22609 VL - 22 IS - 12 KW - COVID-19 KW - coronavirus KW - Twitter KW - hate speech KW - social network analysis KW - social media KW - public health KW - pandemic KW - deep learning KW - non-negative matrix factorization KW - NMF KW - convolutional neural network KW - CNN N2 - 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. UR - http://www.jmir.org/2020/12/e22609/ UR - http://dx.doi.org/10.2196/22609 UR - http://www.ncbi.nlm.nih.gov/pubmed/33207310 ID - info:doi/10.2196/22609 ER - TY - JOUR AU - Xu, Qing AU - Shen, Ziyi AU - Shah, Neal AU - Cuomo, Raphael AU - Cai, Mingxiang AU - Brown, Matthew AU - Li, Jiawei AU - Mackey, Tim PY - 2020/12/7 TI - Characterizing Weibo Social Media Posts From Wuhan, China During the Early Stages of the COVID-19 Pandemic: Qualitative Content Analysis JO - JMIR Public Health Surveill SP - e24125 VL - 6 IS - 4 KW - COVID-19 KW - infodemiology KW - infoveillance KW - infodemic KW - Weibo KW - social media KW - content analysis KW - China KW - data mining KW - knowledge KW - attitude KW - behavior N2 - 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. UR - http://publichealth.jmir.org/2020/4/e24125/ UR - http://dx.doi.org/10.2196/24125 UR - http://www.ncbi.nlm.nih.gov/pubmed/33175693 ID - info:doi/10.2196/24125 ER - TY - JOUR AU - Bhatti, Rahila AU - Khamis, Hassan Amar AU - Khatib, Samara AU - Shiraz, Seemin AU - Matfin, Glenn PY - 2020/12/7 TI - Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study JO - JMIR Public Health Surveill SP - e22471 VL - 6 IS - 4 KW - Diabetes KW - COVID-19 KW - characteristic KW - outcome KW - chronic condition KW - cross-sectional N2 - 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. UR - http://publichealth.jmir.org/2020/4/e22471/ UR - http://dx.doi.org/10.2196/22471 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284130 ID - info:doi/10.2196/22471 ER - TY - JOUR AU - Post, Ann Lori AU - Issa, Ziad Tariq AU - Boctor, J. Michael AU - Moss, B. Charles AU - Murphy, L. Robert AU - Ison, G. Michael AU - Achenbach, J. Chad AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - White, Janine AU - Faber, Mitchell Joshua Marco AU - Culler, Kasen AU - Brandt, A. Cynthia AU - Oehmke, Francis James PY - 2020/12/3 TI - Dynamic Public Health Surveillance to Track and Mitigate the US COVID-19 Epidemic: Longitudinal Trend Analysis Study JO - J Med Internet Res SP - e24286 VL - 22 IS - 12 KW - global COVID-19 surveillance KW - United States public health surveillance KW - US COVID-19 KW - surveillance metrics KW - dynamic panel data KW - generalized method of the moments KW - United States econometrics KW - US SARS-CoV-2 KW - US COVID-19 surveillance system KW - US COVID-19 transmission speed KW - COVID-19 transmission acceleration KW - COVID-19 speed KW - COVID-19 acceleration KW - COVID-19 jerk KW - COVID-19 persistence KW - Arellano-Bond estimator KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2020/12/e24286 UR - http://dx.doi.org/10.2196/24286 UR - http://www.ncbi.nlm.nih.gov/pubmed/33216726 ID - info:doi/10.2196/24286 ER - TY - JOUR AU - Berkovic, Danielle AU - Ackerman, N. Ilana AU - Briggs, M. Andrew AU - Ayton, Darshini PY - 2020/12/3 TI - Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis JO - J Med Internet Res SP - e24550 VL - 22 IS - 12 KW - COVID-19 KW - SARS-CoV-2 KW - novel coronavirus KW - social media KW - Twitter KW - content analysis KW - sentiment analysis KW - microblogging KW - arthritis N2 - 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. UR - https://www.jmir.org/2020/12/e24550 UR - http://dx.doi.org/10.2196/24550 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170802 ID - info:doi/10.2196/24550 ER - TY - JOUR AU - Zhang, Melvyn AU - Chow, Aloysius AU - Smith, Helen PY - 2020/12/3 TI - COVID-19 Contact-Tracing Apps: Analysis of the Readability of Privacy Policies JO - J Med Internet Res SP - e21572 VL - 22 IS - 12 KW - COVID-19 KW - smartphone apps KW - contact tracing KW - privacy policy KW - readability KW - app KW - privacy KW - surveillance UR - https://www.jmir.org/2020/12/e21572 UR - http://dx.doi.org/10.2196/21572 UR - http://www.ncbi.nlm.nih.gov/pubmed/33170798 ID - info:doi/10.2196/21572 ER - TY - JOUR AU - Xu, Paiheng AU - Dredze, Mark AU - Broniatowski, A. David PY - 2020/12/3 TI - The Twitter Social Mobility Index: Measuring Social Distancing Practices With Geolocated Tweets JO - J Med Internet Res SP - e21499 VL - 22 IS - 12 KW - COVID-19 KW - social distancing KW - mobility KW - Twitter KW - social media KW - surveillance KW - tracking KW - travel KW - index N2 - 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. UR - https://www.jmir.org/2020/12/e21499 UR - http://dx.doi.org/10.2196/21499 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048823 ID - info:doi/10.2196/21499 ER - TY - JOUR AU - Zhang, Yuemei AU - Cheng, Sheng-Ru PY - 2020/12/3 TI - Evaluating the Need for Routine COVID-19 Testing of Emergency Department Staff: Quantitative Analysis JO - JMIR Public Health Surveill SP - e20260 VL - 6 IS - 4 KW - infectious KW - diseases KW - COVID-19 KW - modeling KW - policy KW - emergency medicine KW - healthcare KW - health policy KW - screening tests KW - surveillance screening N2 - Background: As the number of COVID-19 cases in the US continues to increase and hospitals experience shortage of personal protective equipment (PPE), health care workers have been disproportionately affected. However, since COVID-19 testing is now easily available, there is a need to evaluate whether routine testing should be performed for asymptomatic health care workers. Objective: This study aimed to provide a quantitative analysis of the predicted impact that regular testing of health care workers for COVID-19 may have on the prevention of the disease among emergency department patients and staff. Methods: Using publicly available data on COVID-19 cases and emergency department visits, as well as internal hospital staffing information, we developed a mathematical model to predict the impact of periodic COVID-19 testing of asymptomatic staff members of the emergency department in COVID-19?affected regions. We calculated various transmission constants based on the Diamond Princess cruise ship data, used a logistic model to calculate new infections, and developed a Markov model based on the average incubation period for COVID-19. Results: Our model predicts that after 180 days, with a transmission constant of 1.219e-4 new infections/person2, weekly COVID-19 testing of health care workers would reduce new health care worker and patient infections by approximately 3%-5.9%, and biweekly testing would reduce infections in both by 1%-2.1%. At a transmission constant of 3.660e-4 new infections/person2, weekly testing would reduce infections by 11%-23% and biweekly testing would reduce infections by 5.5%-13%. At a lower transmission constant of 4.067e-5 new infections/person2, weekly and biweekly COVID-19 testing for health care workers would result in an approximately 1% and 0.5%-0.8% reduction in infections, respectively. Conclusions: Periodic COVID-19 testing for emergency department staff in regions that are heavily affected by COVID-19 or are facing resource constraints may significantly reduce COVID-19 transmission among health care workers and previously uninfected patients. UR - http://publichealth.jmir.org/2020/4/e20260/ UR - http://dx.doi.org/10.2196/20260 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052873 ID - info:doi/10.2196/20260 ER - TY - JOUR AU - Fusillo, Tara PY - 2020/12/2 TI - Predicting Health Disparities in Regions at Risk of Severe Illness to Inform Health Care Resource Allocation During Pandemics: Observational Study JO - JMIRx Med SP - e22470 VL - 1 IS - 1 KW - coronavirus KW - SARS-CoV-2 KW - COVID-19 KW - pandemic KW - socioeconomic status KW - predictive model KW - health care resource allocation N2 - 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. UR - https://med.jmirx.org/2020/1/e22470/ UR - http://dx.doi.org/10.2196/22470 UR - http://www.ncbi.nlm.nih.gov/pubmed/33711085 ID - info:doi/10.2196/22470 ER - TY - JOUR AU - Du, Junfeng AU - Mayer, Gwendolyn AU - Hummel, Svenja AU - Oetjen, Neele AU - Gronewold, Nadine AU - Zafar, Ali AU - Schultz, Jobst-Hendrik PY - 2020/12/2 TI - Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study JO - J Med Internet Res SP - e24240 VL - 22 IS - 12 KW - mental health KW - COVID-19 KW - China KW - depression KW - anxiety KW - lockdown KW - coping strategies KW - stressors KW - stress KW - doctors KW - nurses KW - students KW - media consumption KW - WeChat N2 - 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. UR - https://www.jmir.org/2020/12/e24240 UR - http://dx.doi.org/10.2196/24240 UR - http://www.ncbi.nlm.nih.gov/pubmed/33197231 ID - info:doi/10.2196/24240 ER - TY - JOUR AU - Plante, B. Timothy AU - Blau, M. Aaron AU - Berg, N. Adrian AU - Weinberg, S. Aaron AU - Jun, C. Ik AU - Tapson, F. Victor AU - Kanigan, S. Tanya AU - Adib, B. Artur PY - 2020/12/2 TI - 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 JO - J Med Internet Res SP - e24048 VL - 22 IS - 12 KW - COVID-19 KW - SARS-CoV-2 KW - machine learning KW - artificial intelligence KW - electronic medical records KW - laboratory results KW - development KW - validation KW - testing KW - model KW - emergency department N2 - 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. UR - https://www.jmir.org/2020/12/e24048 UR - http://dx.doi.org/10.2196/24048 UR - http://www.ncbi.nlm.nih.gov/pubmed/33226957 ID - info:doi/10.2196/24048 ER - TY - JOUR AU - Sutter, Rebecca AU - Cuellar, E. Alison AU - Harvey, Megan AU - Hong, Alicia Y. PY - 2020/12/1 TI - Academic Nurse-Managed Community Clinics Transitioning to Telehealth: Case Report on the Rapid Response to COVID-19 JO - JMIR Nursing SP - e24521 VL - 3 IS - 1 KW - telehealth KW - telemedicine KW - COVID-19, nurse practitioners KW - safety net clinics KW - community clinics KW - nurse KW - clinic KW - transition N2 - 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. UR - https://nursing.jmir.org/2020/1/e24521/ UR - http://dx.doi.org/10.2196/24521 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496682 ID - info:doi/10.2196/24521 ER - TY - JOUR AU - Doraiswamy, Sathyanarayanan AU - Abraham, Amit AU - Mamtani, Ravinder AU - Cheema, Sohaila PY - 2020/12/1 TI - Use of Telehealth During the COVID-19 Pandemic: Scoping Review JO - J Med Internet Res SP - e24087 VL - 22 IS - 12 KW - COVID-19 KW - telehealth KW - telemedicine KW - scoping review N2 - 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. UR - https://www.jmir.org/2020/12/e24087 UR - http://dx.doi.org/10.2196/24087 UR - http://www.ncbi.nlm.nih.gov/pubmed/33147166 ID - info:doi/10.2196/24087 ER - TY - JOUR AU - Sobowale, Kunmi AU - Hilliard, Heather AU - Ignaszewski, J. Martha AU - Chokroverty, Linda PY - 2020/12/1 TI - Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media JO - J Med Internet Res SP - e21886 VL - 22 IS - 12 KW - social media KW - digital health KW - COVID-19 KW - adolescent KW - public health KW - disaster KW - communication KW - affordances UR - https://www.jmir.org/2020/12/e21886 UR - http://dx.doi.org/10.2196/21886 UR - http://www.ncbi.nlm.nih.gov/pubmed/33226956 ID - info:doi/10.2196/21886 ER - TY - JOUR AU - Nakano, Takashi AU - Ikeda, Yoichi PY - 2020/11/30 TI - Novel Indicator to Ascertain the Status and Trend of COVID-19 Spread: Modeling Study JO - J Med Internet Res SP - e20144 VL - 22 IS - 11 KW - communicable diseases KW - COVID-19 KW - SARS-CoV-2 KW - model KW - modeling KW - virus KW - infectious disease KW - spread N2 - 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. UR - http://www.jmir.org/2020/11/e20144/ UR - http://dx.doi.org/10.2196/20144 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180742 ID - info:doi/10.2196/20144 ER - TY - JOUR AU - Humer, Elke AU - Stippl, Peter AU - Pieh, Christoph AU - Pryss, Rüdiger AU - Probst, Thomas PY - 2020/11/27 TI - Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study JO - J Med Internet Res SP - e20246 VL - 22 IS - 11 KW - psychotherapists KW - remote psychotherapy KW - telephone KW - internet KW - experiences KW - expectations KW - COVID-19 KW - telehealth KW - therapy KW - psychology N2 - Background: The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy. Objective: This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020). Methods: Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed. Results: Psychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P<.001). Psychodynamic (P=.001) and humanistic (P=.005) therapists reported a higher comparability of telephone-based psychotherapy to in-person psychotherapy than behavioral therapists. Experiences with remote therapy (both web- and telephone-based) were more positive than previously expected (P<.001). Psychodynamic therapists reported more positive experiences with telephone-based psychotherapy than expected compared to behavioral (P=.03) and systemic (P=.002) therapists. In general, web-based psychotherapy was rated more positively (regarding comparability to psychotherapy with personal contact and experiences vs expectations) than telephone-based psychotherapy (P<.001); however, psychodynamic therapists reported their previous expectations to be equal to their actual experiences for both telephone- and web-based psychotherapy. Conclusions: Psychotherapists found their experiences with remote psychotherapy (ie, web- or telephone-based psychotherapy) to be better than expected but found that this mode was not totally comparable to face-to-face psychotherapy with personal contact. Especially, behavioral therapists were found to rate telephone-based psychotherapy less favorably than therapists with other theoretical backgrounds. UR - http://www.jmir.org/2020/11/e20246/ UR - http://dx.doi.org/10.2196/20246 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151896 ID - info:doi/10.2196/20246 ER - TY - JOUR AU - Rajkumar, Philip Ravi PY - 2020/11/27 TI - The Relationship Between Demographic, Socioeconomic, and Health-Related Parameters and the Impact of COVID-19 on 24 Regions in India: Exploratory Cross-Sectional Study JO - JMIR Public Health Surveill SP - e23083 VL - 6 IS - 4 KW - burden of disease KW - COVID-19 KW - diarrheal disease KW - ischemic heart disease KW - population size KW - sex ratio N2 - 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. UR - http://publichealth.jmir.org/2020/4/e23083/ UR - http://dx.doi.org/10.2196/23083 UR - http://www.ncbi.nlm.nih.gov/pubmed/33147164 ID - info:doi/10.2196/23083 ER - TY - JOUR AU - Alsharif, Abdullah PY - 2020/11/26 TI - Applying eHealth for Pandemic Management in Saudi Arabia in the Context of COVID-19: Survey Study and Framework Proposal JO - JMIR Med Inform SP - e19524 VL - 8 IS - 11 KW - COVID-19 KW - eHealth framework KW - infectious disease KW - pandemic KW - eHealth KW - public health N2 - Background: The increased frequency of epidemics such as Middle East respiratory syndrome, severe acute respiratory syndrome, Ebola virus, and Zika virus has created stress on health care management and operations as well as on relevant stakeholders. In addition, the recent COVID-19 outbreak has been creating challenges for various countries and their respective health care organizations in managing and controlling the pandemic. One of the most important observations during the recent outbreak is the lack of effective eHealth frameworks for managing and controlling pandemics. Objective: The aims of this study are to review the current National eHealth Strategy of Saudi Arabia and to propose an integrated eHealth framework that can be effective for managing health care operations and services during pandemics. Methods: A questionnaire-based survey was administered to 316 health care professionals to review the current national eHealth framework of Saudi Arabia and identify the objectives, factors, and components that are key for managing and controlling pandemics. Purposive sampling was used to collect responses from diverse experts, including physicians, technical experts, nurses, administrative experts, and pharmacists. The survey was administered at five hospitals in Saudi Arabia by forwarding the survey link using a web-based portal. A sample population of 350 was achieved, which was filtered to exclude incomplete and ineligible samples, giving a sample of 316 participants. Results: Of the 316 participants, 187 (59.2%) found the current eHealth framework to be ineffective, and more than 50% of the total participants stated that the framework lacked some essential components and objectives. Additional components and objectives focusing on using eHealth for managing information, creating awareness, increasing accessibility and reachability, promoting self-management and self-collaboration, promoting electronic services, and extensive stakeholder engagement were considered to be the most important factors by more than 80% of the total participants. Conclusions: Managing pandemics requires an effective and efficient eHealth framework that can be used to manage various health care services by integrating different eHealth components and collaborating with all stakeholders. UR - http://medinform.jmir.org/2020/11/e19524/ UR - http://dx.doi.org/10.2196/19524 UR - http://www.ncbi.nlm.nih.gov/pubmed/33035174 ID - info:doi/10.2196/19524 ER - TY - JOUR AU - Wang, Junze AU - Zhou, Ying AU - Zhang, Wei AU - Evans, Richard AU - Zhu, Chengyan PY - 2020/11/26 TI - Concerns Expressed by Chinese Social Media Users During the COVID-19 Pandemic: Content Analysis of Sina Weibo Microblogging Data JO - J Med Internet Res SP - e22152 VL - 22 IS - 11 KW - coronavirus KW - COVID-19 KW - social media KW - public health KW - Sina Weibo KW - public opinion KW - citizen concerns N2 - Background: The COVID-19 pandemic has created a global health crisis that is affecting economies and societies worldwide. During times of uncertainty and unexpected change, people have turned to social media platforms as communication tools and primary information sources. Platforms such as Twitter and Sina Weibo have allowed communities to share discussion and emotional support; they also play important roles for individuals, governments, and organizations in exchanging information and expressing opinions. However, research that studies the main concerns expressed by social media users during the pandemic is limited. Objective: The aim of this study was to examine the main concerns raised and discussed by citizens on Sina Weibo, the largest social media platform in China, during the COVID-19 pandemic. Methods: We used a web crawler tool and a set of predefined search terms (New Coronavirus Pneumonia, New Coronavirus, and COVID-19) to investigate concerns raised by Sina Weibo users. Textual information and metadata (number of likes, comments, retweets, publishing time, and publishing location) of microblog posts published between December 1, 2019, and July 32, 2020, were collected. After segmenting the words of the collected text, we used a topic modeling technique, latent Dirichlet allocation (LDA), to identify the most common topics posted by users. We analyzed the emotional tendencies of the topics, calculated the proportional distribution of the topics, performed user behavior analysis on the topics using data collected from the number of likes, comments, and retweets, and studied the changes in user concerns and differences in participation between citizens living in different regions of mainland China. Results: Based on the 203,191 eligible microblog posts collected, we identified 17 topics and grouped them into 8 themes. These topics were pandemic statistics, domestic epidemic, epidemics in other countries worldwide, COVID-19 treatments, medical resources, economic shock, quarantine and investigation, patients? outcry for help, work and production resumption, psychological influence, joint prevention and control, material donation, epidemics in neighboring countries, vaccine development, fueling and saluting antiepidemic action, detection, and study resumption. The mean sentiment was positive for 11 topics and negative for 6 topics. The topic with the highest mean of retweets was domestic epidemic, while the topic with the highest mean of likes was quarantine and investigation. Conclusions: Concerns expressed by social media users are highly correlated with the evolution of the global pandemic. During the COVID-19 pandemic, social media has provided a platform for Chinese government departments and organizations to better understand public concerns and demands. Similarly, social media has provided channels to disseminate information about epidemic prevention and has influenced public attitudes and behaviors. Government departments, especially those related to health, can create appropriate policies in a timely manner through monitoring social media platforms to guide public opinion and behavior during epidemics. UR - http://www.jmir.org/2020/11/e22152/ UR - http://dx.doi.org/10.2196/22152 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151894 ID - info:doi/10.2196/22152 ER - TY - JOUR AU - Shauly, Orr AU - Stone, Gregory AU - Gould, Daniel PY - 2020/11/26 TI - The Public?s Perception of the Severity and Global Impact at the Start of the SARS-CoV-2 Pandemic: A Crowdsourcing-Based Cross-Sectional Analysis JO - J Med Internet Res SP - e19768 VL - 22 IS - 11 KW - Amazon Mechanical Turk KW - crowdsourcing KW - COVID-19, SARS-CoV-2 KW - pandemic KW - perception KW - public opinion KW - survey KW - severity KW - impact KW - behavior KW - education N2 - Background: COVID-19 is a rapidly developing threat to most people in the United States and abroad. The behaviors of the public are important to understand, as they may have a tremendous impact on the course of this novel coronavirus pandemic. Objective: This study intends to assess the US population?s perception and knowledge of the virus as a threat and the behaviors of the general population in response. Methods: A prospective cross-sectional study was conducted with random volunteers recruited through Amazon Mechanical Turk, an internet crowdsourcing service, on March 24, 2020. Results: A total of 969 participants met the inclusion criteria. It was found that the perceived severity of the COVID-19 pandemic significantly differed between age groups (P<.001) and men and women (P<.001). A majority of study participants were actively adhering to the Centers for Disease Control and Prevention guidelines. Conclusions: Though many participants identified COVID-19 as a threat, many failed to place themselves appropriately in the correct categories with respect to risk. This may indicate a need for additional public education for appropriately defining the risk of this novel pandemic. UR - http://www.jmir.org/2020/11/e19768/ UR - http://dx.doi.org/10.2196/19768 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108314 ID - info:doi/10.2196/19768 ER - TY - JOUR AU - Dong, Wei AU - Tao, Jinhu AU - Xia, Xiaolin AU - Ye, Lin AU - Xu, Hanli AU - Jiang, Peiye AU - Liu, Yangyang PY - 2020/11/25 TI - Public Emotions and Rumors Spread During the COVID-19 Epidemic in China: Web-Based Correlation Study JO - J Med Internet Res SP - e21933 VL - 22 IS - 11 KW - public emotions KW - rumor KW - infodemic KW - infodemiology KW - infoveillance KW - China KW - COVID-19 N2 - Background: Various online rumors have led to inappropriate behaviors among the public in response to the COVID-19 epidemic in China. These rumors adversely affect people?s physical and mental health. Therefore, a better understanding of the relationship between public emotions and rumors during the epidemic may help generate useful strategies for guiding public emotions and dispelling rumors. Objective: This study aimed to explore whether public emotions are related to the dissemination of online rumors in the context of COVID-19. Methods: We used the web-crawling tool Scrapy to gather data published by People?s Daily on Sina Weibo, a popular social media platform in China, after January 8, 2020. Netizens? comments under each Weibo post were collected. Nearly 1 million comments thus collected were divided into 5 categories: happiness, sadness, anger, fear, and neutral, based on the underlying emotional information identified and extracted from the comments by using a manual identification process. Data on rumors spread online were collected through Tencent?s Jiaozhen platform. Time-lagged cross-correlation analyses were performed to examine the relationship between public emotions and rumors. Results: Our results indicated that the angrier the public felt, the more rumors there would likely be (r=0.48, P<.001). Similar results were observed for the relationship between fear and rumors (r=0.51, P<.001) and between sadness and rumors (r=0.47, P<.001). Furthermore, we found a positive correlation between happiness and rumors, with happiness lagging the emergence of rumors by 1 day (r=0.56, P<.001). In addition, our data showed a significant positive correlation between fear and fearful rumors (r=0.34, P=.02). Conclusions: Our findings confirm that public emotions are related to the rumors spread online in the context of COVID-19 in China. Moreover, these findings provide several suggestions, such as the use of web-based monitoring methods, for relevant authorities and policy makers to guide public emotions and behavior during this public health emergency. UR - http://www.jmir.org/2020/11/e21933/ UR - http://dx.doi.org/10.2196/21933 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112757 ID - info:doi/10.2196/21933 ER - TY - JOUR AU - Cui, Tingting AU - Yang, Guoping AU - Ji, Lili AU - Zhu, Lin AU - Zhen, Shiqi AU - Shi, Naiyang AU - Xu, Yan AU - Jin, Hui PY - 2020/11/25 TI - Chinese Residents? Perceptions of COVID-19 During the Pandemic: Online Cross-sectional Survey Study JO - J Med Internet Res SP - e21672 VL - 22 IS - 11 KW - COVID-19 KW - perception KW - China KW - cross-sectional survey KW - health education KW - time-varying reproduction number KW - knowledge KW - skill KW - behavior KW - work resumption KW - study resumption N2 - 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. UR - http://www.jmir.org/2020/11/e21672/ UR - http://dx.doi.org/10.2196/21672 UR - http://www.ncbi.nlm.nih.gov/pubmed/33152684 ID - info:doi/10.2196/21672 ER - TY - JOUR AU - Chang, Angela AU - Schulz, Johannes Peter AU - Tu, ShengTsung AU - Liu, Tingchi Matthew PY - 2020/11/25 TI - Communicative Blame in Online Communication of the COVID-19 Pandemic: Computational Approach of Stigmatizing Cues and Negative Sentiment Gauged With Automated Analytic Techniques JO - J Med Internet Res SP - e21504 VL - 22 IS - 11 KW - placing blame KW - culprits KW - sentiment analysis KW - infodemic analysis KW - political grievances KW - COVID-19 KW - communication KW - pandemic KW - social media KW - negativity KW - infodemic KW - infodemiology KW - infoveillance KW - blame KW - stigma N2 - Background: Information about a new coronavirus emerged in 2019 and rapidly spread around the world, gaining significant public attention and attracting negative bias. The use of stigmatizing language for the purpose of blaming sparked a debate. Objective: This study aims to identify social stigma and negative sentiment toward the blameworthy agents in social communities. Methods: We enabled a tailored text-mining platform to identify data in their natural settings by retrieving and filtering online sources, and constructed vocabularies and learning word representations from natural language processing for deductive analysis along with the research theme. The data sources comprised of ten news websites, eleven discussion forums, one social network, and two principal media sharing networks in Taiwan. A synthesis of news and social networking analytics was present from December 30, 2019, to March 31, 2020. Results: We collated over 1.07 million Chinese texts. Almost two-thirds of the texts on COVID-19 came from news services (n=683,887, 63.68%), followed by Facebook (n=297,823, 27.73%), discussion forums (n=62,119, 5.78%), and Instagram and YouTube (n=30,154, 2.81%). Our data showed that online news served as a hotbed for negativity and for driving emotional social posts. Online information regarding COVID-19 associated it with China?and a specific city within China through references to the ?Wuhan pneumonia??potentially encouraging xenophobia. The adoption of this problematic moniker had a high frequency, despite the World Health Organization guideline to avoid biased perceptions and ethnic discrimination. Social stigma is disclosed through negatively valenced responses, which are associated with the most blamed targets. Conclusions: Our sample is sufficiently representative of a community because it contains a broad range of mainstream online media. Stigmatizing language linked to the COVID-19 pandemic shows a lack of civic responsibility that encourages bias, hostility, and discrimination. Frequently used stigmatizing terms were deemed offensive, and they might have contributed to recent backlashes against China by directing blame and encouraging xenophobia. The implications ranging from health risk communication to stigma mitigation and xenophobia concerns amid the COVID-19 outbreak are emphasized. Understanding the nomenclature and biased terms employed in relation to the COVID-19 outbreak is paramount. We propose solidarity with communication professionals in combating the COVID-19 outbreak and the infodemic. Finding solutions to curb the spread of virus bias, stigma, and discrimination is imperative. UR - http://www.jmir.org/2020/11/e21504/ UR - http://dx.doi.org/10.2196/21504 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108306 ID - info:doi/10.2196/21504 ER - TY - JOUR AU - Xue, Jia AU - Chen, Junxiang AU - Hu, Ran AU - Chen, Chen AU - Zheng, Chengda AU - Su, Yue AU - Zhu, Tingshao PY - 2020/11/25 TI - Twitter Discussions and Emotions About the COVID-19 Pandemic: Machine Learning Approach JO - J Med Internet Res SP - e20550 VL - 22 IS - 11 KW - machine learning KW - Twitter data KW - COVID-19 KW - infodemic KW - infodemiology KW - infoveillance KW - public discussion KW - public sentiment KW - Twitter KW - social media KW - virus N2 - Background: It is important to measure the public response to the COVID-19 pandemic. Twitter is an important data source for infodemiology studies involving public response monitoring. Objective: The objective of this study is to examine COVID-19?related discussions, concerns, and sentiments using tweets posted by Twitter users. Methods: We analyzed 4 million Twitter messages related to the COVID-19 pandemic using a list of 20 hashtags (eg, ?coronavirus,? ?COVID-19,? ?quarantine?) from March 7 to April 21, 2020. We used a machine learning approach, Latent Dirichlet Allocation (LDA), to identify popular unigrams and bigrams, salient topics and themes, and sentiments in the collected tweets. Results: Popular unigrams included ?virus,? ?lockdown,? and ?quarantine.? Popular bigrams included ?COVID-19,? ?stay home,? ?corona virus,? ?social distancing,? and ?new cases.? We identified 13 discussion topics and categorized them into 5 different themes: (1) public health measures to slow the spread of COVID-19, (2) social stigma associated with COVID-19, (3) COVID-19 news, cases, and deaths, (4) COVID-19 in the United States, and (5) COVID-19 in the rest of the world. Across all identified topics, the dominant sentiments for the spread of COVID-19 were anticipation that measures can be taken, followed by mixed feelings of trust, anger, and fear related to different topics. The public tweets revealed a significant feeling of fear when people discussed new COVID-19 cases and deaths compared to other topics. Conclusions: This study showed that Twitter data and machine learning approaches can be leveraged for an infodemiology study, enabling research into evolving public discussions and sentiments during the COVID-19 pandemic. As the situation rapidly evolves, several topics are consistently dominant on Twitter, such as confirmed cases and death rates, preventive measures, health authorities and government policies, COVID-19 stigma, and negative psychological reactions (eg, fear). Real-time monitoring and assessment of Twitter discussions and concerns could provide useful data for public health emergency responses and planning. Pandemic-related fear, stigma, and mental health concerns are already evident and may continue to influence public trust when a second wave of COVID-19 occurs or there is a new surge of the current pandemic. UR - http://www.jmir.org/2020/11/e20550/ UR - http://dx.doi.org/10.2196/20550 UR - http://www.ncbi.nlm.nih.gov/pubmed/33119535 ID - info:doi/10.2196/20550 ER - TY - JOUR AU - Lian, Wanmin AU - Wen, Li AU - Zhou, Qiru AU - Zhu, Weijie AU - Duan, Wenzhou AU - Xiao, Xiongzhi AU - Mhungu, Florence AU - Huang, Wenchen AU - Li, Chongchong AU - Cheng, Weibin AU - Tian, Junzhang PY - 2020/11/24 TI - Digital Health Technologies Respond to the COVID-19 Pandemic In a Tertiary Hospital in China: Development and Usability Study JO - J Med Internet Res SP - e24505 VL - 22 IS - 11 KW - Internet hospital KW - COVID-19 KW - automated screening KW - symptom KW - monitoring KW - web-based consultation KW - psychological support KW - emergency KW - digital health KW - hospital KW - China KW - screening N2 - 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. UR - http://www.jmir.org/2020/11/e24505/ UR - http://dx.doi.org/10.2196/24505 UR - http://www.ncbi.nlm.nih.gov/pubmed/33141679 ID - info:doi/10.2196/24505 ER - TY - JOUR AU - Levine, Hannun Oren AU - McGillion, Michael AU - Levine, Mark PY - 2020/11/24 TI - Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation JO - JMIR Cancer SP - e24222 VL - 6 IS - 2 KW - care KW - patient-physician relationship KW - patient-centered care KW - oncology care delivery KW - virtual visits KW - telehealth KW - virtual care KW - cancer KW - oncology KW - evaluation KW - COVID-19 UR - http://cancer.jmir.org/2020/2/e24222/ UR - http://dx.doi.org/10.2196/24222 UR - http://www.ncbi.nlm.nih.gov/pubmed/33180741 ID - info:doi/10.2196/24222 ER - TY - JOUR AU - Saha, Koustuv AU - Torous, John AU - Caine, D. Eric AU - De Choudhury, Munmun PY - 2020/11/24 TI - Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media JO - J Med Internet Res SP - e22600 VL - 22 IS - 11 KW - social media KW - Twitter KW - language KW - psychosocial effects KW - mental health KW - transfer learning KW - depression KW - anxiety KW - stress KW - social support KW - emotions KW - COVID-19 KW - coronavirus KW - crisis N2 - Background: The COVID-19 pandemic has caused several disruptions in personal and collective lives worldwide. The uncertainties surrounding the pandemic have also led to multifaceted mental health concerns, which can be exacerbated with precautionary measures such as social distancing and self-quarantining, as well as societal impacts such as economic downturn and job loss. Despite noting this as a ?mental health tsunami?, the psychological effects of the COVID-19 crisis remain unexplored at scale. Consequently, public health stakeholders are currently limited in identifying ways to provide timely and tailored support during these circumstances. Objective: Our study aims to provide insights regarding people?s psychosocial concerns during the COVID-19 pandemic by leveraging social media data. We aim to study the temporal and linguistic changes in symptomatic mental health and support expressions in the pandemic context. Methods: We obtained about 60 million Twitter streaming posts originating from the United States from March 24 to May 24, 2020, and compared these with about 40 million posts from a comparable period in 2019 to attribute the effect of COVID-19 on people?s social media self-disclosure. Using these data sets, we studied people?s self-disclosure on social media in terms of symptomatic mental health concerns and expressions of support. We employed transfer learning classifiers that identified the social media language indicative of mental health outcomes (anxiety, depression, stress, and suicidal ideation) and support (emotional and informational support). We then examined the changes in psychosocial expressions over time and language, comparing the 2020 and 2019 data sets. Results: We found that all of the examined psychosocial expressions have significantly increased during the COVID-19 crisis?mental health symptomatic expressions have increased by about 14%, and support expressions have increased by about 5%, both thematically related to COVID-19. We also observed a steady decline and eventual plateauing in these expressions during the COVID-19 pandemic, which may have been due to habituation or due to supportive policy measures enacted during this period. Our language analyses highlighted that people express concerns that are specific to and contextually related to the COVID-19 crisis. Conclusions: We studied the psychosocial effects of the COVID-19 crisis by using social media data from 2020, finding that people?s mental health symptomatic and support expressions significantly increased during the COVID-19 period as compared to similar data from 2019. However, this effect gradually lessened over time, suggesting that people adapted to the circumstances and their ?new normal.? Our linguistic analyses revealed that people expressed mental health concerns regarding personal and professional challenges, health care and precautionary measures, and pandemic-related awareness. This study shows the potential to provide insights to mental health care and stakeholders and policy makers in planning and implementing measures to mitigate mental health risks amid the health crisis. UR - http://www.jmir.org/2020/11/e22600/ UR - http://dx.doi.org/10.2196/22600 UR - http://www.ncbi.nlm.nih.gov/pubmed/33156805 ID - info:doi/10.2196/22600 ER - TY - JOUR AU - Shen, S. Tony AU - Chen, Z. Aaron AU - Bovonratwet, Patawut AU - Shen, L. Carol AU - Su, P. Edwin PY - 2020/11/23 TI - COVID-19?Related Internet Search Patterns Among People in the United States: Exploratory Analysis JO - J Med Internet Res SP - e22407 VL - 22 IS - 11 KW - COVID-19 KW - pandemic KW - internet KW - infodemic KW - infodemiology KW - infoveillance KW - natural language processing KW - NLP KW - health information KW - information seeking N2 - 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. UR - http://www.jmir.org/2020/11/e22407/ UR - http://dx.doi.org/10.2196/22407 UR - http://www.ncbi.nlm.nih.gov/pubmed/33147163 ID - info:doi/10.2196/22407 ER - TY - JOUR AU - Niburski, Kacper AU - Niburski, Oskar PY - 2020/11/20 TI - Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study JO - J Med Internet Res SP - e20044 VL - 22 IS - 11 KW - COVID-19 KW - behavioral economics KW - public health KW - behavior KW - economics KW - media KW - influence KW - infodemic KW - infodemiology KW - infoveillance KW - Twitter KW - analysis KW - trend N2 - 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. UR - http://www.jmir.org/2020/11/e20044/ UR - http://dx.doi.org/10.2196/20044 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151895 ID - info:doi/10.2196/20044 ER - TY - JOUR AU - AU - Hashmi, Madiha AU - Beane, Abi AU - Murthy, Srinivas AU - Dondorp, M. Arjen AU - Haniffa, Rashan PY - 2020/11/23 TI - Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries JO - JMIR Public Health Surveill SP - e21939 VL - 6 IS - 4 KW - critical care KW - registry KW - informatics KW - COVID-19 KW - severe acute respiratory infection KW - pandemic KW - surveillance KW - cloud-based KW - research KW - low-and-middle-income countries UR - http://publichealth.jmir.org/2020/4/e21939/ UR - http://dx.doi.org/10.2196/21939 UR - http://www.ncbi.nlm.nih.gov/pubmed/33147162 ID - info:doi/10.2196/21939 ER - TY - JOUR AU - Chu, Wei-Min AU - Shieh, Gow-Jen AU - Wu, Shi-Liang AU - Sheu, Huey-Herng Wayne PY - 2020/11/20 TI - Use of Facebook by Academic Medical Centers in Taiwan During the COVID-19 Pandemic: Observational Study JO - J Med Internet Res SP - e21501 VL - 22 IS - 11 KW - COVID-19 KW - social media KW - Facebook KW - medical centers KW - Taiwan KW - communication KW - video post KW - survey KW - health promotion KW - engagement N2 - Background: The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan?s success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success. Objective: This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic. Methods: We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19?related posts or non?COVID-19?related posts. COVID-19?related posts were split into 4 categories: policy of Taiwan?s Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of ?likes,? number of messages left, number of shares, video or non-video post, and date of search. Results: The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more ?likes,? comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook. Conclusions: Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19. UR - http://www.jmir.org/2020/11/e21501/ UR - http://dx.doi.org/10.2196/21501 UR - http://www.ncbi.nlm.nih.gov/pubmed/33119536 ID - info:doi/10.2196/21501 ER - TY - JOUR AU - Post, Ann Lori AU - Argaw, T. Salem AU - Jones, Cameron AU - Moss, B. Charles AU - Resnick, Danielle AU - Singh, Nadya Lauren AU - Murphy, Leo Robert AU - Achenbach, J. Chad AU - White, Janine AU - Issa, Ziad Tariq AU - Boctor, J. Michael AU - Oehmke, Francis James PY - 2020/11/19 TI - A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy JO - J Med Internet Res SP - e24248 VL - 22 IS - 11 KW - global COVID-19 surveillance KW - African public health surveillance KW - sub-Saharan African COVID-19 KW - African surveillance metrics KW - dynamic panel data KW - generalized method of the moments KW - African econometrics KW - African SARS-CoV-2 KW - African COVID-19 surveillance system KW - African COVID-19 transmission speed KW - African COVID-19 transmission acceleration KW - COVID-19 transmission deceleration KW - COVID-19 transmission jerk KW - COVID-19 7-day persistence KW - Sao Tome and Principe KW - Senegal KW - Seychelles KW - Sierra Leone KW - Somalia KW - South Africa KW - South Sudan KW - Sudan KW - Suriname KW - Swaziland KW - Tanzania KW - Togo KW - Uganda KW - Zambia KW - Zimbabwe KW - Gambia KW - Ghana KW - Guinea KW - Guinea-Bissau KW - Kenya KW - Lesotho KW - Liberia KW - Madagascar KW - Malawi KW - Mali KW - Mauritania KW - Mauritius KW - Mozambique KW - Namibia KW - Niger KW - Nigeria KW - Rwanda KW - Angola KW - Benin KW - Botswana KW - Burkina Faso KW - Burundi KW - Cameroon KW - Central African Republic KW - Chad KW - Comoros KW - Congo KW - Cote d'Ivoire KW - Democratic Republic of Congo KW - Equatorial Guinea KW - Eritrea KW - Ethiopia KW - Gabon N2 - 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 UR - https://www.jmir.org/2020/11/e24248 UR - http://dx.doi.org/10.2196/24248 UR - http://www.ncbi.nlm.nih.gov/pubmed/33211026 ID - info:doi/10.2196/24248 ER - TY - JOUR AU - Al-Hasan, Abrar AU - Khuntia, Jiban AU - Yim, Dobin PY - 2020/11/18 TI - Threat, Coping, and Social Distance Adherence During COVID-19: Cross-Continental Comparison Using an Online Cross-Sectional Survey JO - J Med Internet Res SP - e23019 VL - 22 IS - 11 KW - COVID-19 KW - adherence KW - coping appraisal KW - threat appraisal KW - protection motivation theory KW - social distancing KW - information sources KW - social media KW - knowledge KW - coping KW - threat KW - protection KW - motivation KW - cross-sectional KW - survey N2 - 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. UR - http://www.jmir.org/2020/11/e23019/ UR - http://dx.doi.org/10.2196/23019 UR - http://www.ncbi.nlm.nih.gov/pubmed/33119538 ID - info:doi/10.2196/23019 ER - TY - JOUR AU - Alanazi, Eisa AU - Alashaikh, Abdulaziz AU - Alqurashi, Sarah AU - Alanazi, Aued PY - 2020/11/18 TI - Identifying and Ranking Common COVID-19 Symptoms From Tweets in Arabic: Content Analysis JO - J Med Internet Res SP - e21329 VL - 22 IS - 11 KW - health KW - informatics KW - social networks KW - Twitter KW - anosmia KW - Arabic KW - COVID-19 KW - symptom N2 - Background: A substantial amount of COVID-19?related data is generated by Twitter users every day. Self-reports of COVID-19 symptoms on Twitter can reveal a great deal about the disease and its prevalence in the community. In particular, self-reports can be used as a valuable resource to learn more about common symptoms and whether their order of appearance differs among different groups in the community. These data may be used to develop a COVID-19 risk assessment system that is tailored toward a specific group of people. Objective: The aim of this study was to identify the most common symptoms reported by patients with COVID-19, as well as the order of symptom appearance, by examining tweets in Arabic. Methods: We searched Twitter posts in Arabic for personal reports of COVID-19 symptoms from March 1 to May 27, 2020. We identified 463 Arabic users who had tweeted about testing positive for COVID-19 and extracted the symptoms they associated with the disease. Furthermore, we asked them directly via personal messaging to rank the appearance of the first 3 symptoms they had experienced immediately before (or after) their COVID-19 diagnosis. Finally, we tracked their Twitter timeline to identify additional symptoms that were mentioned within ±5 days from the day of the first tweet on their COVID-19 diagnosis. In total, 270 COVID-19 self-reports were collected, and symptoms were (at least partially) ranked. Results: The collected self-reports contained 893 symptoms from 201 (74%) male and 69 (26%) female Twitter users. The majority (n=270, 82%) of the tracked users were living in Saudi Arabia (n=125, 46%) and Kuwait (n=98, 36%). Furthermore, 13% (n=36) of the collected reports were from asymptomatic individuals. Of the 234 users with symptoms, 66% (n=180) provided a chronological order of appearance for at least 3 symptoms. Fever (n=139, 59%), headache (n=101, 43%), and anosmia (n=91, 39%) were the top 3 symptoms mentioned in the self-reports. Additionally, 28% (n=65) reported that their COVID-19 experience started with a fever, 15% (n=34) with a headache, and 12% (n=28) with anosmia. Of the 110 symptomatic cases from Saudi Arabia, the most common 3 symptoms were fever (n=65, 59%), anosmia (n=46, 42%), and headache (n=42, 38%). Conclusions: This study identified the most common symptoms of COVID-19 from tweets in Arabic. These symptoms can be further analyzed in clinical settings and may be incorporated into a real-time COVID-19 risk estimator. UR - http://www.jmir.org/2020/11/e21329/ UR - http://dx.doi.org/10.2196/21329 UR - http://www.ncbi.nlm.nih.gov/pubmed/33119539 ID - info:doi/10.2196/21329 ER - TY - JOUR AU - Li, Mengyao AU - Liu, Li AU - Yang, Yilong AU - Wang, Yang AU - Yang, Xiaoshi AU - Wu, Hui PY - 2020/11/18 TI - Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e20656 VL - 22 IS - 11 KW - COVID-19 KW - anxiety KW - panic KW - health risk KW - communication KW - social media N2 - 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. UR - http://www.jmir.org/2020/11/e20656/ UR - http://dx.doi.org/10.2196/20656 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108308 ID - info:doi/10.2196/20656 ER - TY - JOUR AU - de Lusignan, Simon AU - Liyanage, Harshana AU - McGagh, Dylan AU - Jani, Dinesh Bhautesh AU - Bauwens, Jorgen AU - Byford, Rachel AU - Evans, Dai AU - Fahey, Tom AU - Greenhalgh, Trisha AU - Jones, Nicholas AU - Mair, S. Frances AU - Okusi, Cecilia AU - Parimalanathan, Vaishnavi AU - Pell, P. Jill AU - Sherlock, Julian AU - Tamburis, Oscar AU - Tripathy, Manasa AU - Ferreira, Filipa AU - Williams, John AU - Hobbs, Richard F. D. PY - 2020/11/17 TI - COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology JO - JMIR Public Health Surveill SP - e21434 VL - 6 IS - 4 KW - COVID-19 KW - medical informatics KW - sentinel surveillance N2 - Background: Creating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. Objective: This study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. Methods: We described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system?independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. Results: Our use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological sampling, and health outcomes at an individual practice and at the national level; (2) feedback through a dashboard; (3) a national observatory; (4) regular updates for Public Health England; and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). Conclusions: The underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential. UR - http://publichealth.jmir.org/2020/4/e21434/ UR - http://dx.doi.org/10.2196/21434 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112762 ID - info:doi/10.2196/21434 ER - TY - JOUR AU - McMahon, Andrew AU - Robb, C. Nicole PY - 2020/11/16 TI - Reinfection with SARS-CoV-2: Discrete SIR (Susceptible, Infected, Recovered) Modeling Using Empirical Infection Data JO - JMIR Public Health Surveill SP - e21168 VL - 6 IS - 4 KW - infectious disease KW - SARS-CoV-2 KW - COVID-19 KW - SIR KW - modeling KW - reinfection N2 - Background: The novel coronavirus SARS-CoV-2, which causes the COVID-19 disease, has resulted in a global pandemic. Since its emergence in December 2019, the virus has infected millions of people, caused the deaths of hundreds of thousands, and resulted in incalculable social and economic damage. Understanding the infectivity and transmission dynamics of the virus is essential to determine how best to reduce mortality while ensuring minimal social restrictions on the lives of the general population. Anecdotal evidence is available, but detailed studies have not yet revealed whether infection with the virus results in immunity. Objective: The objective of this study was to use mathematical modeling to investigate the reinfection frequency of COVID-19. Methods: We have used the SIR (Susceptible, Infected, Recovered) framework and random processing based on empirical SARS-CoV-2 infection and fatality data from different regions to calculate the number of reinfections that would be expected to occur if no immunity to the disease occurred. Results: Our model predicts that cases of reinfection should have been observed by now if primary SARS-CoV-2 infection did not protect individuals from subsequent exposure in the short term; however, no such cases have been documented. Conclusions: This work concludes that infection with SARS-CoV-2 provides short-term immunity to reinfection and therefore offers useful insight for serological testing strategies, lockdown easing, and vaccine development. UR - http://publichealth.jmir.org/2020/4/e21168/ UR - http://dx.doi.org/10.2196/21168 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052872 ID - info:doi/10.2196/21168 ER - TY - JOUR AU - Lee, Jae Jung AU - Kang, Kyung-Ah AU - Wang, Ping Man AU - Zhao, Zhi Sheng AU - Wong, Ha Janet Yuen AU - O'Connor, Siobhan AU - Yang, Ching Sook AU - Shin, Sunhwa PY - 2020/11/13 TI - Associations Between COVID-19 Misinformation Exposure and Belief With COVID-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study JO - J Med Internet Res SP - e22205 VL - 22 IS - 11 KW - COVID-19 KW - misinformation KW - infodemic KW - infodemiology KW - anxiety KW - depression KW - PTSD KW - knowledge KW - preventive behaviors KW - prevention KW - behavior N2 - 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. UR - http://www.jmir.org/2020/11/e22205/ UR - http://dx.doi.org/10.2196/22205 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048825 ID - info:doi/10.2196/22205 ER - TY - JOUR AU - Xu, Hong AU - Gan, Yong AU - Zheng, Daikun AU - Wu, Bo AU - Zhu, Xian AU - Xu, Chang AU - Liu, Chenglu AU - Tao, Zhou AU - Hu, Yaoyue AU - Chen, Min AU - Li, Mingjing AU - Lu, Zuxun AU - Chen, Jack PY - 2020/11/13 TI - 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 JO - J Med Internet Res SP - e21372 VL - 22 IS - 11 KW - COVID-19 KW - nonpharmaceutical personal interventions KW - NPI KW - public health KW - mask wearing KW - intervention KW - infection KW - risk perception KW - knowledge KW - attitude KW - online survey KW - China N2 - 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. UR - http://www.jmir.org/2020/11/e21372/ UR - http://dx.doi.org/10.2196/21372 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108317 ID - info:doi/10.2196/21372 ER - TY - JOUR AU - Qin, Lei AU - Wang, Yidan AU - Sun, Qiang AU - Zhang, Xiaomei AU - Shia, Ben-Chang AU - Liu, Chengcheng PY - 2020/11/13 TI - Analysis of the COVID-19 Epidemic Transmission Network in Mainland China: K-Core Decomposition Study JO - JMIR Public Health Surveill SP - e24291 VL - 6 IS - 4 KW - COVID-19 KW - epidemic network KW - prevention and control KW - k-core decomposition N2 - 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. UR - http://publichealth.jmir.org/2020/4/e24291/ UR - http://dx.doi.org/10.2196/24291 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108309 ID - info:doi/10.2196/24291 ER - TY - JOUR AU - Do, N. Binh AU - Tran, V. Tien AU - Phan, T. Dung AU - Nguyen, C. Hoang AU - Nguyen, P. Thao T. AU - Nguyen, C. Huu AU - Ha, H. Tung AU - Dao, K. Hung AU - Trinh, V. Manh AU - Do, V. Thinh AU - Nguyen, Q. Hung AU - Vo, T. Tam AU - Nguyen, T. Nhan P. AU - Tran, Q. Cuong AU - Tran, V. Khanh AU - Duong, T. Trang AU - Pham, X. Hai AU - Nguyen, V. Lam AU - Nguyen, T. Kien AU - Chang, S. Peter W. AU - Duong, Van Tuyen PY - 2020/11/12 TI - 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 JO - J Med Internet Res SP - e22894 VL - 22 IS - 11 KW - COVID-19 KW - health literacy KW - eHealth literacy KW - health care workers KW - personal protective equipment KW - handwashing KW - masks KW - disposing KW - lifestyle KW - Vietnam KW - eHealth KW - adherence KW - infection prevention KW - control N2 - 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 (?=0.42); satisfactory convergent validity with high item-scale correlations (?=0.80-0.84); and high internal consistency (Cronbach ?=.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. UR - https://www.jmir.org/2020/11/e22894 UR - http://dx.doi.org/10.2196/22894 UR - http://www.ncbi.nlm.nih.gov/pubmed/33122164 ID - info:doi/10.2196/22894 ER - TY - JOUR AU - Mohamad, Emma AU - Tham, Sern Jen AU - Ayub, Hadi Suffian AU - Hamzah, Rezal Mohammad AU - Hashim, Hasrul AU - Azlan, Anis Arina PY - 2020/11/12 TI - Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study JO - J Med Internet Res SP - e23922 VL - 22 IS - 11 KW - COVID-19 KW - information source KW - confidence KW - media KW - social media KW - government KW - Malaysia KW - online information KW - survey N2 - 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. UR - http://www.jmir.org/2020/11/e23922/ UR - http://dx.doi.org/10.2196/23922 UR - http://www.ncbi.nlm.nih.gov/pubmed/33151897 ID - info:doi/10.2196/23922 ER - TY - JOUR AU - Cao, Zicheng AU - Tang, Feng AU - Chen, Cai AU - Zhang, Chi AU - Guo, Yichen AU - Lin, Ruizhen AU - Huang, Zhihong AU - Teng, Yi AU - Xie, Ting AU - Xu, Yutian AU - Song, Yanxin AU - Wu, Feng AU - Dong, Peipei AU - Luo, Ganfeng AU - Jiang, Yawen AU - Zou, Huachun AU - Chen, Yao-Qing AU - Sun, Litao AU - Shu, Yuelong AU - Du, Xiangjun PY - 2020/11/11 TI - Impact of Systematic Factors on the Outbreak Outcomes of the Novel COVID-19 Disease in China: Factor Analysis Study JO - J Med Internet Res SP - e23853 VL - 22 IS - 11 KW - COVID-19 KW - new cases KW - growth rate KW - multidimensional factors KW - statistical machine learning N2 - 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. UR - http://www.jmir.org/2020/11/e23853/ UR - http://dx.doi.org/10.2196/23853 UR - http://www.ncbi.nlm.nih.gov/pubmed/33098287 ID - info:doi/10.2196/23853 ER - TY - JOUR AU - Pan, Pan AU - Li, Yichao AU - Xiao, Yongjiu AU - Han, Bingchao AU - Su, Longxiang AU - Su, Mingliang AU - Li, Yansheng AU - Zhang, Siqi AU - Jiang, Dapeng AU - Chen, Xia AU - Zhou, Fuquan AU - Ma, Ling AU - Bao, Pengtao AU - Xie, Lixin PY - 2020/11/11 TI - Prognostic Assessment of COVID-19 in the Intensive Care Unit by Machine Learning Methods: Model Development and Validation JO - J Med Internet Res SP - e23128 VL - 22 IS - 11 KW - COVID-19 KW - ICU KW - machine learning KW - death prediction model KW - factor analysis KW - SHAP KW - LIME N2 - Background: Patients with COVID-19 in the intensive care unit (ICU) have a high mortality rate, and methods to assess patients? prognosis early and administer precise treatment are of great significance. Objective: The aim of this study was to use machine learning to construct a model for the analysis of risk factors and prediction of mortality among ICU patients with COVID-19. Methods: In this study, 123 patients with COVID-19 in the ICU of Vulcan Hill Hospital were retrospectively selected from the database, and the data were randomly divided into a training data set (n=98) and test data set (n=25) with a 4:1 ratio. Significance tests, correlation analysis, and factor analysis were used to screen 100 potential risk factors individually. Conventional logistic regression methods and four machine learning algorithms were used to construct the risk prediction model for the prognosis of patients with COVID-19 in the ICU. The performance of these machine learning models was measured by the area under the receiver operating characteristic curve (AUC). Interpretation and evaluation of the risk prediction model were performed using calibration curves, SHapley Additive exPlanations (SHAP), Local Interpretable Model-Agnostic Explanations (LIME), etc, to ensure its stability and reliability. The outcome was based on the ICU deaths recorded from the database. Results: Layer-by-layer screening of 100 potential risk factors finally revealed 8 important risk factors that were included in the risk prediction model: lymphocyte percentage, prothrombin time, lactate dehydrogenase, total bilirubin, eosinophil percentage, creatinine, neutrophil percentage, and albumin level. Finally, an eXtreme Gradient Boosting (XGBoost) model established with the 8 important risk factors showed the best recognition ability in the training set of 5-fold cross validation (AUC=0.86) and the verification queue (AUC=0.92). The calibration curve showed that the risk predicted by the model was in good agreement with the actual risk. In addition, using the SHAP and LIME algorithms, feature interpretation and sample prediction interpretation algorithms of the XGBoost black box model were implemented. Additionally, the model was translated into a web-based risk calculator that is freely available for public usage. Conclusions: The 8-factor XGBoost model predicts risk of death in ICU patients with COVID-19 well; it initially demonstrates stability and can be used effectively to predict COVID-19 prognosis in ICU patients. UR - https://www.jmir.org/2020/11/e23128 UR - http://dx.doi.org/10.2196/23128 UR - http://www.ncbi.nlm.nih.gov/pubmed/33035175 ID - info:doi/10.2196/23128 ER - TY - JOUR AU - Boon-Itt, Sakun AU - Skunkan, Yukolpat PY - 2020/11/11 TI - Public Perception of the COVID-19 Pandemic on Twitter: Sentiment Analysis and Topic Modeling Study JO - JMIR Public Health Surveill SP - e21978 VL - 6 IS - 4 KW - COVID-19 KW - Twitter KW - social media KW - infoveillance KW - infodemiology KW - infodemic KW - data KW - health informatics KW - mining KW - perception KW - topic modeling N2 - Background: COVID-19 is a scientifically and medically novel disease that is not fully understood because it has yet to be consistently and deeply studied. Among the gaps in research on the COVID-19 outbreak, there is a lack of sufficient infoveillance data. Objective: The aim of this study was to increase understanding of public awareness of COVID-19 pandemic trends and uncover meaningful themes of concern posted by Twitter users in the English language during the pandemic. Methods: Data mining was conducted on Twitter to collect a total of 107,990 tweets related to COVID-19 between December 13 and March 9, 2020. The analyses included frequency of keywords, sentiment analysis, and topic modeling to identify and explore discussion topics over time. A natural language processing approach and the latent Dirichlet allocation algorithm were used to identify the most common tweet topics as well as to categorize clusters and identify themes based on the keyword analysis. Results: The results indicate three main aspects of public awareness and concern regarding the COVID-19 pandemic. First, the trend of the spread and symptoms of COVID-19 can be divided into three stages. Second, the results of the sentiment analysis showed that people have a negative outlook toward COVID-19. Third, based on topic modeling, the themes relating to COVID-19 and the outbreak were divided into three categories: the COVID-19 pandemic emergency, how to control COVID-19, and reports on COVID-19. Conclusions: Sentiment analysis and topic modeling can produce useful information about the trends in the discussion of the COVID-19 pandemic on social media as well as alternative perspectives to investigate the COVID-19 crisis, which has created considerable public awareness. This study shows that Twitter is a good communication channel for understanding both public concern and public awareness about COVID-19. These findings can help health departments communicate information to alleviate specific public concerns about the disease. UR - http://publichealth.jmir.org/2020/4/e21978/ UR - http://dx.doi.org/10.2196/21978 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108310 ID - info:doi/10.2196/21978 ER - TY - JOUR AU - Wirth, Nikolaus Felix AU - Johns, Marco AU - Meurers, Thierry AU - Prasser, Fabian PY - 2020/11/10 TI - Citizen-Centered Mobile Health Apps Collecting Individual-Level Spatial Data for Infectious Disease Management: Scoping Review JO - JMIR Mhealth Uhealth SP - e22594 VL - 8 IS - 11 KW - pandemic KW - epidemic KW - infectious disease management KW - mobile apps KW - automated digital contact tracing KW - mobility tracking KW - outbreak detection KW - location-based risk assessment KW - public health KW - informatics KW - app KW - infectious disease KW - COVID-19 KW - review N2 - 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). UR - http://mhealth.jmir.org/2020/11/e22594/ UR - http://dx.doi.org/10.2196/22594 UR - http://www.ncbi.nlm.nih.gov/pubmed/33074833 ID - info:doi/10.2196/22594 ER - TY - JOUR AU - Älgå, Andreas AU - Eriksson, Oskar AU - Nordberg, Martin PY - 2020/11/10 TI - Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study JO - J Med Internet Res SP - e21559 VL - 22 IS - 11 KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - pandemic KW - topic modeling KW - research KW - literature N2 - Background: The COVID-19 pandemic has spread at an alarming speed, and effective treatment for the disease is still lacking. The body of evidence on COVID-19 has been increasing at an impressive pace, creating the need for a method to rapidly assess the current knowledge and identify key information. Gold standard methods such as systematic reviews and meta-analyses are regarded unsuitable because they have a narrow scope and are very time consuming. Objective: This study aimed to explore the published scientific literature on COVID-19 and map the research evolution during the early phase of the COVID-19 pandemic. Methods: We performed a PubMed search to analyze the titles, keywords, and abstracts of published papers on COVID-19. We used latent Dirichlet allocation modeling to extract topics and conducted a trend analysis to understand the temporal changes in research for each topic, journal impact factor (JIF), and geographic origin. Results: Based on our search, we identified 16,670 relevant articles dated between February 14, 2020, and June 1, 2020. Of these, 6 articles were reports from peer-reviewed randomized trials on patients with COVID-19. We identified 14 main research topics, of which the most common topics were health care responses (2812/16,670, 16.86%) and clinical manifestations (1828/16,670, 10.91%). We found an increasing trend for research on clinical manifestations and protective measures and a decreasing trend for research on disease transmission, epidemiology, health care response, and radiology. Publications on protective measures, immunology, and clinical manifestations were associated with the highest JIF. The overall median JIF was 3.7 (IQR 2.6-5.9), and we found that the JIF for these publications declined over time. The top countries producing research were the United States, China, Italy, and the United Kingdom. Conclusions: In less than 6 months since the novel coronavirus was first detected, a remarkably high number of research articles on COVID-19 have been published. Here, we discuss and present the temporal changes in the available COVID-19 research during the early phase of the pandemic. Our findings may aid researchers and policy makers to form a structured view of the current COVID-19 evidence base and provide further research directions. UR - http://www.jmir.org/2020/11/e21559/ UR - http://dx.doi.org/10.2196/21559 UR - http://www.ncbi.nlm.nih.gov/pubmed/33031049 ID - info:doi/10.2196/21559 ER - TY - JOUR AU - Schifeling, H. Christopher AU - Shanbhag, Prajakta AU - Johnson, Angene AU - Atwater, C. Riannon AU - Koljack, Claire AU - Parnes, L. Bennett AU - Vejar, M. Maria AU - Farro, A. Samantha AU - Phimphasone-Brady, Phoutdavone AU - Lum, D. Hillary PY - 2020/11/10 TI - Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis JO - JMIR Aging SP - e23176 VL - 3 IS - 2 KW - telemedicine KW - telehealth KW - telephone KW - videoconferencing KW - health care disparities KW - older adults KW - geriatrics KW - advance care planning KW - advanced directives KW - COVID-19 KW - coronavirus pandemic KW - SARS-CoV-2 KW - primary care N2 - Background: Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. Objective: This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. Methods: We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. Results: Of the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P<.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; P=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (P=.003, P=.01, P<.001, respectively). Conclusions: Although clinicians spent more time on video visits than telephone visits, more than half of this study?s older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention. UR - http://aging.jmir.org/2020/2/e23176/ UR - http://dx.doi.org/10.2196/23176 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048821 ID - info:doi/10.2196/23176 ER - TY - JOUR AU - Kim, Hyung-Jun AU - Han, Deokjae AU - Kim, Jeong-Han AU - Kim, Daehyun AU - Ha, Beomman AU - Seog, Woong AU - Lee, Yeon-Kyeng AU - Lim, Dosang AU - Hong, Ok Sung AU - Park, Mi-Jin AU - Heo, JoonNyung PY - 2020/11/9 TI - An Easy-to-Use Machine Learning Model to Predict the Prognosis of Patients With COVID-19: Retrospective Cohort Study JO - J Med Internet Res SP - e24225 VL - 22 IS - 11 KW - COVID-19 KW - machine learning KW - prognosis KW - SARS-CoV-2 KW - severe acute respiratory syndrome coronavirus 2 N2 - 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. UR - http://www.jmir.org/2020/11/e24225/ UR - http://dx.doi.org/10.2196/24225 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108316 ID - info:doi/10.2196/24225 ER - TY - JOUR AU - Zhao, Yusui AU - Xu, Shuiyang AU - Wang, Lei AU - Huang, Yu AU - Xu, Yue AU - Xu, Yan AU - Lv, Qiaohong AU - Wang, Zhen AU - Wu, Qingqing PY - 2020/11/9 TI - Concerns About Information Regarding COVID-19 on the Internet: Cross-Sectional Study JO - J Med Internet Res SP - e20487 VL - 22 IS - 11 KW - coronavirus KW - COVID-19 KW - disease prevention KW - internet KW - knowledge N2 - Background: Since the outbreak of COVID-19, the Chinese government and the Chinese Center for Disease Control and Prevention have released COVID-19?related information to the public through various channels to raise their concern level of the pandemic, increase their knowledge of disease prevention, and ensure the uptake of proper preventive practices. Objective: Our objectives were to determine Chinese netizens? concerns related to COVID-19 and the relationship between their concerns and information on the internet. We also aimed to elucidate the association between individuals? levels of concern, knowledge, and behaviors related to COVID-19. Methods: The questionnaire, which consisted of 15 closed-ended questions, was designed to investigate Chinese netizens? knowledge about COVID-19. The self-selection online survey method of nonprobability sampling was used to recruit participants through Dingxiangyisheng WeChat (a public, medical, and health service platform in China) accounts. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data. Results: In total, 10,304 respondents were surveyed on the internet (response rate=1.75%; 10,304/590,000). Nearly all (n=9803, 95.30%) participants were concerned about ?confirmed cases? of COVID-19, and 87.70% (n=9036) received information about the outbreak through social media websites. There were significant differences in participants? concerns by sex (P=.02), age (P<.001), educational attainment (P=.001), and occupation (P<.001). All knowledge questions and preventive practices were associated with concerns about COVID-19. The results of the multivariate logistic regression indicated that participants? sex, educational attainment, occupation and employment status, knowledge acquisition, and concern level were significantly associated with the practice of proper preventive behaviors. Conclusions: This study elucidated Chinese netizens? concerns, information sources, and preventive behaviors related to the COVID-19 pandemic. Sex, educational attainment, occupation and employment status, knowledge acquisition, and level of concern were key factors associated with proper preventive behaviors. This offers a theoretical basis for the government to provide targeted disease prevention and control information to the public. UR - http://www.jmir.org/2020/11/e20487/ UR - http://dx.doi.org/10.2196/20487 UR - http://www.ncbi.nlm.nih.gov/pubmed/33095740 ID - info:doi/10.2196/20487 ER - TY - JOUR AU - Turkington, Robin AU - Mulvenna, Maurice AU - Bond, Raymond AU - Ennis, Edel AU - Potts, Courtney AU - Moore, Ciaran AU - Hamra, Louise AU - Morrissey, Jacqui AU - Isaksen, Mette AU - Scowcroft, Elizabeth AU - O'Neill, Siobhan PY - 2020/11/6 TI - Behavior of Callers to a Crisis Helpline Before and During the COVID-19 Pandemic: Quantitative Data Analysis JO - JMIR Ment Health SP - e22984 VL - 7 IS - 11 KW - COVID-19 KW - coronavirus KW - pandemic KW - mental health KW - crisis helplines KW - machine learning KW - clustering KW - caller behavior N2 - Background: The World Health Organization declared the outbreak of COVID-19 to be an international pandemic in March 2020. While numbers of new confirmed cases of the disease and death tolls are rising at an alarming rate on a daily basis, there is concern that the pandemic and the measures taken to counteract it could cause an increase in distress among the public. Hence, there could be an increase in need for emotional support within the population, which is complicated further by the reduction of existing face-to-face mental health services as a result of measures taken to limit the spread of the virus. Objective: The objective of this study was to determine whether the COVID-19 pandemic has had any influence on the calls made to Samaritans Ireland, a national crisis helpline within the Republic of Ireland. Methods: This study presents an analysis of calls made to Samaritans Ireland in a four-week period before the first confirmed case of COVID-19 (calls=41,648, callers=3752) and calls made to the service within a four-week period after a restrictive lockdown was imposed by the government of the Republic of Ireland (calls=46,043, callers=3147). Statistical analysis was conducted to explore any differences between the duration of calls in the two periods at a global level and at an hourly level. We performed k-means clustering to determine the types of callers who used the helpline based on their helpline call usage behavior and to assess the impact of the pandemic on the caller type usage patterns. Results: The analysis revealed that calls were of a longer duration in the postlockdown period in comparison with the pre?COVID-19 period. There were changes in the behavior of individuals in the cluster types defined by caller behavior, where some caller types tended to make longer calls to the service in the postlockdown period. There were also changes in caller behavior patterns with regard to the time of day of the call; variations were observed in the duration of calls at particular times of day, where average call durations increased in the early hours of the morning. Conclusions: The results of this study highlight the impact of COVID-19 on a national crisis helpline service. Statistical differences were observed in caller behavior between the prelockdown and active lockdown periods. The findings suggest that service users relied on crisis helpline services more during the lockdown period due to an increased sense of isolation, worsening of underlying mental illness due to the pandemic, and reduction or overall removal of access to other support resources. Practical implications and limitations are discussed. UR - http://mental.jmir.org/2020/11/e22984/ UR - http://dx.doi.org/10.2196/22984 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112759 ID - info:doi/10.2196/22984 ER - TY - JOUR AU - Vaid, Akhil AU - Somani, Sulaiman AU - Russak, J. Adam AU - De Freitas, K. Jessica AU - Chaudhry, F. Fayzan AU - Paranjpe, Ishan AU - Johnson, W. Kipp AU - Lee, J. Samuel AU - Miotto, Riccardo AU - Richter, Felix AU - Zhao, Shan AU - Beckmann, D. Noam AU - Naik, Nidhi AU - Kia, Arash AU - Timsina, Prem AU - Lala, Anuradha AU - Paranjpe, Manish AU - Golden, Eddye AU - Danieletto, Matteo AU - Singh, Manbir AU - Meyer, Dara AU - O'Reilly, F. Paul AU - Huckins, Laura AU - Kovatch, Patricia AU - Finkelstein, Joseph AU - Freeman, M. Robert AU - Argulian, Edgar AU - Kasarskis, Andrew AU - Percha, Bethany AU - Aberg, A. Judith AU - Bagiella, Emilia AU - Horowitz, R. Carol AU - Murphy, Barbara AU - Nestler, J. Eric AU - Schadt, E. Eric AU - Cho, H. Judy AU - Cordon-Cardo, Carlos AU - Fuster, Valentin AU - Charney, S. Dennis AU - Reich, L. David AU - Bottinger, P. Erwin AU - Levin, A. Matthew AU - Narula, Jagat AU - Fayad, A. Zahi AU - Just, C. Allan AU - Charney, W. Alexander AU - Nadkarni, N. Girish AU - Glicksberg, S. Benjamin PY - 2020/11/6 TI - Machine Learning to Predict Mortality and Critical Events in a Cohort of Patients With COVID-19 in New York City: Model Development and Validation JO - J Med Internet Res SP - e24018 VL - 22 IS - 11 KW - machine learning KW - COVID-19 KW - electronic health record KW - TRIPOD KW - clinical informatics KW - prediction KW - mortality KW - EHR KW - cohort KW - hospital KW - performance N2 - Background: COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking. Objective: The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points. Methods: We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19?positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions. Results: Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction. Conclusions: We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes. UR - https://www.jmir.org/2020/11/e24018 UR - http://dx.doi.org/10.2196/24018 UR - http://www.ncbi.nlm.nih.gov/pubmed/33027032 ID - info:doi/10.2196/24018 ER - TY - JOUR AU - Xue, Jia AU - Chen, Junxiang AU - Chen, Chen AU - Hu, Ran AU - Zhu, Tingshao PY - 2020/11/6 TI - The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets JO - J Med Internet Res SP - e24361 VL - 22 IS - 11 KW - Twitter KW - family violence KW - COVID-19 KW - machine learning KW - big data KW - infodemiology KW - infoveillance N2 - Background: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. Objective: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. Methods: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. Results: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence?related news (eg, Tara Reade, Melissa DeRosa). Conclusions: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks. UR - http://www.jmir.org/2020/11/e24361/ UR - http://dx.doi.org/10.2196/24361 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108315 ID - info:doi/10.2196/24361 ER - TY - JOUR AU - Golinelli, Davide AU - Boetto, Erik AU - Carullo, Gherardo AU - Nuzzolese, Giovanni Andrea AU - Landini, Paola Maria AU - Fantini, Pia Maria PY - 2020/11/6 TI - Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature JO - J Med Internet Res SP - e22280 VL - 22 IS - 11 KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - digital heath KW - review KW - literature KW - mitigate KW - impact KW - eHealth N2 - Background: The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools. Objective: The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems. Methods: We conducted a systematic review of early COVID-19?related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas. Results: The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)?powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement. Conclusions: In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years. UR - http://www.jmir.org/2020/11/e22280/ UR - http://dx.doi.org/10.2196/22280 UR - http://www.ncbi.nlm.nih.gov/pubmed/33079693 ID - info:doi/10.2196/22280 ER - TY - JOUR AU - Yu, Nan AU - Pan, Shuya AU - Yang, Chia-chen AU - Tsai, Jiun-Yi PY - 2020/11/6 TI - Exploring the Role of Media Sources on COVID-19?Related Discrimination Experiences and Concerns Among Asian People in the United States: Cross-Sectional Survey Study JO - J Med Internet Res SP - e21684 VL - 22 IS - 11 KW - COVID-19 KW - discrimination KW - Asians KW - Asian Americans KW - media source KW - social media KW - prejudice? N2 - Background: Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. Objective: This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face. Methods: A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire. Results: Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses ?very often,? ?often,? and ?sometimes,? the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses ?very often? and ?often,? were ?people act as if they think you are dangerous? (25/235, 11%) and ?being treated with less courtesy or respect? (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (?=.18, P=.01) and having concerns about future episodes of discrimination the community may face (?=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (?=.31, P<.001). Conclusions: Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution. UR - http://www.jmir.org/2020/11/e21684/ UR - http://dx.doi.org/10.2196/21684 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108307 ID - info:doi/10.2196/21684 ER - TY - JOUR AU - Heo, JoonNyung AU - Sung, MinDong AU - Yoon, Sangchul AU - Jang, Jinkyu AU - Lee, Wonwoo AU - Han, Deokjae AU - Kim, Hyung-Jun AU - Kim, Han-Kyeol AU - Han, Hyuk Ji AU - Seog, Woong AU - Ha, Beomman AU - Park, Rang Yu PY - 2020/11/6 TI - A Patient Self-Checkup App for COVID-19: Development and Usage Pattern Analysis JO - J Med Internet Res SP - e19665 VL - 22 IS - 11 KW - COVID-19 KW - mobile app KW - smartphone KW - mobile phone KW - self-checkup N2 - Background: Clear guidelines for a patient with suspected COVID-19 infection are unavailable. Many countries rely on assessments through a national hotline or telecommunications, but this only adds to the burden of an already overwhelmed health care system. In this study, we developed an algorithm and a web application to help patients get screened. Objective: This study aims to aid the general public by developing a web-based application that helps patients decide when to seek medical care during a novel disease outbreak. Methods: The algorithm was developed via consultations with 6 physicians who directly screened, diagnosed, and/or treated patients with COVID-19. The algorithm mainly focused on when to test a patient in order to allocate limited resources more efficiently. The application was designed to be mobile-friendly and deployed on the web. We collected the application usage pattern data from March 1 to March 27, 2020. We evaluated the association between the usage pattern and the numbers of COVID-19 confirmed, screened, and mortality cases by access location and digital literacy by age group. Results: The algorithm used epidemiological factors, presence of fever, and other symptoms. In total, 83,460 users accessed the application 105,508 times. Despite the lack of advertisement, almost half of the users accessed the application from outside of Korea. Even though the digital literacy of the 60+ years age group is half of that of individuals in their 50s, the number of users in both groups was similar for our application. Conclusions: We developed an expert-opinion?based algorithm and web-based application for screening patients. This innovation can be helpful in circumstances where information on a novel disease is insufficient and may facilitate efficient medical resource allocation. UR - https://www.jmir.org/2020/11/e19665 UR - http://dx.doi.org/10.2196/19665 UR - http://www.ncbi.nlm.nih.gov/pubmed/33079692 ID - info:doi/10.2196/19665 ER - TY - JOUR AU - Shah, Sarwar Syed Ghulam AU - Nogueras, David AU - van Woerden, Cornelis Hugo AU - Kiparoglou, Vasiliki PY - 2020/11/5 TI - The COVID-19 Pandemic: A Pandemic of Lockdown Loneliness and the Role of Digital Technology JO - J Med Internet Res SP - e22287 VL - 22 IS - 11 KW - COVID-19 KW - coronavirus KW - pandemic KW - social isolation KW - loneliness KW - lockdown KW - social distancing KW - digital technology KW - social connectedness KW - social networking KW - online digital tools UR - http://www.jmir.org/2020/11/e22287/ UR - http://dx.doi.org/10.2196/22287 UR - http://www.ncbi.nlm.nih.gov/pubmed/33108313 ID - info:doi/10.2196/22287 ER - TY - JOUR AU - Dubin, M. Justin AU - Wyant, Austin W. AU - Balaji, C. Navin AU - Ong, LK William AU - Kettache, H. Reda AU - Haffaf, Malik AU - Zouari, Skander AU - Santillan, Diego AU - Autrán Gómez, Maria Ana AU - Sadeghi-Nejad, Hossein AU - Loeb, Stacy AU - Borin, F. James AU - Gomez Rivas, Juan AU - Grummet, Jeremy AU - Ramasamy, Ranjith AU - Teoh, C. Jeremy Y. PY - 2020/11/5 TI - Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e21875 VL - 22 IS - 11 KW - coronavirus KW - COVID-19 KW - technology KW - telemedicine KW - telehealth KW - urology KW - cross-sectional KW - perception KW - usability KW - barrier KW - implementation N2 - Background: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. Objective: The aim of this study was to investigate current telemedicine usage by urologists, urologists? perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. Methods: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists? perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. Results: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients? lack of technological comprehension, patients? lack of access to the required technology, and reimbursement concerns. Conclusions: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists? usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest. UR - https://www.jmir.org/2020/11/e21875 UR - http://dx.doi.org/10.2196/21875 UR - http://www.ncbi.nlm.nih.gov/pubmed/33031047 ID - info:doi/10.2196/21875 ER - TY - JOUR AU - Al-Rawi, Ahmed AU - Siddiqi, Maliha AU - Morgan, Rosemary AU - Vandan, Nimisha AU - Smith, Julia AU - Wenham, Clare PY - 2020/11/5 TI - COVID-19 and the Gendered Use of Emojis on Twitter: Infodemiology Study JO - J Med Internet Res SP - e21646 VL - 22 IS - 11 KW - emojis KW - social media KW - Twitter KW - gender KW - COVID-19 KW - sentiment KW - meaning N2 - Background: The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public?s gendered discourses about the pandemic. Objective: This study aims at exploring how people of different genders (eg, men, women, and sex and gender minorities) are discussed in relation to COVID-19 through the study of Twitter emojis. Methods: We collected over 50 million tweets referencing the hashtags #Covid-19 and #Covid19 for a period of more than 2 months in early 2020. Using a mixed method, we extracted three data sets containing tweets that reference men, women, and sexual and gender minorities, and we then analyzed emoji use along each gender category. We identified five major themes in our analysis including morbidity fears, health concerns, employment and financial issues, praise for frontline workers, and unique gendered emoji use. The top 600 emojis were manually classified based on their sentiment, indicating how positive, negative, or neutral each emoji is and studying their use frequencies. Results: The findings indicate that the majority of emojis are overwhelmingly positive in nature along the different genders, but sexual and gender minorities, and to a lesser extent women, are discussed more negatively than men. There were also many differences alongside discourses of men, women, and gender minorities when certain topics were discussed, such as death, financial and employment matters, gratitude, and health care, and several unique gendered emojis were used to express specific issues like community support. Conclusions: Emoji research can shed light on the gendered impacts of COVID-19, offering researchers an important source of information on health crises as they happen in real time. UR - http://www.jmir.org/2020/11/e21646/ UR - http://dx.doi.org/10.2196/21646 UR - http://www.ncbi.nlm.nih.gov/pubmed/33052871 ID - info:doi/10.2196/21646 ER - TY - JOUR AU - Thomas, Rae AU - Michaleff, A. Zoe AU - Greenwood, Hannah AU - Abukmail, Eman AU - Glasziou, Paul PY - 2020/11/4 TI - Concerns and Misconceptions About the Australian Government?s COVIDSafe App: Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e23081 VL - 6 IS - 4 KW - health KW - policy KW - COVID-19 KW - digital tracing app KW - COVIDSafe N2 - 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. UR - http://publichealth.jmir.org/2020/4/e23081/ UR - http://dx.doi.org/10.2196/23081 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048826 ID - info:doi/10.2196/23081 ER - TY - JOUR AU - Heo, JoonNyung AU - Park, Ae Ji AU - Han, Deokjae AU - Kim, Hyung-Jun AU - Ahn, Daeun AU - Ha, Beomman AU - Seog, Woong AU - Park, Rang Yu PY - 2020/11/4 TI - COVID-19 Outcome Prediction and Monitoring Solution for Military Hospitals in South Korea: Development and Evaluation of an Application JO - J Med Internet Res SP - e22131 VL - 22 IS - 11 KW - COVID-19 KW - patient management KW - prediction model KW - military medicine KW - proportional hazards models KW - outcome KW - prediction KW - monitoring KW - app KW - usability KW - modeling N2 - 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. UR - https://www.jmir.org/2020/11/e22131 UR - http://dx.doi.org/10.2196/22131 UR - http://www.ncbi.nlm.nih.gov/pubmed/33048824 ID - info:doi/10.2196/22131 ER - TY - JOUR AU - Zhou, Jiawei AU - Ghose, Bishwajit AU - Wang, Ruoxi AU - Wu, Ruijun AU - Li, Zhifei AU - Huang, Rui AU - Feng, Da AU - Feng, Zhanchun AU - Tang, Shangfeng PY - 2020/11/2 TI - Health Perceptions and Misconceptions Regarding COVID-19 in China: Online Survey Study JO - J Med Internet Res SP - e21099 VL - 22 IS - 11 KW - COVID-19 KW - perceptions KW - knowledge KW - coronavirus KW - SARS-CoV-2 KW - pandemic KW - rapid KW - online KW - surveys KW - public health N2 - Background: Great efforts have been made to prevent the spread of COVID-19, including national initiatives to promote the change of personal behaviors. The lessons learned from the 2003 SARS outbreak indicate that knowledge and attitudes about infectious diseases are related to panic among the population, which may further complicate efforts to prevent the spread of infectious diseases. Misunderstandings may result in behaviors such as underestimation, panic, and taking ineffective measures to avoid infection; these behaviors are likely to cause the epidemic to spread further. Objective: The purpose of this study is to assess public health perceptions and misunderstandings about COVID-19 in China, and to propose targeted response measures based on the findings to control the development of the epidemic. Methods: The study was conducted in April 2020 through an online survey, with participants in 8 provinces in Eastern, Central, and Western China. We designed a questionnaire with a health knowledge section consisting of 5 questions (4 conventional questions and 1 misleading question) on clinical features of and preventive measures against COVID-19. Descriptive statistics, chi-square analysis, binary logistic regression, and Mantel-Haenszel hierarchical analysis were used for statistical analysis. Results: In total, 4788 participants completed the survey and the mean knowledge score was 4.63 (SD 0.67), gained mainly through experts (76.1%), television (60.0%), newspapers (57.9%), and opinions (46.6%) and videos (42.9%) from social media. Compared to those who obtained information from only 1 or 2 channels, people who obtained information from >3 channels had increased health perception and a better ability to identify misleading information. Suggestions from experts were the most positive information source (?2=41.61), while information on social media was the most misleading. Those aged >60 years (OR 1.52, 95% CI 1.10-2.11), those with a lower or middle income (OR 1.36, 95% CI 1.00-1.83), those not working and not able to work (OR 1.83, 95% CI 1.04-3.21), those with a household income <100,000 RMB (2 suspected symptoms (OR 2.95, 95% CI 1.50-5.80) were more likely to be misled by videos on social media, but the error correction effect of expert advice was limited in these groups. Conclusions: Multiple information channels can improve public health perception and the identification of misleading information during the COVID-19 pandemic. Videos on social media increased the risk of rumor propagation among vulnerable groups. We suggest the government should strengthen social media regulation and increase experts? influence on the targeted vulnerable populations to reduce the risk of rumors spreading. UR - https://www.jmir.org/2020/11/e21099 UR - http://dx.doi.org/10.2196/21099 UR - http://www.ncbi.nlm.nih.gov/pubmed/33027037 ID - info:doi/10.2196/21099 ER - TY - JOUR AU - Zingone, Fabiana AU - Siniscalchi, Monica AU - Savarino, Vincenzo Edoardo AU - Barberio, Brigida AU - Cingolani, Linda AU - D'Incà, Renata AU - De Filippo, Romana Francesca AU - Camera, Silvia AU - Ciacci, Carolina PY - 2020/11/2 TI - Perception of the COVID-19 Pandemic Among Patients With Inflammatory Bowel Disease in the Time of Telemedicine: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e19574 VL - 22 IS - 11 KW - COVID-19 KW - IBD KW - ulcerative colitis KW - Crohn disease KW - telemedicine KW - biologic agents KW - perception KW - survey N2 - Background: After the COVID-19 outbreak, the Italian Government stopped most regular health care activity. As a result, patients with inflammatory bowel disease (IBD) had limited access to outpatient clinics and hospitals. Objective: This study aimed to analyze the perception of the COVID-19 emergency among patients with IBD during the early weeks of the lockdown. Methods: We invited adult patients with IBD from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) by email to answer an ad hoc anonymous survey about COVID-19. We also collected data on demographic and disease characteristics. Results: In total, 167 patients with IBD from Padua and 83 patients from Salerno answered the survey (age: mean 39.7 years, SD 13.9 years; female: n=116, 46.4%). We found that patients with IBD were particularly worried about the COVID-19 pandemic (enough: 77/250, 30.8%; much/very much: 140/250, 56.0%), as they felt more vulnerable to COVID-19 due to their condition (enough: 70/250, 28.0%; much/very much: 109/250, 43.6%). Patients with IBD from the red zone of Veneto were more worried than patients from Campania (P=.001), and men felt more susceptible to the virus than women (P=.05). Additionally, remote medicine was appreciated more by younger patients than older patients (P=.04). Conclusions: The results of our survey demonstrate that the lockdown had a significant impact on the psychological aspects of patients with IBD and suggest the need for increasing communication with patients with IBD (eg, through telemedicine) to ensure patients receive adequate health care, correct information, and proper psychological support. UR - https://www.jmir.org/2020/11/e19574 UR - http://dx.doi.org/10.2196/19574 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006945 ID - info:doi/10.2196/19574 ER - TY - JOUR AU - Paradiso, Virgilio Angelo AU - De Summa, Simona AU - Loconsole, Daniela AU - Procacci, Vito AU - Sallustio, Anna AU - Centrone, Francesca AU - Silvestris, Nicola AU - Cafagna, Vito AU - De Palma, Giuseppe AU - Tufaro, Antonio AU - Garrisi, Michele Vito AU - Chironna, Maria PY - 2020/10/30 TI - Rapid Serological Assays and SARS-CoV-2 Real-Time Polymerase Chain Reaction Assays for the Detection of SARS-CoV-2: Comparative Study JO - J Med Internet Res SP - e19152 VL - 22 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - serological test KW - RT-PCR N2 - Background: Real-time polymerase chain reaction (RT-PCR) testing for the identification of viral nucleic acid is the current standard for the diagnosis of SARS-CoV-2 infection, but technical issues limit its utilization for large-scale screening. Serological immunoglobulin M (IgM)/IgG testing has been proposed as a useful tool for detecting SARS-CoV-2 exposure. Objective: The objective of our study was to compare the results of the rapid serological VivaDiag test for SARS-CoV-2?related IgM/IgG detection with those of the standard RT-PCR laboratory test for identifying SARS-CoV-2 nucleic acid. Methods: We simultaneously performed both serological and molecular tests with a consecutive series of 191 symptomatic patients. The results provided by a new rapid serological colorimetric test for analyzing IgM/IgG expression were compared with those of RT-PCR testing for SARS-CoV-2 detection. Results: Of the 191 subjects, 70 (36.6%) tested positive for SARS-CoV-2 based on RT-PCR results, while 34 (17.3%) tested positive based on serological IgM/IgG expression. Additionally, 13 (6.8%) subjects tested positive based on serological test results, but also tested negative based on RT-PCR results. The rapid serological test had a sensitivity of 30% and a specificity of 89% compared to the standard RT-PCR assay. Interestingly, the performance of both assays improved 8 days after symptom appearance. After 10 days had passed since symptom appearance, the predictive value of the rapid serological test was higher than that of the standard molecular assay (proportion of positive results: 40% vs 20%). Multivariate analysis showed that age >58 years (P<.01) and period of >15 days after symptom onset (P<.02) were significant and independent factors associated with serological test positivity. Conclusions: The rapid serological test analyzed in this study seems limited in terms of usefulness when diagnosing SARS-CoV-2 infection. However, it may be useful for providing relevant information on people?s immunoreaction to COVID-19 exposure. UR - http://www.jmir.org/2020/10/e19152/ UR - http://dx.doi.org/10.2196/19152 UR - http://www.ncbi.nlm.nih.gov/pubmed/33031048 ID - info:doi/10.2196/19152 ER - TY - JOUR AU - Li, Dehe AU - Hu, Yinhuan AU - Pfaff, Holger AU - Wang, Liuming AU - Deng, Lu AU - Lu, Chuntao AU - Xia, Shixiao AU - Cheng, Siyu AU - Zhu, Ximin AU - Wu, Xiaoyue PY - 2020/10/29 TI - Determinants of Patients? Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China JO - J Med Internet Res SP - e22716 VL - 22 IS - 10 KW - internet hospital KW - health care?seeking intention KW - online inquiry KW - theory of planned behavior KW - chronic disease KW - structural equation modeling KW - China KW - COVID-19 KW - intention KW - online service KW - eHealth KW - behavior KW - modeling N2 - Background: Internet hospitals show great potential for adequately fulfilling people?s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients? intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients? behavioral intention is necessary to support the development of internet hospitals in China and promote patients? intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. Objective: The purpose of this study is to identify the determinants of patients? intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). Methods: The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. Results: A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (?=.624, P=.004 and ?=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (?=.207; P=.001). Conclusions: Perceived behavioral control and perceived severity of disease are the most important determinants of patients? intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients? adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients? intention to use online inquiry services provided by internet hospitals. UR - http://www.jmir.org/2020/10/e22716/ UR - http://dx.doi.org/10.2196/22716 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006941 ID - info:doi/10.2196/22716 ER - TY - JOUR AU - Wu, Yu-Rui AU - Chou, Tzu-Jung AU - Wang, Yi-Jen AU - Tsai, Jaw-Shiun AU - Cheng, Shao-Yi AU - Yao, Chien-An AU - Peng, Jen-Kuei AU - Hu, Wen-Yu AU - Chiu, Tai-Yuan AU - Huang, Hsien-Liang PY - 2020/10/28 TI - Smartphone-Enabled, Telehealth-Based Family Conferences in Palliative Care During the COVID-19 Pandemic: Pilot Observational Study JO - JMIR Mhealth Uhealth SP - e22069 VL - 8 IS - 10 KW - smartphone KW - mobile phone KW - telehealth KW - family conference KW - shared decision making KW - COVID-19 KW - palliative care KW - end-of-life care N2 - Background: In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. Objective: We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. Methods: Family conferences comprised three phases designed according to telehealth implementation guidelines?the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: ?team talk,? ?option talk,? and ?decision talk.? The model has been implemented at a national cancer treatment center in Taiwan since February 2020. Results: From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients? mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). Conclusions: Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic. UR - http://mhealth.jmir.org/2020/10/e22069/ UR - http://dx.doi.org/10.2196/22069 UR - http://www.ncbi.nlm.nih.gov/pubmed/33021483 ID - info:doi/10.2196/22069 ER - TY - JOUR AU - Izquierdo, Luis Jose AU - Ancochea, Julio AU - AU - Soriano, B. Joan PY - 2020/10/28 TI - Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing JO - J Med Internet Res SP - e21801 VL - 22 IS - 10 KW - artificial intelligence KW - big data KW - COVID-19 KW - electronic health records KW - tachypnea KW - SARS-CoV-2 KW - predictive model N2 - Background: Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. Objective: Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. Methods: We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. Results: A total of 10,504 patients with a clinical or polymerase chain reaction?confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature <39 degrees Celsius (or >39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. Conclusions: Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admission. UR - http://www.jmir.org/2020/10/e21801/ UR - http://dx.doi.org/10.2196/21801 UR - http://www.ncbi.nlm.nih.gov/pubmed/33090964 ID - info:doi/10.2196/21801 ER - TY - JOUR AU - Chen, Jiayang AU - See, Choong Kay PY - 2020/10/27 TI - Artificial Intelligence for COVID-19: Rapid Review JO - J Med Internet Res SP - e21476 VL - 22 IS - 10 KW - coronavirus KW - deep learning KW - machine learning KW - medical informatics KW - computing KW - SARS virus KW - COVID-19 KW - artificial intelligence KW - review N2 - Background: COVID-19 was first discovered in December 2019 and has since evolved into a pandemic. Objective: To address this global health crisis, artificial intelligence (AI) has been deployed at various levels of the health care system. However, AI has both potential benefits and limitations. We therefore conducted a review of AI applications for COVID-19. Methods: We performed an extensive search of the PubMed and EMBASE databases for COVID-19?related English-language studies published between December 1, 2019, and March 31, 2020. We supplemented the database search with reference list checks. A thematic analysis and narrative review of AI applications for COVID-19 was conducted. Results: In total, 11 papers were included for review. AI was applied to COVID-19 in four areas: diagnosis, public health, clinical decision making, and therapeutics. We identified several limitations including insufficient data, omission of multimodal methods of AI-based assessment, delay in realization of benefits, poor internal/external validation, inability to be used by laypersons, inability to be used in resource-poor settings, presence of ethical pitfalls, and presence of legal barriers. AI could potentially be explored in four other areas: surveillance, combination with big data, operation of other core clinical services, and management of patients with COVID-19. Conclusions: In view of the continuing increase in the number of cases, and given that multiple waves of infections may occur, there is a need for effective methods to help control the COVID-19 pandemic. Despite its shortcomings, AI holds the potential to greatly augment existing human efforts, which may otherwise be overwhelmed by high patient numbers. UR - http://www.jmir.org/2020/10/e21476/ UR - http://dx.doi.org/10.2196/21476 UR - http://www.ncbi.nlm.nih.gov/pubmed/32946413 ID - info:doi/10.2196/21476 ER - TY - JOUR AU - Badell-Grau, A. Rafael AU - Cuff, Patrick Jordan AU - Kelly, P. Brendan AU - Waller-Evans, Helen AU - Lloyd-Evans, Emyr PY - 2020/10/27 TI - Investigating the Prevalence of Reactive Online Searching in the COVID-19 Pandemic: Infoveillance Study JO - J Med Internet Res SP - e19791 VL - 22 IS - 10 KW - chloroquine KW - coronavirus KW - COVID-19 KW - fake news KW - Google Trends KW - ibuprofen KW - infodemiology KW - misinformation N2 - Background: The ongoing pandemic has placed an unprecedented strain on global society, health care, governments, and mass media. Public dissemination of government policies, medical interventions, and misinformation has been remarkably rapid and largely unregulated during the COVID-19 pandemic, resulting in increased misinterpretations, miscommunication, and public panic. Being the first full-scale global pandemic of the digital age, COVID-19 has presented novel challenges pertinent to government advice, the spread of news and misinformation, and the trade-off between the accessibility of science and the premature public use of unproven medical interventions.  Objective: This study aims to assess the use of internet search terms relating to COVID-19 information and misinformation during the global pandemic, identify which were most used in six affected countries, investigate any temporal trends and the likely propagators of key search terms, and determine any correlation between the per capita cases and deaths with the adoption of these search terms in each of the six countries. Methods: This study uses relative search volume data extracted from Google Trends for search terms linked to the COVID-19 pandemic alongside per capita case and mortality data extracted from the European Open Data Portal to identify the temporal dynamics of the spread of news and misinformation during the global pandemic in six affected countries (Australia, Germany, Italy, Spain, the United Kingdom, and the United States). A correlation analysis was carried out to ascertain any correlation between the temporal trends of search term use and the rise of per capita mortality and disease cases. Results: Of the selected search terms, most were searched immediately following promotion by governments, public figures, or viral circulation of information, but also in relation to the publication of scientific resources, which were sometimes misinterpreted before further dissemination. Strong correlations were identified between the volume of these COVID-19?related search terms (overall mean Spearman rho 0.753, SD 0.158), and per capita mortality (mean per capita deaths Spearman rho 0.690, SD 0.168) and cases (mean per capita cases Spearman rho 0.800, SD 0.112). Conclusions: These findings illustrate the increased rate and volume of the public consumption of novel information during a global health care crisis. The positive correlation between mortality and online searching, particularly in countries with lower COVID-19 testing rates, may demonstrate the imperative to safeguard official communications and dispel misinformation in these countries. Online news, government briefings, and social media provide a powerful tool for the dissemination of important information to the public during pandemics, but their misuse and the presentation of misrepresented medical information should be monitored, minimized, and addressed to safeguard public safety. Ultimately, governments, public health authorities, and scientists have a moral imperative to safeguard the truth and maintain an accessible discourse with the public to limit fear. UR - https://www.jmir.org/2020/10/e19791 UR - http://dx.doi.org/10.2196/19791 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915763 ID - info:doi/10.2196/19791 ER - TY - JOUR AU - Wang, Yilun AU - Zhang, Yuqing AU - Bennell, Kim AU - White, Kenta Daniel AU - Wei, Jie AU - Wu, Ziying AU - He, Hongyi AU - Liu, Shaohui AU - Luo, Xianghang AU - Hu, Shuo AU - Zeng, Chao AU - Lei, Guanghua PY - 2020/10/26 TI - Physical Distancing Measures and Walking Activity in Middle-aged and Older Residents in Changsha, China, During the COVID-19 Epidemic Period: Longitudinal Observational Study JO - J Med Internet Res SP - e21632 VL - 22 IS - 10 KW - COVID-19 KW - pandemic KW - physical distancing KW - steps KW - walking activity N2 - Background: Physical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle. Objective: The objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic. Methods: We used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ?40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (?1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (?1500 steps/day for ?14 days) using logistic regression. Results: Among 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction<.001) were both associated with a higher prevalence of frequent low daily steps and were more pronounced during the epidemic period. More education was associated with a lower prevalence of frequent low daily steps during the reference period but not the epidemic period (P for interaction=.34). Body mass index or comorbidity were not associated with frequent low daily steps during either period. Conclusions: Daily steps of Changsha residents aged ?40 years dropped significantly during the COVID-19 period, especially among older adults and females. Although successful physical distancing, measured by the rapid downward trend in daily step counts of residents, played a critical role in the containment of the COVID-19 epidemic, our findings of an increase in the prevalence of frequent low daily steps raise concerns about unintended effects on physical activity. UR - http://www.jmir.org/2020/10/e21632/ UR - http://dx.doi.org/10.2196/21632 UR - http://www.ncbi.nlm.nih.gov/pubmed/33027035 ID - info:doi/10.2196/21632 ER - TY - JOUR AU - Hsu, Michael AU - Ahern, K. David AU - Suzuki, Joji PY - 2020/10/26 TI - Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic JO - JMIR Ment Health SP - e21814 VL - 7 IS - 10 KW - digital phenotyping KW - digital psychiatry KW - addiction KW - psychiatry KW - coronavirus KW - COVID-19 KW - digital health KW - treatment KW - drugs KW - substance use disorder UR - http://mental.jmir.org/2020/10/e21814/ UR - http://dx.doi.org/10.2196/21814 UR - http://www.ncbi.nlm.nih.gov/pubmed/33031044 ID - info:doi/10.2196/21814 ER - TY - JOUR AU - Chandrasekaran, Ranganathan AU - Mehta, Vikalp AU - Valkunde, Tejali AU - Moustakas, Evangelos PY - 2020/10/23 TI - Topics, Trends, and Sentiments of Tweets About the COVID-19 Pandemic: Temporal Infoveillance Study JO - J Med Internet Res SP - e22624 VL - 22 IS - 10 KW - coronavirus KW - infodemiology KW - infoveillance KW - infodemic KW - twitter KW - COVID-19 KW - social media KW - sentiment analysis KW - trends KW - topic modeling KW - disease surveillance N2 - Background: With restrictions on movement and stay-at-home orders in place due to the COVID-19 pandemic, social media platforms such as Twitter have become an outlet for users to express their concerns, opinions, and feelings about the pandemic. Individuals, health agencies, and governments are using Twitter to communicate about COVID-19. Objective: The aims of this study were to examine key themes and topics of English-language COVID-19?related tweets posted by individuals and to explore the trends and variations in how the COVID-19?related tweets, key topics, and associated sentiments changed over a period of time from before to after the disease was declared a pandemic. Methods: Building on the emergent stream of studies examining COVID-19?related tweets in English, we performed a temporal assessment covering the time period from January 1 to May 9, 2020, and examined variations in tweet topics and sentiment scores to uncover key trends. Combining data from two publicly available COVID-19 tweet data sets with those obtained in our own search, we compiled a data set of 13.9 million English-language COVID-19?related tweets posted by individuals. We use guided latent Dirichlet allocation (LDA) to infer themes and topics underlying the tweets, and we used VADER (Valence Aware Dictionary and sEntiment Reasoner) sentiment analysis to compute sentiment scores and examine weekly trends for 17 weeks. Results: Topic modeling yielded 26 topics, which were grouped into 10 broader themes underlying the COVID-19?related tweets. Of the 13,937,906 examined tweets, 2,858,316 (20.51%) were about the impact of COVID-19 on the economy and markets, followed by spread and growth in cases (2,154,065, 15.45%), treatment and recovery (1,831,339, 13.14%), impact on the health care sector (1,588,499, 11.40%), and governments response (1,559,591, 11.19%). Average compound sentiment scores were found to be negative throughout the examined time period for the topics of spread and growth of cases, symptoms, racism, source of the outbreak, and political impact of COVID-19. In contrast, we saw a reversal of sentiments from negative to positive for prevention, impact on the economy and markets, government response, impact on the health care industry, and treatment and recovery. Conclusions: Identification of dominant themes, topics, sentiments, and changing trends in tweets about the COVID-19 pandemic can help governments, health care agencies, and policy makers frame appropriate responses to prevent and control the spread of the pandemic. UR - http://www.jmir.org/2020/10/e22624/ UR - http://dx.doi.org/10.2196/22624 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006937 ID - info:doi/10.2196/22624 ER - TY - JOUR AU - Jewell, S. Jennifer AU - Farewell, V. Charlotte AU - Welton-Mitchell, Courtney AU - Lee-Winn, Angela AU - Walls, Jessica AU - Leiferman, A. Jenn PY - 2020/10/23 TI - Mental Health During the COVID-19 Pandemic in the United States: Online Survey JO - JMIR Form Res SP - e22043 VL - 4 IS - 10 KW - COVID-19 KW - mental health KW - pandemic KW - depression KW - anxiety KW - well-being KW - stress N2 - Background: The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. Objective: This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. Methods: Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19?specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19?specific concerns, and mental health and well-being outcomes. Results: Approximately 50% (536/1076) of the US sample was aged ?45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (?0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05). Conclusions: Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media. UR - http://formative.jmir.org/2020/10/e22043/ UR - http://dx.doi.org/10.2196/22043 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006939 ID - info:doi/10.2196/22043 ER - TY - JOUR AU - Koehlmoos, Pérez Tracey AU - Janvrin, Lynn Miranda AU - Korona-Bailey, Jessica AU - Madsen, Cathaleen AU - Sturdivant, Rodney PY - 2020/10/22 TI - COVID-19 Self-Reported Symptom Tracking Programs in the United States: Framework Synthesis JO - J Med Internet Res SP - e23297 VL - 22 IS - 10 KW - COVID-19 KW - coronavirus KW - framework analysis KW - information resources KW - patient-reported outcome measures KW - self-reported KW - surveillance KW - monitoring KW - symptom tracking KW - synthesis N2 - Background: With the continued spread of COVID-19 in the United States, identifying potential outbreaks before infected individuals cross the clinical threshold is key to allowing public health officials time to ensure local health care institutions are adequately prepared. In response to this need, researchers have developed participatory surveillance technologies that allow individuals to report emerging symptoms daily so that their data can be extrapolated and disseminated to local health care authorities. Objective: This study uses a framework synthesis to evaluate existing self-reported symptom tracking programs in the United States for COVID-19 as an early-warning tool for probable clusters of infection. This in turn will inform decision makers and health care planners about these technologies and the usefulness of their information to aid in federal, state, and local efforts to mobilize effective current and future pandemic responses. Methods: Programs were identified through keyword searches and snowball sampling, then screened for inclusion. A best fit framework was constructed for all programs that met the inclusion criteria by collating information collected from each into a table for easy comparison. Results: We screened 8 programs; 6 were included in our final framework synthesis. We identified multiple common data elements, including demographic information like race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included collection of data regarding smoking status, mental well-being, and suspected exposure to COVID-19. Conclusions: Several programs currently exist that track COVID-19 symptoms from participants on a semiregular basis. Coordination between symptom tracking program research teams and local and state authorities is currently lacking, presenting an opportunity for collaboration to avoid duplication of efforts and more comprehensive knowledge dissemination. UR - http://www.jmir.org/2020/10/e23297/ UR - http://dx.doi.org/10.2196/23297 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006943 ID - info:doi/10.2196/23297 ER - TY - JOUR AU - Yordanov, Youri AU - Dechartres, Agnes AU - Lescure, Xavier AU - Apra, Caroline AU - Villie, Pascaline AU - Marchand-Arvier, Jerome AU - Debuc, Erwan AU - Dinh, Aurélien AU - Jourdain, Patrick AU - PY - 2020/10/22 TI - Covidom, a Telesurveillance Solution for Home Monitoring Patients With COVID-19 JO - J Med Internet Res SP - e20748 VL - 22 IS - 10 KW - COVID-19 KW - coronavirus disease KW - home monitoring KW - telesurveillance KW - monitoring KW - patient KW - infectious disease KW - app UR - http://www.jmir.org/2020/10/e20748/ UR - http://dx.doi.org/10.2196/20748 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006938 ID - info:doi/10.2196/20748 ER - TY - JOUR AU - Gong, Xue AU - Han, Yangyang AU - Hou, Mengchi AU - Guo, Rui PY - 2020/10/22 TI - Online Public Attention During the Early Days of the COVID-19 Pandemic: Infoveillance Study Based on Baidu Index JO - JMIR Public Health Surveill SP - e23098 VL - 6 IS - 4 KW - Baidu Index KW - public attention KW - time lag cross-correlation analysis KW - COVID-19 N2 - Background: The COVID-19 pandemic has become a global public health event, attracting worldwide attention. As a tool to monitor public awareness, internet search engines have been widely used in public health emergencies. Objective: This study aims to use online search data (Baidu Index) to monitor the public?s attention and verify internet search engines? function in public attention monitoring of public health emergencies. Methods: We collected the Baidu Index and the case monitoring data from January 20, 2020, to April 20, 2020. We combined the Baidu Index of keywords related to COVID-19 to describe the public attention?s temporal trend and spatial distribution, and conducted the time lag cross-correlation analysis. Results: The Baidu Index temporal trend indicated that the changes of the Baidu Index had a clear correspondence with the development time node of the pandemic. The Baidu Index spatial distribution showed that in the regions of central and eastern China, with denser populations, larger internet user bases, and higher economic development levels, the public was more concerned about COVID-19. In addition, the Baidu Index was significantly correlated with six case indicators of new confirmed cases, new death cases, new cured discharge cases, cumulative confirmed cases, cumulative death cases, and cumulative cured discharge cases. Moreover, the Baidu Index was 0-4 days earlier than new confirmed and new death cases, and about 20 days earlier than new cured and discharged cases while 3-5 days later than the change of cumulative cases. Conclusions: The national public?s demand for epidemic information is urgent regardless of whether it is located in the hardest hit area. The public was more sensitive to the daily new case data that represents the progress of the epidemic, but the public?s attention to the epidemic situation in other areas may lag behind. We could set the Baidu Index as the sentinel and the database in the online infoveillance system for infectious disease and public health emergencies. According to the monitoring data, the government needs to prevent and control the possible outbreak in advance and communicate the risks to the public so as to ensure the physical and psychological health of the public in the epidemic. UR - http://publichealth.jmir.org/2020/4/e23098/ UR - http://dx.doi.org/10.2196/23098 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960177 ID - info:doi/10.2196/23098 ER - TY - JOUR AU - Dula, Nicole Adrienne AU - Gealogo Brown, Gretchel AU - Aggarwal, Aarushi AU - Clark, L. Kal PY - 2020/10/21 TI - Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go? JO - JMIR Aging SP - e21608 VL - 3 IS - 2 KW - stroke KW - ischemic stroke KW - COVID-19 KW - SARS-CoV-2 KW - emergency medicine KW - cerebrovascular UR - http://aging.jmir.org/2020/2/e21608/ UR - http://dx.doi.org/10.2196/21608 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006936 ID - info:doi/10.2196/21608 ER - TY - JOUR AU - Perlman, Amichai AU - Vodonos Zilberg, Alina AU - Bak, Peter AU - Dreyfuss, Michael AU - Leventer-Roberts, Maya AU - Vurembrand, Yael AU - Jeffries, E. Howard AU - Fisher, Eyal AU - Steuerman, Yael AU - Namir, Yinat AU - Goldschmidt, Yaara AU - Souroujon, Daniel PY - 2020/10/20 TI - Characteristics and Symptoms of App Users Seeking COVID-19?Related Digital Health Information and Remote Services: Retrospective Cohort Study JO - J Med Internet Res SP - e23197 VL - 22 IS - 10 KW - digital health KW - remote care KW - symptom checker KW - telemedicine KW - COVID-19 KW - symptom KW - cohort study KW - self-reported KW - online tool N2 - Background: Patient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice. Objective: The aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19?related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools. Methods: This study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)?driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19?related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician. Results: During the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department. Conclusions: Our results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19. UR - http://www.jmir.org/2020/10/e23197/ UR - http://dx.doi.org/10.2196/23197 UR - http://www.ncbi.nlm.nih.gov/pubmed/32961527 ID - info:doi/10.2196/23197 ER - TY - JOUR AU - Younis, Joseph AU - Freitag, Harvy AU - Ruthberg, S. Jeremy AU - Romanes, P. Jonathan AU - Nielsen, Craig AU - Mehta, Neil PY - 2020/10/20 TI - Social Media as an Early Proxy for Social Distancing Indicated by the COVID-19 Reproduction Number: Observational Study JO - JMIR Public Health Surveill SP - e21340 VL - 6 IS - 4 KW - COVID-19 KW - social media KW - Google Trends KW - Twitter KW - Instagram KW - reproduction number KW - estimated reproduction number KW - social distancing KW - public health surveillance KW - social media surveillance KW - Google Maps KW - Apple Maps KW - pandemic KW - epidemic N2 - Background:  The magnitude and time course of the COVID-19 epidemic in the United States depends on early interventions to reduce the basic reproductive number to below 1. It is imperative, then, to develop methods to actively assess where quarantine measures such as social distancing may be deficient and suppress those potential resurgence nodes as early as possible. Objective: We ask if social media is an early indicator of public social distancing measures in the United States by investigating its correlation with the time-varying reproduction number (Rt) as compared to social mobility estimates reported from Google and Apple Maps. Methods:  In this observational study, the estimated Rt was obtained for the period between March 5 and April 5, 2020, using the EpiEstim package. Social media activity was assessed using queries of ?social distancing? or ?#socialdistancing? on Google Trends, Instagram, and Twitter, with social mobility assessed using Apple and Google Maps data. Cross-correlations were performed between Rt and social media activity or mobility for the United States. We used Pearson correlations and the coefficient of determination (?) with significance set to P<.05. Results: Negative correlations were found between Google search interest for ?social distancing? and Rt in the United States (P<.001), and between search interest and state-specific Rt for 9 states with the highest COVID-19 cases (P<.001); most states experienced a delay varying between 3-8 days before reaching significance. A negative correlation was seen at a 4-day delay from the start of the Instagram hashtag ?#socialdistancing? and at 6 days for Twitter (P<.001). Significant correlations between Rt and social media manifest earlier in time compared to social mobility measures from Google and Apple Maps, with peaks at ?6 and ?4 days. Meanwhile, changes in social mobility correlated best with Rt at ?2 days and +1 day for workplace and grocery/pharmacy, respectively. Conclusions: Our study demonstrates the potential use of Google Trends, Instagram, and Twitter as epidemiological tools in the assessment of social distancing measures in the United States during the early course of the COVID-19 pandemic. Their correlation and earlier rise and peak in correlative strength with Rt when compared to social mobility may provide proactive insight into whether social distancing efforts are sufficiently enacted. Whether this proves valuable in the creation of more accurate assessments of the early epidemic course is uncertain due to limitations. These limitations include the use of a biased sample that is internet literate with internet access, which may covary with socioeconomic status, education, geography, and age, and the use of subtotal social media mentions of social distancing. Future studies should focus on investigating how social media reactions change during the course of the epidemic, as well as the conversion of social media behavior to actual physical behavior. UR - http://publichealth.jmir.org/2020/4/e21340/ UR - http://dx.doi.org/10.2196/21340 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001831 ID - info:doi/10.2196/21340 ER - TY - JOUR AU - Drissi, Nidal AU - Alhmoudi, Ayat AU - Al Nuaimi, Hana AU - Alkhyeli, Mahra AU - Alsalami, Shaikha AU - Ouhbi, Sofia PY - 2020/10/20 TI - Investigating the Impact of COVID-19 Lockdown on the Psychological Health of University Students and Their Attitudes Toward Mobile Mental Health Solutions: Two-Part Questionnaire Study JO - JMIR Form Res SP - e19876 VL - 4 IS - 10 KW - COVID-19 KW - GHQ-12 KW - mobile KW - apps KW - m-health KW - m-mental health KW - UAE KW - attitudes KW - university students KW - questionnaire N2 - Background: The COVID-19 outbreak was first reported to the World Health Organization on December 31, 2019, and it was officially declared a public health emergency of international concern on January 30, 2020. The COVID-19 outbreak and the safety measures taken to control it caused many psychological issues in populations worldwide, such as depression, anxiety, and stress. Objective: The objectives of this study were to assess the psychological effects of the lockdown due to the COVID-19 outbreak on university students in the United Arab Emirates (UAE) and to investigate the students? awareness of mobile mental health care apps as well as their attitudes toward the use of these apps. Methods: A two-part self-administered web-based questionnaire was delivered to students at United Arab Emirates University. The first part of the questionnaire assessed the mental state of the participants using the 12-item General Health Questionnaire (GHQ-12), while the second part contained questions investigating the participants? awareness of and attitudes toward mental health care apps. Students were invited to fill out the web-based questionnaire via social media and mailing lists. Results: A total of 154 students participated in the survey, and the majority were female. The results of the GHQ-12 analysis showed that the students were experiencing psychological issues related to depression and anxiety as well as social dysfunction. The results also revealed a lack of awareness of mental health care apps and uncertainty regarding the use of such apps. Approximately one-third of the participants (44/154, 28.6%) suggested preferred functionalities and characteristics of mobile mental health care apps, such as affordable price, simple design, ease of use, web-based therapy, communication with others experiencing the same issues, and tracking of mental status. Conclusions: Like many groups of people worldwide, university students in the UAE were psychologically affected by the lockdown due to the COVID-19 outbreak. Although apps can be useful tools for mental health care delivery, especially in circumstances such as those produced by the outbreak, the students in this study showed a lack of awareness of these apps and mixed attitudes toward them. Improving the digital health literacy of university students in the UAE by increasing their awareness of mental health care apps and the treatment methods and benefits of the apps, as well as involving students in the app creation process, may encourage students to use these tools for mental health care. UR - http://formative.jmir.org/2020/10/e19876/ UR - http://dx.doi.org/10.2196/19876 UR - http://www.ncbi.nlm.nih.gov/pubmed/32969340 ID - info:doi/10.2196/19876 ER - TY - JOUR AU - Wu, Lianpin AU - Jin, Qike AU - Chen, Jie AU - He, Jiawei AU - Brett-Major, M. David AU - Dong, James Jianghu PY - 2020/10/20 TI - Diagnostic Accuracy of Chest Computed Tomography Scans for Suspected Patients With COVID-19: Receiver Operating Characteristic Curve Analysis JO - JMIR Public Health Surveill SP - e19424 VL - 6 IS - 4 KW - COVID-19 KW - chest CT scans KW - nucleic acid testing KW - retrospective cohort study KW - AUC KW - ROC N2 - Background: Computed tomography (CT) scans are increasingly available in clinical care globally. They enable a rapid and detailed assessment of tissue and organ involvement in disease processes that are relevant to diagnosis and management, particularly in the context of the COVID-19 pandemic. Objective: The aim of this paper is to identify differences in the CT scan findings of patients who were COVID-19 positive (confirmed via nucleic acid testing) to patients who were confirmed COVID-19 negative. Methods: A retrospective cohort study was proposed to compare patient clinical characteristics and CT scan findings in suspected COVID-19 cases. A multivariable logistic model with LASSO (least absolute shrinkage and selection operator) selection for variables was used to identify the good predictors from all available predictors. The area under the curve (AUC) with 95% CI was calculated for each of the selected predictors and the combined selected key predictors based on receiver operating characteristic curve analysis. Results: A total of 94 (56%) patients were confirmed positive for COVID-19 from the suspected 167 patients. We found that elderly people were more likely to be infected with COVID-19. Among the 94 confirmed positive patients, 2 (2%) patients were admitted to an intensive care unit. No patients died during the study period. We found that the presence, distribution, and location of CT lesions were associated with the presence of COVID-19. White blood cell count, cough, and a travel history to Wuhan were also the top predictors for COVID-19. The overall AUC of these selected predictors is 0.97 (95% CI 0.93-1.00). Conclusions: Taken together with nucleic acid testing, we found that CT scans can allow for the rapid diagnosis of COVID-19. This study suggests that chest CT scans should be more broadly adopted along with nucleic acid testing in the initial assessment of suspected COVID-19 cases, especially for patients with nonspecific symptoms. UR - http://publichealth.jmir.org/2020/4/e19424/ UR - http://dx.doi.org/10.2196/19424 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001830 ID - info:doi/10.2196/19424 ER - TY - JOUR AU - Luellen, Eric PY - 2020/10/19 TI - 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 JO - JMIRx Med SP - e23582 VL - 1 IS - 1 KW - infectious disease KW - SARS-CoV-2 KW - COVID-19 KW - public health KW - immunity KW - mass vaccinations KW - therapeutics KW - stem-cell growth factor-beta N2 - 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-?) 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-? 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-? (>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-? may be a novel treatment for COVID-19. Individuals with an SCGF-? 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-? and M-CSF appear to be promising novel therapeutics for patients with COVID-19. UR - https://med.jmirx.org/2020/1/e23582/ UR - http://dx.doi.org/10.2196/23582 UR - http://www.ncbi.nlm.nih.gov/pubmed/33711083 ID - info:doi/10.2196/23582 ER - TY - JOUR AU - Herbert, Jeremy AU - Horsham, Caitlin AU - Ford, Helen AU - Wall, Alexander AU - Hacker, Elke PY - 2020/10/19 TI - Deployment of a Smart Handwashing Station in a School Setting During the COVID-19 Pandemic: Field Study JO - JMIR Public Health Surveill SP - e22305 VL - 6 IS - 4 KW - COVID-19 KW - hand hygiene KW - health promotion KW - public health KW - preventive medicine KW - digital health technology N2 - Background: Hand hygiene is one of the most effective ways to remove germs, prevent the spread of infectious pathogens, and avoid getting sick. Since the COVID-19 pandemic began, health authorities have been advocating good hand hygiene practices. Objective: The primary aim of this study is to field test a prototype smart handwashing station deployed in a school setting during the COVID-19 pandemic. Methods: We deployed a smart handwashing station and examined key technological considerations including connectivity, security, and data management systems, as well as the health and safety of users. Results: The smart handwashing station was deployed for 10 days in a school setting in Australia during the COVID-19 pandemic. The smart handwashing station?s electrical components remained operational during field testing and underwent robust cleaning protocols each day. The handwashing station was used 1138 times during the field test and there was no COVID-19 transmission at the school during the testing. Conclusions: This study demonstrates that a personalized feedback approach using technology can successfully be implemented at a school and can provide a platform to improve hand hygiene among school-aged children. UR - http://publichealth.jmir.org/2020/4/e22305/ UR - http://dx.doi.org/10.2196/22305 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006559 ID - info:doi/10.2196/22305 ER - TY - JOUR AU - Joshi, U. Aditi AU - Lewiss, E. Resa AU - Aini, Maria AU - Babula, Bracken AU - Henwood, C. Patricia PY - 2020/10/16 TI - Solving Community SARS-CoV-2 Testing With Telehealth: Development and Implementation for Screening, Evaluation and Testing JO - JMIR Mhealth Uhealth SP - e20419 VL - 8 IS - 10 KW - telehealth KW - telemedicine KW - disaster planning KW - pandemic KW - COVID-19 KW - SARS-CoV-2 KW - emergency medicine KW - testing N2 - Background: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19?related concerns. Objective: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. Methods: Screening algorithms for patients with SARS-CoV-2?related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. Results: From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. Conclusions: Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs. UR - http://mhealth.jmir.org/2020/10/e20419/ UR - http://dx.doi.org/10.2196/20419 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006942 ID - info:doi/10.2196/20419 ER - TY - JOUR AU - Dubey, Dutt Akash PY - 2020/10/15 TI - The Resurgence of Cyber Racism During the COVID-19 Pandemic and its Aftereffects: Analysis of Sentiments and Emotions in Tweets JO - JMIR Public Health Surveill SP - e19833 VL - 6 IS - 4 KW - COVID-19 KW - pandemic KW - China KW - racism KW - WHO KW - Twitter KW - infodemiology KW - infodemic N2 - Background: With increasing numbers of patients with COVID-19 globally, China and the World Health Organization have been blamed by some for the spread of this disease. Consequently, instances of racism and hateful acts have been reported around the world. When US President Donald Trump used the term ?Chinese Virus,? this issue gained momentum, and ethnic Asians are now being targeted. The online situation looks similar, with increases in hateful comments and posts. Objective: The aim of this paper is to analyze the increasing instances of cyber racism during the COVID-19 pandemic, by assessing emotions and sentiments associated with tweets on Twitter. Methods: In total, 16,000 tweets from April 11-16, 2020, were analyzed to determine their associated sentiments and emotions. Statistical analysis was carried out using R. Twitter API and the sentimentr package were used to collect tweets and then evaluate their sentiments, respectively. This research analyzed the emotions and sentiments associated with terms like ?Chinese Virus,? ?Wuhan Virus,? and ?Chinese Corona Virus.? Results: The results suggest that the majority of the analyzed tweets were of negative sentiment and carried emotions of fear, sadness, anger, and disgust. There was a high usage of slurs and profane words. In addition, terms like ?China Lied People Died,? ?Wuhan Health Organization,? ?Kung Flu,? ?China Must Pay,? and ?CCP is Terrorist? were frequently used in these tweets. Conclusions: This study provides insight into the rise in cyber racism seen on Twitter. Based on the findings, it can be concluded that a substantial number of users are tweeting with mostly negative sentiments toward ethnic Asians, China, and the World Health Organization. UR - http://publichealth.jmir.org/2020/4/e19833/ UR - http://dx.doi.org/10.2196/19833 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936772 ID - info:doi/10.2196/19833 ER - TY - JOUR AU - Saurabh, Suman AU - Verma, Kumar Mahendra AU - Gautam, Vaishali AU - Kumar, Nitesh AU - Goel, Dhanesh Akhil AU - Gupta, Kumar Manoj AU - Bhardwaj, Pankaj AU - Misra, Sanjeev PY - 2020/10/15 TI - Transmission Dynamics of the COVID-19 Epidemic at the District Level in India: Prospective Observational Study JO - JMIR Public Health Surveill SP - e22678 VL - 6 IS - 4 KW - Epidemiology KW - SARS-CoV-2 KW - COVID-19 KW - serial interval KW - basic reproduction number KW - projection KW - outbreak response KW - India KW - mathematical modeling KW - infectious disease N2 - 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. UR - http://publichealth.jmir.org/2020/4/e22678/ UR - http://dx.doi.org/10.2196/22678 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001839 ID - info:doi/10.2196/22678 ER - TY - JOUR AU - Xu, Huifang AU - Gonzalez Mendez, Jose Maria AU - Guo, Lanwei AU - Chen, Qiong AU - Zheng, Liyang AU - Chen, Peipei AU - Cao, Xiaoqin AU - Liu, Shuzheng AU - Sun, Xibin AU - Zhang, Shaokai AU - Qiao, Youlin PY - 2020/10/15 TI - Knowledge, Awareness, and Attitudes Relating to the COVID-19 Pandemic Among Different Populations in Central China: Cross-Sectional Survey JO - J Med Internet Res SP - e22628 VL - 22 IS - 10 KW - COVID-19 KW - knowledge KW - awareness KW - attitude N2 - 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. UR - https://www.jmir.org/2020/10/e22628 UR - http://dx.doi.org/10.2196/22628 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886623 ID - info:doi/10.2196/22628 ER - TY - JOUR AU - Wang, Wenjun AU - Wang, Yikai AU - Zhang, Xin AU - Jia, Xiaoli AU - Li, Yaping AU - Dang, Shuangsuo PY - 2020/10/5 TI - Using WeChat, a Chinese Social Media App, for Early Detection of the COVID-19 Outbreak in December 2019: Retrospective Study JO - JMIR Mhealth Uhealth SP - e19589 VL - 8 IS - 10 KW - novel coronavirus KW - SARS KW - SARS-CoV-2 KW - COVID-19 KW - social media KW - WeChat KW - early detection KW - surveillance KW - infodemiology KW - infoveillance N2 - Background: A novel coronavirus, SARS-CoV-2, was identified in December 2019, when the first cases were reported in Wuhan, China. The once-localized outbreak has since been declared a pandemic. As of April 24, 2020, there have been 2.7 million confirmed cases and nearly 200,000 deaths. Early warning systems using new technologies should be established to prevent or mitigate such events in the future. Objective: This study aimed to explore the possibility of detecting the SARS-CoV-2 outbreak in 2019 using social media. Methods: WeChat Index is a data service that shows how frequently a specific keyword appears in posts, subscriptions, and search over the last 90 days on WeChat, the most popular Chinese social media app. We plotted daily WeChat Index results for keywords related to SARS-CoV-2 from November 17, 2019, to February 14, 2020. Results: WeChat Index hits for ?Feidian? (which means severe acute respiratory syndrome in Chinese) stayed at low levels until 16 days ahead of the local authority?s outbreak announcement on December 31, 2019, when the index increased significantly. The WeChat Index values persisted at relatively high levels from December 15 to 29, 2019, and rose rapidly on December 30, 2019, the day before the announcement. The WeChat Index hits also spiked for the keywords ?SARS,? ?coronavirus,? ?novel coronavirus,? ?shortness of breath,? ?dyspnea,? and ?diarrhea,? but these terms were not as meaningful for the early detection of the outbreak as the term ?Feidian?. Conclusions: By using retrospective infoveillance data from the WeChat Index, the SARS-CoV-2 outbreak in December 2019 could have been detected about two weeks before the outbreak announcement. WeChat may offer a new approach for the early detection of disease outbreaks. UR - https://mhealth.jmir.org/2020/10/e19589 UR - http://dx.doi.org/10.2196/19589 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931439 ID - info:doi/10.2196/19589 ER - TY - JOUR AU - Wang, Taiyao AU - Paschalidis, Aris AU - Liu, Quanying AU - Liu, Yingxia AU - Yuan, Ye AU - Paschalidis, Ch Ioannis PY - 2020/10/15 TI - Predictive Models of Mortality for Hospitalized Patients With COVID-19: Retrospective Cohort Study JO - JMIR Med Inform SP - e21788 VL - 8 IS - 10 KW - coronavirus KW - COVID-19 KW - mortality KW - Wuhan KW - China KW - machine learning KW - logistic regression KW - support vector machine KW - predictive modeling N2 - Background: The novel coronavirus SARS-CoV-2 and its associated disease, COVID-19, have caused worldwide disruption, leading countries to take drastic measures to address the progression of the disease. As SARS-CoV-2 continues to spread, hospitals are struggling to allocate resources to patients who are most at risk. In this context, it has become important to develop models that can accurately predict the severity of infection of hospitalized patients to help guide triage, planning, and resource allocation. Objective: The aim of this study was to develop accurate models to predict the mortality of hospitalized patients with COVID-19 using basic demographics and easily obtainable laboratory data. Methods: We performed a retrospective study of 375 hospitalized patients with COVID-19 in Wuhan, China. The patients were randomly split into derivation and validation cohorts. Regularized logistic regression and support vector machine classifiers were trained on the derivation cohort, and accuracy metrics (F1 scores) were computed on the validation cohort. Two types of models were developed: the first type used laboratory findings from the entire length of the patient?s hospital stay, and the second type used laboratory findings that were obtained no later than 12 hours after admission. The models were further validated on a multicenter external cohort of 542 patients. Results: Of the 375 patients with COVID-19, 174 (46.4%) died of the infection. The study cohort was composed of 224/375 men (59.7%) and 151/375 women (40.3%), with a mean age of 58.83 years (SD 16.46). The models developed using data from throughout the patients? length of stay demonstrated accuracies as high as 97%, whereas the models with admission laboratory variables possessed accuracies of up to 93%. The latter models predicted patient outcomes an average of 11.5 days in advance. Key variables such as lactate dehydrogenase, high-sensitivity C-reactive protein, and percentage of lymphocytes in the blood were indicated by the models. In line with previous studies, age was also found to be an important variable in predicting mortality. In particular, the mean age of patients who survived COVID-19 infection (50.23 years, SD 15.02) was significantly lower than the mean age of patients who died of the infection (68.75 years, SD 11.83; P<.001). Conclusions: Machine learning models can be successfully employed to accurately predict outcomes of patients with COVID-19. Our models achieved high accuracies and could predict outcomes more than one week in advance; this promising result suggests that these models can be highly useful for resource allocation in hospitals. UR - http://medinform.jmir.org/2020/10/e21788/ UR - http://dx.doi.org/10.2196/21788 UR - http://www.ncbi.nlm.nih.gov/pubmed/33055061 ID - info:doi/10.2196/21788 ER - TY - JOUR AU - Zhao, Xiaoman AU - Fan, Ju AU - Basnyat, Iccha AU - Hu, Baijing PY - 2020/10/15 TI - Online Health Information Seeking Using ?#COVID-19 Patient Seeking Help? on Weibo in Wuhan, China: Descriptive Study JO - J Med Internet Res SP - e22910 VL - 22 IS - 10 KW - COVID-19 KW - coronavirus KW - information seeking KW - social media KW - Wuhan N2 - Background: First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state?s risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information?seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic. Objective: The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the ?#COVID-19 Patient Seeking Help? hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak? Methods: Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using ?#COVID-19 Patient Seeking Help? and explored their online health information?seeking behavior. Results: The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients? social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support. Conclusions: Overall, the findings contribute to our understanding of health information?seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play. UR - http://www.jmir.org/2020/10/e22910/ UR - http://dx.doi.org/10.2196/22910 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001838 ID - info:doi/10.2196/22910 ER - TY - JOUR AU - Tosi, Davide AU - Campi, Alessandro PY - 2020/10/14 TI - 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 JO - J Med Internet Res SP - e21081 VL - 22 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - big data KW - data analytics KW - predictive models KW - prediction KW - modeling KW - Italy KW - diffusion N2 - 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. UR - http://www.jmir.org/2020/10/e21081/ UR - http://dx.doi.org/10.2196/21081 UR - http://www.ncbi.nlm.nih.gov/pubmed/33027038 ID - info:doi/10.2196/21081 ER - TY - JOUR AU - Liu, Ping-Yen AU - Tsai, Yi-Shan AU - Chen, Po-Lin AU - Tsai, Huey-Pin AU - Hsu, Ling-Wei AU - Wang, Chi-Shiang AU - Lee, Nan-Yao AU - Huang, Mu-Shiang AU - Wu, Yun-Chiao AU - Ko, Wen-Chien AU - Yang, Yi-Ching AU - Chiang, Jung-Hsien AU - Shen, Meng-Ru PY - 2020/10/14 TI - Application of an Artificial Intelligence Trilogy to Accelerate Processing of Suspected Patients With SARS-CoV-2 at a Smart Quarantine Station: Observational Study JO - J Med Internet Res SP - e19878 VL - 22 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - artificial intelligence KW - smart device assisted decision making KW - quarantine station N2 - 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. UR - http://www.jmir.org/2020/10/e19878/ UR - http://dx.doi.org/10.2196/19878 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001832 ID - info:doi/10.2196/19878 ER - TY - JOUR AU - Ahmed, Kamran AU - Bukhari, Arish Muhammad AU - Mlanda, Tamayi AU - Kimenyi, Paul Jean AU - Wallace, Polly AU - Okot Lukoya, Charles AU - Hamblion, L. Esther AU - Impouma, Benido PY - 2020/10/14 TI - Novel Approach to Support Rapid Data Collection, Management, and Visualization During the COVID-19 Outbreak Response in the World Health Organization African Region: Development of a Data Summarization and Visualization Tool JO - JMIR Public Health Surveill SP - e20355 VL - 6 IS - 4 KW - COVID-19 KW - health information management KW - data collection KW - visualization KW - EWARS KW - WHO African region KW - Go.Data KW - outbreak KW - pandemic KW - health emergencies N2 - Background: The COVID-19 pandemic has created unprecedented challenges to the systematic and timely sharing of COVID-19 field data collection and management. The World Health Organization (WHO) is working with health partners on the rollout and implementation of a robust electronic field data collection platform. The delay in the deployment and rollout of this electronic platform in the WHO African Region, as a consequence of the application of large-scale public health and social measures including movement restrictions and geographical area quarantine, left a gap between data collection and management. This lead to the need to develop interim data management solutions to accurately monitor the evolution of the pandemic and support the deployment of appropriate public health interventions. Objective: The aim of this study is to review the design, development, and implementation of the COVID-19 Data Summarization and Visualization (DSV) tool as a rapidly deployable solution to fill this critical data collection gap as an interim solution. Methods: This paper reviews the processes undertaken to research and develop a tool to bridge the data collection gap between the onset of a COVID-19 outbreak and the start of data collection using a prioritized electronic platform such as Go.Data in the WHO African Region. Results: In anticipation of the implementation of a prioritized tool for field data collection, the DSV tool was deployed in 18 member states for COVID-19 outbreak data management. We highlight preliminary findings and lessons learned from the DSV tool deployment in the WHO African Region. Conclusions: We developed a rapidly deployable tool for COVID-19 data collection and visualization in the WHO African Region. The lessons drawn on this experience offer an opportunity to learn and apply these to improve future similar public health informatics initiatives in an outbreak or similar humanitarian setting, particularly in low- and middle-income countries. UR - http://publichealth.jmir.org/2020/4/e20355/ UR - http://dx.doi.org/10.2196/20355 UR - http://www.ncbi.nlm.nih.gov/pubmed/32997641 ID - info:doi/10.2196/20355 ER - TY - JOUR AU - Gomides, Ana AU - Ferreira, Gilda AU - Kakehasi, Adriana AU - Lacerda, Marcus AU - Marques, Cláudia AU - Mota, Licia AU - Paiva, Eduardo AU - Pileggi, Gecilmara AU - Provenza, José AU - Reis-Neto, Edgard AU - Sampaio, Vanderson AU - Xavier, Ricardo AU - Pinheiro, Marcelo PY - 2020/10/14 TI - 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 JO - JMIR Res Protoc SP - e23532 VL - 9 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - antimalarial KW - rheumatic diseases KW - mortality KW - immune system KW - immunology KW - protocol KW - observational KW - pharmacological KW - drug N2 - 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 UR - http://www.researchprotocols.org/2020/10/e23532/ UR - http://dx.doi.org/10.2196/23532 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924956 ID - info:doi/10.2196/23532 ER - TY - JOUR AU - Low, M. Daniel AU - Rumker, Laurie AU - Talkar, Tanya AU - Torous, John AU - Cecchi, Guillermo AU - Ghosh, S. Satrajit PY - 2020/10/12 TI - Natural Language Processing Reveals Vulnerable Mental Health Support Groups and Heightened Health Anxiety on Reddit During COVID-19: Observational Study JO - J Med Internet Res SP - e22635 VL - 22 IS - 10 KW - COVID-19 KW - mental health KW - psychiatry KW - infodemiology KW - infoveillance KW - infodemic KW - social media KW - Reddit KW - natural language processing KW - ADHD KW - eating disorders KW - anxiety KW - suicidality N2 - Background: The COVID-19 pandemic is impacting mental health, but it is not clear how people with different types of mental health problems were differentially impacted as the initial wave of cases hit. Objective: The aim of this study is to leverage natural language processing (NLP) with the goal of characterizing changes in 15 of the world?s largest mental health support groups (eg, r/schizophrenia, r/SuicideWatch, r/Depression) found on the website Reddit, along with 11 non?mental health groups (eg, r/PersonalFinance, r/conspiracy) during the initial stage of the pandemic. Methods: We created and released the Reddit Mental Health Dataset including posts from 826,961 unique users from 2018 to 2020. Using regression, we analyzed trends from 90 text-derived features such as sentiment analysis, personal pronouns, and semantic categories. Using supervised machine learning, we classified posts into their respective support groups and interpreted important features to understand how different problems manifest in language. We applied unsupervised methods such as topic modeling and unsupervised clustering to uncover concerns throughout Reddit before and during the pandemic. Results: We found that the r/HealthAnxiety forum showed spikes in posts about COVID-19 early on in January, approximately 2 months before other support groups started posting about the pandemic. There were many features that significantly increased during COVID-19 for specific groups including the categories ?economic stress,? ?isolation,? and ?home,? while others such as ?motion? significantly decreased. We found that support groups related to attention-deficit/hyperactivity disorder, eating disorders, and anxiety showed the most negative semantic change during the pandemic out of all mental health groups. Health anxiety emerged as a general theme across Reddit through independent supervised and unsupervised machine learning analyses. For instance, we provide evidence that the concerns of a diverse set of individuals are converging in this unique moment of history; we discovered that the more users posted about COVID-19, the more linguistically similar (less distant) the mental health support groups became to r/HealthAnxiety (?=?0.96, P<.001). Using unsupervised clustering, we found the suicidality and loneliness clusters more than doubled in the number of posts during the pandemic. Specifically, the support groups for borderline personality disorder and posttraumatic stress disorder became significantly associated with the suicidality cluster. Furthermore, clusters surrounding self-harm and entertainment emerged. Conclusions: By using a broad set of NLP techniques and analyzing a baseline of prepandemic posts, we uncovered patterns of how specific mental health problems manifest in language, identified at-risk users, and revealed the distribution of concerns across Reddit, which could help provide better resources to its millions of users. We then demonstrated that textual analysis is sensitive to uncover mental health complaints as they appear in real time, identifying vulnerable groups and alarming themes during COVID-19, and thus may have utility during the ongoing pandemic and other world-changing events such as elections and protests. UR - http://www.jmir.org/2020/10/e22635/ UR - http://dx.doi.org/10.2196/22635 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936777 ID - info:doi/10.2196/22635 ER - TY - JOUR AU - Gozzi, Nicolò AU - Tizzani, Michele AU - Starnini, Michele AU - Ciulla, Fabio AU - Paolotti, Daniela AU - Panisson, André AU - Perra, Nicola PY - 2020/10/12 TI - Collective Response to Media Coverage of the COVID-19 Pandemic on Reddit and Wikipedia: Mixed-Methods Analysis JO - J Med Internet Res SP - e21597 VL - 22 IS - 10 KW - social media KW - news coverage KW - digital epidemiology KW - infodemiology KW - infoveillance KW - infodemic KW - data science KW - topic modeling KW - pandemic KW - COVID-19 KW - Reddit KW - Wikipedia KW - information KW - response KW - risk perception KW - behavior N2 - Background: The exposure and consumption of information during epidemic outbreaks may alter people?s risk perception and trigger behavioral changes, which can ultimately affect the evolution of the disease. It is thus of utmost importance to map the dissemination of information by mainstream media outlets and the public response to this information. However, our understanding of this exposure-response dynamic during the COVID-19 pandemic is still limited. Objective: The goal of this study is to characterize the media coverage and collective internet response to the COVID-19 pandemic in four countries: Italy, the United Kingdom, the United States, and Canada. Methods: We collected a heterogeneous data set including 227,768 web-based news articles and 13,448 YouTube videos published by mainstream media outlets, 107,898 user posts and 3,829,309 comments on the social media platform Reddit, and 278,456,892 views of COVID-19?related Wikipedia pages. To analyze the relationship between media coverage, epidemic progression, and users? collective web-based response, we considered a linear regression model that predicts the public response for each country given the amount of news exposure. We also applied topic modelling to the data set using nonnegative matrix factorization. Results: Our results show that public attention, quantified as user activity on Reddit and active searches on Wikipedia pages, is mainly driven by media coverage; meanwhile, this activity declines rapidly while news exposure and COVID-19 incidence remain high. Furthermore, using an unsupervised, dynamic topic modeling approach, we show that while the levels of attention dedicated to different topics by media outlets and internet users are in good accordance, interesting deviations emerge in their temporal patterns. Conclusions: Overall, our findings offer an additional key to interpret public perception and response to the current global health emergency and raise questions about the effects of attention saturation on people?s collective awareness and risk perception and thus on their tendencies toward behavioral change. UR - http://www.jmir.org/2020/10/e21597/ UR - http://dx.doi.org/10.2196/21597 UR - http://www.ncbi.nlm.nih.gov/pubmed/32960775 ID - info:doi/10.2196/21597 ER - TY - JOUR AU - Ma, Shujuan AU - Zhang, Jiayue AU - Zeng, Minyan AU - Yun, Qingping AU - Guo, Wei AU - Zheng, Yixiang AU - Zhao, Shi AU - Wang, H. Maggie AU - Yang, Zuyao PY - 2020/10/12 TI - Epidemiological Parameters of COVID-19: Case Series Study JO - J Med Internet Res SP - e19994 VL - 22 IS - 10 KW - coronavirus disease 2019 KW - COVID-19 KW - incubation period KW - serial interval KW - basic reproduction number KW - presymptomatic transmission N2 - 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. UR - http://www.jmir.org/2020/10/e19994/ UR - http://dx.doi.org/10.2196/19994 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001833 ID - info:doi/10.2196/19994 ER - TY - JOUR AU - Wu, Jun AU - Wang, Jian AU - Nicholas, Stephen AU - Maitland, Elizabeth AU - Fan, Qiuyan PY - 2020/10/9 TI - Application of Big Data Technology for COVID-19 Prevention and Control in China: Lessons and Recommendations JO - J Med Internet Res SP - e21980 VL - 22 IS - 10 KW - big data KW - COVID-19 KW - disease prevention and control N2 - Background: In the prevention and control of infectious diseases, previous research on the application of big data technology has mainly focused on the early warning and early monitoring of infectious diseases. Although the application of big data technology for COVID-19 warning and monitoring remain important tasks, prevention of the disease?s rapid spread and reduction of its impact on society are currently the most pressing challenges for the application of big data technology during the COVID-19 pandemic. After the outbreak of COVID-19 in Wuhan, the Chinese government and nongovernmental organizations actively used big data technology to prevent, contain, and control the spread of COVID-19. Objective: The aim of this study is to discuss the application of big data technology to prevent, contain, and control COVID-19 in China; draw lessons; and make recommendations. Methods: We discuss the data collection methods and key data information that existed in China before the outbreak of COVID-19 and how these data contributed to the prevention and control of COVID-19. Next, we discuss China?s new data collection methods and new information assembled after the outbreak of COVID-19. Based on the data and information collected in China, we analyzed the application of big data technology from the perspectives of data sources, data application logic, data application level, and application results. In addition, we analyzed the issues, challenges, and responses encountered by China in the application of big data technology from four perspectives: data access, data use, data sharing, and data protection. Suggestions for improvements are made for data collection, data circulation, data innovation, and data security to help understand China?s response to the epidemic and to provide lessons for other countries? prevention and control of COVID-19. Results: In the process of the prevention and control of COVID-19 in China, big data technology has played an important role in personal tracking, surveillance and early warning, tracking of the virus?s sources, drug screening, medical treatment, resource allocation, and production recovery. The data used included location and travel data, medical and health data, news media data, government data, online consumption data, data collected by intelligent equipment, and epidemic prevention data. We identified a number of big data problems including low efficiency of data collection, difficulty in guaranteeing data quality, low efficiency of data use, lack of timely data sharing, and data privacy protection issues. To address these problems, we suggest unified data collection standards, innovative use of data, accelerated exchange and circulation of data, and a detailed and rigorous data protection system. Conclusions: China has used big data technology to prevent and control COVID-19 in a timely manner. To prevent and control infectious diseases, countries must collect, clean, and integrate data from a wide range of sources; use big data technology to analyze a wide range of big data; create platforms for data analyses and sharing; and address privacy issues in the collection and use of big data. UR - http://www.jmir.org/2020/10/e21980/ UR - http://dx.doi.org/10.2196/21980 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001836 ID - info:doi/10.2196/21980 ER - TY - JOUR AU - Li, Xiaojing AU - Liu, Qinliang PY - 2020/10/9 TI - Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens JO - J Med Internet Res SP - e19684 VL - 22 IS - 10 KW - social media KW - media use KW - COVID-19 KW - pandemic KW - disease knowledge KW - eHealth literacy KW - public health KW - preventive behaviors N2 - 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 (?=.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 (?=.11, P=.001) and eHealth literacy (?=.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 (?=.07) affected this relationship positively and disease knowledge (?=?.07) affected it negatively. Different social media types differed in predicting an individual?s preventive behaviors for COVID-19. Aggregated social media (?=.22, P<.001) was the best predictor, followed by public social media (?=.14, P<.001) and professional social media (?=.11, P=.002). However, official social media (?=.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. UR - http://www.jmir.org/2020/10/e19684/ UR - http://dx.doi.org/10.2196/19684 UR - http://www.ncbi.nlm.nih.gov/pubmed/33006940 ID - info:doi/10.2196/19684 ER - TY - JOUR AU - Mehl, Alicia AU - Bergey, Francois AU - Cawley, Caoimhe AU - Gilsdorf, Andreas PY - 2020/10/9 TI - Syndromic Surveillance Insights from a Symptom Assessment App Before and During COVID-19 Measures in Germany and the United Kingdom: Results From Repeated Cross-Sectional Analyses JO - JMIR Mhealth Uhealth SP - e21364 VL - 8 IS - 10 KW - epidemiology KW - participatory epidemiology KW - participatory surveillance KW - COVID-19 symptom assessment apps KW - symptom checker apps KW - syndromic surveillance KW - COVID-19 measures KW - COVID-19 lockdown KW - digital public health KW - health effects of COVID-19 measures, infoveillance N2 - Background: Unprecedented lockdown measures have been introduced in countries worldwide to mitigate the spread and consequences of COVID-19. Although attention has been focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to the limitations of existing syndromic surveillance data and tools. Objective: The aim of this study is to explore the added value of mobile phone app?based symptom assessment tools as real-time health insight providers to inform public health policy makers. Methods: A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an assessment within the Ada app in Germany and the United Kingdom was conducted between two periods, namely before and after the implementation of ?Phase One? COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using a Pearson chi-square test and reported as log2 fold changes. Results: Overall, 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Overall, 34,200-37,400 symptomatic users in the United Kingdom reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany: 68,600/103,200, 66.52%; United Kingdom: 51,200/71,600, 72.74%). The majority were aged 10-29 years (Germany: 68,500/100,000, 68.45%; United Kingdom: 50,900/68,800, 73.91%), and about one-quarter were aged 30-59 years (Germany: 26,200/100,000, 26.15%; United Kingdom: 14,900/68,800, 21.65%). Overall, 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures period as compared to the Baseline period, and 34 of these were reported in both countries. The following mental health symptoms (log2 fold change, P value) were reported less often during the Measures period: inability to manage constant stress and demands at work (?1.07, P<.001), memory difficulty (?0.56, P<.001), depressed mood (?0.42, P<.001), and impaired concentration (?0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. In total, 14 of the 34 symptoms had statistically significant associations with weather variables. Conclusions: Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system. UR - http://mhealth.jmir.org/2020/10/e21364/ UR - http://dx.doi.org/10.2196/21364 UR - http://www.ncbi.nlm.nih.gov/pubmed/32997640 ID - info:doi/10.2196/21364 ER - TY - JOUR AU - Jonker, Marcel AU - de Bekker-Grob, Esther AU - Veldwijk, Jorien AU - Goossens, Lucas AU - Bour, Sterre AU - Rutten-Van Mölken, Maureen PY - 2020/10/9 TI - COVID-19 Contact Tracing Apps: Predicted Uptake in the Netherlands Based on a Discrete Choice Experiment JO - JMIR Mhealth Uhealth SP - e20741 VL - 8 IS - 10 KW - COVID-19 KW - discrete choice experiment KW - contact tracing KW - participatory epidemiology KW - participatory surveillance KW - app KW - uptake KW - prediction KW - smartphone KW - transmission KW - privacy KW - mobile phone N2 - Background: Smartphone-based contact tracing apps can contribute to reducing COVID-19 transmission rates and thereby support countries emerging from lockdowns as restrictions are gradually eased. Objective: The primary objective of our study is to determine the potential uptake of a contact tracing app in the Dutch population, depending on the characteristics of the app. Methods: A discrete choice experiment was conducted in a nationally representative sample of 900 Dutch respondents. Simulated maximum likelihood methods were used to estimate population average and individual-level preferences using a mixed logit model specification. Individual-level uptake probabilities were calculated based on the individual-level preference estimates and subsequently aggregated into the sample as well as subgroup-specific contact tracing app adoption rates. Results: The predicted app adoption rates ranged from 59.3% to 65.7% for the worst and best possible contact tracing app, respectively. The most realistic contact tracing app had a predicted adoption of 64.1%. The predicted adoption rates strongly varied by age group. For example, the adoption rates of the most realistic app ranged from 45.6% to 79.4% for people in the oldest and youngest age groups (ie, ?75 years vs 15-34 years), respectively. Educational attainment, the presence of serious underlying health conditions, and the respondents? stance on COVID-19 infection risks were also correlated with the predicted adoption rates but to a lesser extent. Conclusions: A secure and privacy-respecting contact tracing app with the most realistic characteristics can obtain an adoption rate as high as 64% in the Netherlands. This exceeds the target uptake of 60% that has been formulated by the Dutch government. The main challenge will be to increase the uptake among older adults, who are least inclined to install and use a COVID-19 contact tracing app. UR - https://mhealth.jmir.org/2020/10/e20741 UR - http://dx.doi.org/10.2196/20741 UR - http://www.ncbi.nlm.nih.gov/pubmed/32795998 ID - info:doi/10.2196/20741 ER - TY - JOUR AU - Pan, Yihang AU - Xin, Meiqi AU - Zhang, Changhua AU - Dong, Willa AU - Fang, Yuan AU - Wu, Wenhui AU - Li, Mingzhe AU - Pang, Jun AU - Zheng, Zilong AU - Wang, Zixin AU - Yuan, Jinqiu AU - He, Yulong PY - 2020/10/8 TI - 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 JO - J Med Internet Res SP - e22596 VL - 22 IS - 10 KW - COVID-19 KW - information exposure KW - risk KW - communication KW - mental health KW - personal preventive measures KW - China KW - cross-sectional KW - public health KW - prevention N2 - 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. UR - http://www.jmir.org/2020/10/e22596/ UR - http://dx.doi.org/10.2196/22596 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936776 ID - info:doi/10.2196/22596 ER - TY - JOUR AU - van Klaveren, W. Charlotte AU - de Jong, M. Peter G. AU - Hendriks, A. Renée AU - Luk, Franka AU - de Vries, J. Aiko P. AU - van der Boog, M. Paul J. AU - Reinders, J. Marlies E. PY - 2020/10/8 TI - Topics, Delivery Modes, and Social-Epistemological Dimensions of Web-Based Information for Patients Undergoing Renal Transplant and Living Donors During the COVID-19 Pandemic: Content Analysis JO - J Med Internet Res SP - e22068 VL - 22 IS - 10 KW - web-based information KW - internet KW - websites KW - patient education KW - COVID-19 KW - renal transplantation KW - eHealth KW - constructivism KW - social-epistemological dimensions KW - teaching modes KW - health communication N2 - Background: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients? understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). Objective: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. Methods: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. Results: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. Conclusions: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed. UR - http://www.jmir.org/2020/10/e22068/ UR - http://dx.doi.org/10.2196/22068 UR - http://www.ncbi.nlm.nih.gov/pubmed/32946412 ID - info:doi/10.2196/22068 ER - TY - JOUR AU - Ali, H. Shahmir AU - Foreman, Joshua AU - Tozan, Yesim AU - Capasso, Ariadna AU - Jones, M. Abbey AU - DiClemente, J. Ralph PY - 2020/10/8 TI - Trends and Predictors of COVID-19 Information Sources and Their Relationship With Knowledge and Beliefs Related to the Pandemic: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e21071 VL - 6 IS - 4 KW - COVID-19 KW - coronavirus KW - pandemic KW - outbreak KW - infectious disease KW - social media KW - information seeking behaviors KW - surveillance N2 - 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. UR - http://publichealth.jmir.org/2020/4/e21071/ UR - http://dx.doi.org/10.2196/21071 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936775 ID - info:doi/10.2196/21071 ER - TY - JOUR AU - Zhang, Haipeng AU - Dimitrov, Dimitar AU - Simpson, Lynn AU - Plaks, Nina AU - Singh, Balaji AU - Penney, Stephen AU - Charles, Jo AU - Sheehan, Rosemary AU - Flammini, Steven AU - Murphy, Shawn AU - Landman, Adam PY - 2020/10/8 TI - A Web-Based, Mobile-Responsive Application to Screen Health Care Workers for COVID-19 Symptoms: Rapid Design, Deployment, and Usage JO - JMIR Form Res SP - e19533 VL - 4 IS - 10 KW - public health KW - clinical informatics KW - digital health KW - coronavirus KW - COVID-19 KW - SARS-CoV-2 KW - 2019-nCov KW - app KW - eHealth N2 - Background: As of July 17, 2020, the COVID-19 pandemic has affected over 14 million people worldwide, with over 3.68 million cases in the United States. As the number of COVID-19 cases increased in Massachusetts, the Massachusetts Department of Public Health mandated that all health care workers be screened for symptoms daily prior to entering any hospital or health care facility. We rapidly created a digital COVID-19 symptom screening tool to enable this screening for a large, academic, integrated health care delivery system, Partners HealthCare, in Boston, Massachusetts. Objective: The aim of this study is to describe the design and development of the COVID Pass COVID-19 symptom screening application and report aggregate usage data from the first three months of its use across the organization. Methods: Using agile principles, we designed, tested, and implemented a solution over the span of one week using progressively customized development approaches as the requirements and use case become more solidified. We developed the minimum viable product (MVP) of a mobile-responsive, web-based, self-service application using research electronic data capture (REDCap). For employees without access to a computer or mobile device to use the self-service application, we established a manual process where in-person, socially distanced screeners asked employees entering the site if they have symptoms and then manually recorded the responses in an Office 365 Form. A custom .NET Framework application solution was developed as COVID Pass was scaled. We collected log data from the .NET application, REDCap, and Microsoft Office 365 from the first three months of enterprise deployment (March 30 to June 30, 2020). Aggregate descriptive statistics, including overall employee attestations by day and site, employee attestations by application method (COVID Pass automatic screening vs manual screening), employee attestations by time of day, and percentage of employees reporting COVID-19 symptoms, were obtained. Results: We rapidly created the MVP and gradually deployed it across the hospitals in our organization. By the end of the first week, the screening application was being used by over 25,000 employees each weekday. After three months, 2,169,406 attestations were recorded with COVID Pass. Over this period, 1865/160,159 employees (1.2%) reported positive symptoms. 1,976,379 of the 2,169,406 attestations (91.1%) were generated from the self-service screening application. The remainder were generated either from manual attestation processes (174,865/2,169,406, 8.1%) or COVID Pass kiosks (25,133/2,169,406, 1.2%). Hospital staff continued to work 24 hours per day, with staff attestations peaking around shift changes between 7 and 8 AM, 2 and 3 PM, 4 and 6 PM, and 11 PM and midnight. Conclusions: Using rapid, agile development, we quickly created and deployed a dedicated employee attestation application that gained widespread adoption and use within our health system. Further, we identified 1865 symptomatic employees who otherwise may have come to work, potentially putting others at risk. We share the story of our implementation, lessons learned, and source code (via GitHub) for other institutions who may want to implement similar solutions. UR - https://formative.jmir.org/2020/10/e19533 UR - http://dx.doi.org/10.2196/19533 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877348 ID - info:doi/10.2196/19533 ER - TY - JOUR AU - Hassani, Asma AU - Khan, Gulfaraz PY - 2020/10/7 TI - Human-Animal Interaction and the Emergence of SARS-CoV-2 JO - JMIR Public Health Surveill SP - e22117 VL - 6 IS - 4 KW - zoonosis KW - human-animal interface KW - COVID-19 KW - SARS-CoV-1 KW - outbreak KW - virus KW - transmission KW - pathogen KW - emergence KW - reservoir UR - http://publichealth.jmir.org/2020/4/e22117/ UR - http://dx.doi.org/10.2196/22117 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001837 ID - info:doi/10.2196/22117 ER - TY - JOUR AU - Garcia-Huidobro, Diego AU - Rivera, Solange AU - Valderrama Chang, Sebastián AU - Bravo, Paula AU - Capurro, Daniel PY - 2020/10/6 TI - System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation JO - J Med Internet Res SP - e22146 VL - 22 IS - 10 KW - telemedicine KW - telehealth KW - virtual medicine KW - health services evaluation KW - COVID-19 N2 - Background: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective: The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods: This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results: A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently. UR - https://www.jmir.org/2020/10/e22146 UR - http://dx.doi.org/10.2196/22146 UR - http://www.ncbi.nlm.nih.gov/pubmed/32903195 ID - info:doi/10.2196/22146 ER - TY - JOUR AU - Schwab, Patrick AU - DuMont Schütte, August AU - Dietz, Benedikt AU - Bauer, Stefan PY - 2020/10/6 TI - Clinical Predictive Models for COVID-19: Systematic Study JO - J Med Internet Res SP - e21439 VL - 22 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - machine learning KW - clinical prediction KW - prediction KW - infectious disease KW - clinical data KW - testing KW - hospitalization KW - intensive care N2 - 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. UR - http://www.jmir.org/2020/10/e21439/ UR - http://dx.doi.org/10.2196/21439 UR - http://www.ncbi.nlm.nih.gov/pubmed/32976111 ID - info:doi/10.2196/21439 ER - TY - JOUR AU - Munsch, Nicolas AU - Martin, Alistair AU - Gruarin, Stefanie AU - Nateqi, Jama AU - Abdarahmane, Isselmou AU - Weingartner-Ortner, Rafael AU - Knapp, Bernhard PY - 2020/10/6 TI - Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study JO - J Med Internet Res SP - e21299 VL - 22 IS - 10 KW - COVID-19 KW - symptom checkers KW - benchmark KW - digital health KW - symptom KW - chatbot KW - accuracy N2 - 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. UR - http://www.jmir.org/2020/10/e21299/ UR - http://dx.doi.org/10.2196/21299 UR - http://www.ncbi.nlm.nih.gov/pubmed/33001828 ID - info:doi/10.2196/21299 ER - TY - JOUR AU - Ahmed, Wasim AU - López Seguí, Francesc AU - Vidal-Alaball, Josep AU - Katz, S. Matthew PY - 2020/10/5 TI - COVID-19 and the ?Film Your Hospital? Conspiracy Theory: Social Network Analysis of Twitter Data JO - J Med Internet Res SP - e22374 VL - 22 IS - 10 KW - COVID-19 KW - coronavirus KW - Twitter KW - misinformation KW - fake news KW - social network analysis KW - public health KW - social media N2 - Background: During the COVID-19 pandemic, a number of conspiracy theories have emerged. A popular theory posits that the pandemic is a hoax and suggests that certain hospitals are ?empty.? Research has shown that accepting conspiracy theories increases the likelihood that an individual may ignore government advice about social distancing and other public health interventions. Due to the possibility of a second wave and future pandemics, it is important to gain an understanding of the drivers of misinformation and strategies to mitigate it. Objective: This study set out to evaluate the #FilmYourHospital conspiracy theory on Twitter, attempting to understand the drivers behind it. More specifically, the objectives were to determine which online sources of information were used as evidence to support the theory, the ratio of automated to organic accounts in the network, and what lessons can be learned to mitigate the spread of such a conspiracy theory in the future. Methods: Twitter data related to the #FilmYourHospital hashtag were retrieved and analyzed using social network analysis across a 7-day period from April 13-20, 2020. The data set consisted of 22,785 tweets and 11,333 Twitter users. The Botometer tool was used to identify accounts with a higher probability of being bots. Results: The most important drivers of the conspiracy theory are ordinary citizens; one of the most influential accounts is a Brexit supporter. We found that YouTube was the information source most linked to by users. The most retweeted post belonged to a verified Twitter user, indicating that the user may have had more influence on the platform. There was a small number of automated accounts (bots) and deleted accounts within the network. Conclusions: Hashtags using and sharing conspiracy theories can be targeted in an effort to delegitimize content containing misinformation. Social media organizations need to bolster their efforts to label or remove content that contains misinformation. Public health authorities could enlist the assistance of influencers in spreading antinarrative content. UR - http://www.jmir.org/2020/10/e22374/ UR - http://dx.doi.org/10.2196/22374 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936771 ID - info:doi/10.2196/22374 ER - TY - JOUR AU - Oehmke, Francis James AU - Moss, B. Charles AU - Singh, Nadya Lauren AU - Oehmke, Bristol Theresa AU - Post, Ann Lori PY - 2020/10/5 TI - Dynamic Panel Surveillance of COVID-19 Transmission in the United States to Inform Health Policy: Observational Statistical Study JO - J Med Internet Res SP - e21955 VL - 22 IS - 10 KW - COVID-19 KW - models KW - surveillance KW - reopening America KW - contagion KW - metrics KW - health policy KW - public health N2 - 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. UR - https://www.jmir.org/2020/10/e21955 UR - http://dx.doi.org/10.2196/21955 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924962 ID - info:doi/10.2196/21955 ER - TY - JOUR AU - Mira, Joaquín José AU - Vicente, Asunción María AU - Lopez-Pineda, Adriana AU - Carrillo, Irene AU - Guilabert, Mercedes AU - Fernández, César AU - Pérez-Jover, Virtudes AU - Martin Delgado, Jimmy AU - Pérez-Pérez, Pastora AU - Cobos Vargas, Angel AU - Astier-Peña, Pilar María AU - Martínez-García, Beatriz Olga AU - Marco-Gómez, Bárbara AU - Abad Bouzán, Cristina PY - 2020/10/5 TI - Preventing and Addressing the Stress Reactions of Health Care Workers Caring for Patients With COVID-19: Development of a Digital Platform (Be + Against COVID) JO - JMIR Mhealth Uhealth SP - e21692 VL - 8 IS - 10 KW - COVID-19 KW - pandemic KW - internet KW - social media KW - mobile app KW - psychosocial KW - support system KW - health personnel KW - app N2 - Background: COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. Objective: The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. Methods: The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. Results: We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18,516 out of 68,913 (26.9%) visits, and the ?Self-Report Acute Stress Scale? was the most visited resource with 6468 out of 18,516 (34.9%) visits. Conclusions: The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines. UR - https://mhealth.jmir.org/2020/10/e21692 UR - http://dx.doi.org/10.2196/21692 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936769 ID - info:doi/10.2196/21692 ER - TY - JOUR AU - Deng, Cheng-Hu AU - Wang, Jing-Qiang AU - Zhu, Li-Ming AU - Liu, He-Wang AU - Guo, Yu AU - Peng, Xue-Hua AU - Shao, Jian-Bo AU - Xia, Wei PY - 2020/10/5 TI - Association of Web-Based Physical Education With Mental Health of College Students in Wuhan During the COVID-19 Outbreak: Cross-Sectional Survey Study JO - J Med Internet Res SP - e21301 VL - 22 IS - 10 KW - COVID-19 KW - college students KW - mental status KW - physical education KW - young adults KW - web-based education KW - global health KW - web-based survey KW - physical activity KW - mental health N2 - Background: The COVID-19 outbreak has affected people?s health worldwide. For college students, web-based physical education is a challenge, as these course are normally offered outdoors. Objective: The aim of this study was to use data from a web-based survey to evaluate the relationship between the mental health status of college students and their sports-related lifestyles. Problems related to web-based physical education were also examined. Methods: A web-based survey was conducted by snowball sampling from May 8 to 11, 2020. Demographic data, mental health status, and sports-related lifestyles of college students in Wuhan as well as issues related to web-based physical education were collected. Mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Results: The study included 1607 respondents from 267 cities. The average scores of the DASS-21 subscales (2.46 for depression, 1.48 for anxiety, and 2.59 for stress) were significantly lower in our study than in a previous study (P<.05). Lower DASS-21 scores were significantly correlated with regular exercise, maintaining exercise habits during the outbreak of COVID-19, exercising more than 1 to 2 times a week, exercise duration >1 hour, and >2000 pedometer steps (all P<.05). None of the three forms of web-based physical education was preferred by more than 50% of respondents. Frequent technical problems were confronted by 1087/1607 students (67.6%). Shape-up exercises (846/1607, 52.6%), a designed combination of exercises (710/1607, 44.2%), and Chinese kung fu (559/1607, 34.8%) were suggested sports for web-based physical education. Conclusions: Mental status was significantly correlated with regular exercise and sufficient exercise duration. Professional physical guidance is needed for college students in selected sports. Exercises not meeting students? preferences, frequent technical problems, and the distant interaction involved in web-based physical education were the main problems that should be solved in future. UR - http://www.jmir.org/2020/10/e21301/ UR - http://dx.doi.org/10.2196/21301 UR - http://www.ncbi.nlm.nih.gov/pubmed/32997639 ID - info:doi/10.2196/21301 ER - TY - JOUR AU - Giunti, Guido AU - Goossens, Richard AU - De Bont, Antoinette AU - Visser, J. Jacob AU - Mulder, Mark AU - Schuit, E. Stephanie C. PY - 2020/10/5 TI - The Need for Sustainable Teleconsultation Systems in the Aftermath of the First COVID-19 Wave JO - J Med Internet Res SP - e21211 VL - 22 IS - 10 KW - telemedicine KW - COVID-19 KW - telehealth KW - teleconsultation KW - exposure KW - software KW - digital health KW - organization UR - http://www.jmir.org/2020/10/e21211/ UR - http://dx.doi.org/10.2196/21211 UR - http://www.ncbi.nlm.nih.gov/pubmed/32997642 ID - info:doi/10.2196/21211 ER - TY - JOUR AU - Jeon, Jouhyun AU - Baruah, Gaurav AU - Sarabadani, Sarah AU - Palanica, Adam PY - 2020/10/2 TI - Identification of Risk Factors and Symptoms of COVID-19: Analysis of Biomedical Literature and Social Media Data JO - J Med Internet Res SP - e20509 VL - 22 IS - 10 KW - SARS-CoV-2 KW - COVID-19 KW - risk factor KW - symptom KW - diagnosis KW - treatment KW - biomedical literature KW - social media KW - Twitter KW - tweets N2 - Background: In December 2019, the COVID-19 outbreak started in China and rapidly spread around the world. Lack of a vaccine or optimized intervention raised the importance of characterizing risk factors and symptoms for the early identification and successful treatment of patients with COVID-19. Objective: This study aims to investigate and analyze biomedical literature and public social media data to understand the association of risk factors and symptoms with the various outcomes observed in patients with COVID-19. Methods: Through semantic analysis, we collected 45 retrospective cohort studies, which evaluated 303 clinical and demographic variables across 13 different outcomes of patients with COVID-19, and 84,140 Twitter posts from 1036 COVID-19?positive users. Machine learning tools to extract biomedical information were introduced to identify mentions of uncommon or novel symptoms in tweets. We then examined and compared two data sets to expand our landscape of risk factors and symptoms related to COVID-19. Results: From the biomedical literature, approximately 90% of clinical and demographic variables showed inconsistent associations with COVID-19 outcomes. Consensus analysis identified 72 risk factors that were specifically associated with individual outcomes. From the social media data, 51 symptoms were characterized and analyzed. By comparing social media data with biomedical literature, we identified 25 novel symptoms that were specifically mentioned in tweets but have been not previously well characterized. Furthermore, there were certain combinations of symptoms that were frequently mentioned together in social media. Conclusions: Identified outcome-specific risk factors, symptoms, and combinations of symptoms may serve as surrogate indicators to identify patients with COVID-19 and predict their clinical outcomes in order to provide appropriate treatments. UR - https://www.jmir.org/2020/10/e20509 UR - http://dx.doi.org/10.2196/20509 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936770 ID - info:doi/10.2196/20509 ER - TY - JOUR AU - Liu, Boxiang AU - Liu, Kaibo AU - Zhang, He AU - Zhang, Liang AU - Bian, Yuchen AU - Huang, Liang PY - 2020/10/2 TI - CoV-Seq, a New Tool for SARS-CoV-2 Genome Analysis and Visualization: Development and Usability Study JO - J Med Internet Res SP - e22299 VL - 22 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - bioinformatics KW - genetics KW - genome KW - virus KW - sequence KW - data sets KW - programming KW - web server N2 - Background: COVID-19 became a global pandemic not long after its identification in late 2019. The genomes of SARS-CoV-2 are being rapidly sequenced and shared on public repositories. To keep up with these updates, scientists need to frequently refresh and reclean data sets, which is an ad hoc and labor-intensive process. Further, scientists with limited bioinformatics or programming knowledge may find it difficult to analyze SARS-CoV-2 genomes. Objective: To address these challenges, we developed CoV-Seq, an integrated web server that enables simple and rapid analysis of SARS-CoV-2 genomes. Methods: CoV-Seq is implemented in Python and JavaScript. The web server and source code URLs are provided in this article. Results: Given a new sequence, CoV-Seq automatically predicts gene boundaries and identifies genetic variants, which are displayed in an interactive genome visualizer and are downloadable for further analysis. A command-line interface is available for high-throughput processing. In addition, we aggregated all publicly available SARS-CoV-2 sequences from the Global Initiative on Sharing Avian Influenza Data (GISAID), National Center for Biotechnology Information (NCBI), European Nucleotide Archive (ENA), and China National GeneBank (CNGB), and extracted genetic variants from these sequences for download and downstream analysis. The CoV-Seq database is updated weekly. Conclusions: We have developed CoV-Seq, an integrated web service for fast and easy analysis of custom SARS-CoV-2 sequences. The web server provides an interactive module for the analysis of custom sequences and a weekly updated database of genetic variants of all publicly accessible SARS-CoV-2 sequences. We believe CoV-Seq will help improve our understanding of the genetic underpinnings of COVID-19. UR - https://www.jmir.org/2020/10/e22299 UR - http://dx.doi.org/10.2196/22299 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931441 ID - info:doi/10.2196/22299 ER - TY - JOUR AU - Sasangohar, Farzan AU - Bradshaw, R. Major AU - Carlson, Millen Marianne AU - Flack, N. James AU - Fowler, C. James AU - Freeland, Diana AU - Head, John AU - Marder, Kate AU - Orme, William AU - Weinstein, Benjamin AU - Kolman, M. Jacob AU - Kash, Bita AU - Madan, Alok PY - 2020/10/1 TI - Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective JO - J Med Internet Res SP - e22523 VL - 22 IS - 10 KW - telemedicine KW - psychiatry KW - preventive psychiatry KW - SARS virus KW - pandemic KW - prevention KW - COVID-19 KW - telehealth KW - perspective UR - https://www.jmir.org/2020/10/e22523 UR - http://dx.doi.org/10.2196/22523 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936768 ID - info:doi/10.2196/22523 ER - TY - JOUR AU - Reilly, E. Shannon AU - Zane, L. Katherine AU - McCuddy, T. William AU - Soulliard, A. Zachary AU - Scarisbrick, M. David AU - Miller, E. Liv AU - Mahoney III, J. James PY - 2020/10/1 TI - Mental Health Practitioners? Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study JO - JMIR Ment Health SP - e21237 VL - 7 IS - 9 KW - COVID-19 KW - clinical practice KW - tele?mental health KW - mental health KW - survey N2 - Background: The COVID-19 pandemic has been associated with increased psychological distress, signaling the need for increased mental health services in the context of stay-at-home policies. Objective: This study aims to characterize how mental health practitioners have changed their practices during the pandemic. The authors hypothesize that mental health practitioners would increase tele?mental health services and that certain provider types would be better able to adapt to tele?mental health than others. Methods: The study surveyed 903 practitioners, primarily psychologists/doctoral-level (Psych/DL) providers, social workers/master?s-level (SW/ML) providers, and neuropsychologists employed in academic medical centers or private practices. Differences among providers were examined using Bonferroni-adjusted chi-square tests and one-way Bonferroni-adjusted analyses of covariance. Results: The majority of the 903 mental health practitioners surveyed rapidly adjusted their practices, predominantly by shifting to tele?mental health appointments (n=729, 80.82%). Whereas 80.44% (n=625) were not using tele?mental health in December 2019, only 22.07% (n=188) were not by late March or early April 2020. Only 2.11% (n=19) reported no COVID-19?related practice adjustments. Two-thirds (596/888, 67.10%) reported providing additional therapeutic services specifically to treat COVID-19?related concerns. Neuropsychologists were less likely and Psych/DL providers and SW/ML providers were more likely than expected to transition to tele?mental health (P<.001). Trainees saw fewer patients (P=.01) and worked remotely more than licensed practitioners (P=.03). Despite lower rates of information technology service access (P<.001), private practice providers reported less difficulty implementing tele?mental health than providers in other settings (P<.001). Overall, the majority (530/889, 59.62%) were interested in continuing to provide tele?mental health services in the future. Conclusions: The vast majority of mental health providers in this study made practice adjustments in response to COVID-19, predominantly by rapidly transitioning to tele?mental health services. Although the majority reported providing additional therapeutic services specifically to treat COVID-19?related concerns, only a small subset endorsed offering such services to medical providers. This has implications for future practical directions, as frontline workers may begin to seek mental health treatment related to the pandemic. Despite differences in tele?mental health uptake based on provider characteristics, the majority were interested in continuing to provide such services in the future. This may help to expand clinical services to those in need via tele?mental health beyond the COVID-19 pandemic. UR - https://mental.jmir.org/2020/10/e21237/ UR - http://dx.doi.org/10.2196/21237 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931440 ID - info:doi/10.2196/21237 ER - TY - JOUR AU - Nan, Shan AU - Tang, Tianhua AU - Feng, Hongshuo AU - Wang, Yijie AU - Li, Mengyang AU - Lu, Xudong AU - Duan, Huilong PY - 2020/10/1 TI - A Computer-Interpretable Guideline for COVID-19: Rapid Development and Dissemination JO - JMIR Med Inform SP - e21628 VL - 8 IS - 10 KW - COVID-19 KW - guideline KW - CDSS KW - openEHR KW - Guideline Definition Language KW - development KW - dissemination KW - electronic health record KW - algorithm N2 - 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. UR - https://medinform.jmir.org/2020/10/e21628 UR - http://dx.doi.org/10.2196/21628 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931443 ID - info:doi/10.2196/21628 ER - TY - JOUR AU - Padala, P. Kalpana AU - Wilson, B. Kerrie AU - Gauss, Heath C. AU - Stovall, D. Jessica AU - Padala, R. Prasad PY - 2020/9/30 TI - VA Video Connect for Clinical Care in Older Adults in a Rural State During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e21561 VL - 22 IS - 9 KW - VA Video Connect KW - older adults KW - rural KW - COVID-19 KW - veterans KW - telehealth KW - elderly KW - disparity KW - veteran affairs KW - capabillity KW - cross-sectional N2 - Background: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. Objective: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. Methods: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans? willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. Results: Participants? mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. Conclusions: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas. UR - http://www.jmir.org/2020/9/e21561/ UR - http://dx.doi.org/10.2196/21561 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936773 ID - info:doi/10.2196/21561 ER - TY - JOUR AU - Pan, Yihang AU - Fang, Yuan AU - Xin, Meiqi AU - Dong, Willa AU - Zhou, Liemin AU - Hou, Qinghua AU - Li, Fanping AU - Sun, Gang AU - Zheng, Zilong AU - Yuan, Jinqiu AU - Wang, Zixin AU - He, Yulong PY - 2020/9/29 TI - Self-Reported Compliance With Personal Preventive Measures Among Chinese Factory Workers at the Beginning of Work Resumption Following the COVID-19 Outbreak: Cross-Sectional Survey Study JO - J Med Internet Res SP - e22457 VL - 22 IS - 9 KW - COVID-19 KW - work resumption, factory workers KW - facemask wearing KW - hand hygiene KW - physical distancing KW - prevention KW - cross-sectional KW - online KW - survey KW - compliance N2 - Background: Maintaining compliance with personal preventive measures is important to achieve a balance of COVID-19 pandemic control and work resumption. Objective: The aim of this study was to investigate self-reported compliance with four personal measures to prevent COVID-19 among a sample of factory workers in Shenzhen, China, at the beginning of work resumption in China following the COVID-19 outbreak. These preventive measures included consistent wearing of face masks in public spaces (the workplace and other public settings); sanitizing hands using soap, liquid soap, or alcohol-based hand sanitizer after returning from public spaces or touching public installations and equipment; avoiding social and meal gatherings; and avoiding crowded places. Methods: The participants were adult factory workers who had resumed work in Shenzhen, China. A stratified two-stage cluster sampling design was used. We randomly selected 14 factories that had resumed work. All full-time employees aged ?18 years who had resumed work in these factories were invited to complete a web-based survey. Out of 4158 workers who had resumed work in these factories, 3035 (73.0%) completed the web-based survey from March 1 to 14, 2020. Multilevel logistic regression models were fitted. Results: Among the 3035 participants, 2938 (96.8%) and 2996 (98.7%) reported always wearing a face mask in the workplace and in other public settings, respectively, in the past month. However, frequencies of self-reported sanitizing hands (2152/3035, 70.9%), avoiding social and meal gatherings (2225/3035, 73.3%), and avoiding crowded places (1997/3035, 65.8%) were relatively low. At the individual level, knowledge about COVID-19 (adjusted odds ratios [AORs] from 1.16, CI 1.10-1.24, to 1.29, CI 1.21-1.37), perceived risk (AORs from 0.58, CI 0.50-0.68, to 0.85, CI 0.72-0.99) and severity (AOR 1.05, CI 1.01-1.09, and AOR 1.07, CI 1.03-1.11) of COVID-19, perceived effectiveness of preventive measures by the individual (AORs from 1.05, CI 1.00-1.10, to 1.09, CI 1.04-1.13), organization (AOR 1.30, CI 1.20-1.41), and government (AORs from 1.14, CI 1.04-1.25, to 1.21, CI 1.02-1.42), perceived preparedness for a potential outbreak after work resumption (AORs from 1.10, CI 1.00-1.21, to 1.50, CI 1.36-1.64), and depressive symptoms (AORs from 0.93, CI 0.91-0.94, to 0.96, CI 0.92-0.99) were associated with self-reported compliance with at least one personal preventive measure. At the interpersonal level, exposure to COVID-19?specific information through official media channels (AOR 1.08, CI 1.04-1.11) and face-to-face communication (AOR 0.90, CI 0.83-0.98) were associated with self-reported sanitizing of hands. The number of preventive measures implemented in the workplace was positively associated with self-reported compliance with all four preventive measures (AORs from 1.30, CI 1.08-1.57, to 1.63, CI 1.45-1.84). Conclusions: Measures are needed to strengthen hand hygiene and physical distancing among factory workers to reduce transmission following work resumption. Future programs in workplaces should address these factors at multiple levels. UR - http://www.jmir.org/2020/9/e22457/ UR - http://dx.doi.org/10.2196/22457 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924947 ID - info:doi/10.2196/22457 ER - TY - JOUR AU - Husnayain, Atina AU - Shim, Eunha AU - Fuad, Anis AU - Su, Chia-Yu Emily PY - 2020/9/29 TI - Understanding the Community Risk Perceptions of the COVID-19 Outbreak in South Korea: Infodemiology Study JO - J Med Internet Res SP - e19788 VL - 22 IS - 9 KW - Google Trends KW - risk KW - perception KW - communication KW - COVID-19 KW - South Korea KW - outbreak KW - infodemiology N2 - Background: South Korea is among the best-performing countries in tackling the coronavirus pandemic by using mass drive-through testing, face mask use, and extensive social distancing. However, understanding the patterns of risk perception could also facilitate effective risk communication to minimize the impacts of disease spread during this crisis. Objective: We attempt to explore patterns of community health risk perceptions of COVID-19 in South Korea using internet search data. Methods: Google Trends (GT) and NAVER relative search volumes (RSVs) data were collected using COVID-19?related terms in the Korean language and were retrieved according to time, gender, age groups, types of device, and location. Online queries were compared to the number of daily new COVID-19 cases and tests reported in the Kaggle open-access data set for the time period of December 5, 2019, to May 31, 2020. Time-lag correlations calculated by Spearman rank correlation coefficients were employed to assess whether correlations between new COVID-19 cases and internet searches were affected by time. We also constructed a prediction model of new COVID-19 cases using the number of COVID-19 cases, tests, and GT and NAVER RSVs in lag periods (of 1-3 days). Single and multiple regressions were employed using backward elimination and a variance inflation factor of <5. Results: The numbers of COVID-19?related queries in South Korea increased during local events including local transmission, approval of coronavirus test kits, implementation of coronavirus drive-through tests, a face mask shortage, and a widespread campaign for social distancing as well as during international events such as the announcement of a Public Health Emergency of International Concern by the World Health Organization. Online queries were also stronger in women (r=0.763-0.823; P<.001) and age groups ?29 years (r=0.726-0.821; P<.001), 30-44 years (r=0.701-0.826; P<.001), and ?50 years (r=0.706-0.725; P<.001). In terms of spatial distribution, internet search data were higher in affected areas. Moreover, greater correlations were found in mobile searches (r=0.704-0.804; P<.001) compared to those of desktop searches (r=0.705-0.717; P<.001), indicating changing behaviors in searching for online health information during the outbreak. These varied internet searches related to COVID-19 represented community health risk perceptions. In addition, as a country with a high number of coronavirus tests, results showed that adults perceived coronavirus test?related information as being more important than disease-related knowledge. Meanwhile, younger, and older age groups had different perceptions. Moreover, NAVER RSVs can potentially be used for health risk perception assessments and disease predictions. Adding COVID-19?related searches provided by NAVER could increase the performance of the model compared to that of the COVID-19 case?based model and potentially be used to predict epidemic curves. Conclusions: The use of both GT and NAVER RSVs to explore patterns of community health risk perceptions could be beneficial for targeting risk communication from several perspectives, including time, population characteristics, and location. UR - http://www.jmir.org/2020/9/e19788/ UR - http://dx.doi.org/10.2196/19788 UR - http://www.ncbi.nlm.nih.gov/pubmed/32931446 ID - info:doi/10.2196/19788 ER - TY - JOUR AU - Jarrett, Mark AU - Schultz, Susanne AU - Lyall, Julie AU - Wang, Jason AU - Stier, Lori AU - De Geronimo, Marcella AU - Nelson, Karen PY - 2020/9/25 TI - Clinical Mortality in a Large COVID-19 Cohort: Observational Study JO - J Med Internet Res SP - e23565 VL - 22 IS - 9 KW - COVID-19 KW - mortality KW - respiratory failure KW - hypoxemia KW - observational KW - review KW - cohort KW - ICU KW - intensive care unit N2 - 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. UR - http://www.jmir.org/2020/9/e23565/ UR - http://dx.doi.org/10.2196/23565 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930099 ID - info:doi/10.2196/23565 ER - TY - JOUR AU - Tsai, Jiun-Yi AU - Phua, Joe AU - Pan, Shuya AU - Yang, Chia-chen PY - 2020/9/25 TI - 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 JO - J Med Internet Res SP - e22767 VL - 22 IS - 9 KW - COVID-19 KW - prejudice KW - news exposure KW - news trust KW - infodemic KW - media bias KW - racism KW - social media use KW - intergroup contact KW - regression KW - moderation analysis KW - cross-sectional survey N2 - 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 (?=.08, P=.02), had a personal infection history (?=.10, P=.004), and interacted with Asian people frequently in their daily lives (?=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media (?=.08, P=.04) and higher levels of trust in social media (?=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets (?=?.15, P=.001) and neutral outlets (?=?.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. UR - http://www.jmir.org/2020/9/e22767/ UR - http://dx.doi.org/10.2196/22767 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924948 ID - info:doi/10.2196/22767 ER - TY - JOUR AU - Liu, J. Jean C. AU - Tong, W. Eddie M. PY - 2020/9/25 TI - The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study JO - J Med Internet Res SP - e22142 VL - 22 IS - 9 KW - mental health KW - social media KW - pandemic KW - depression KW - anxiety KW - stress KW - COVID-19 KW - app KW - risk factor KW - psychology N2 - 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 UR - http://www.jmir.org/2020/9/e22142/ UR - http://dx.doi.org/10.2196/22142 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877349 ID - info:doi/10.2196/22142 ER - TY - JOUR AU - Sun, Shaoxiong AU - Folarin, A. Amos AU - Ranjan, Yatharth AU - Rashid, Zulqarnain AU - Conde, Pauline AU - Stewart, Callum AU - Cummins, Nicholas AU - Matcham, Faith AU - Dalla Costa, Gloria AU - Simblett, Sara AU - Leocani, Letizia AU - Lamers, Femke AU - Sørensen, Soelberg Per AU - Buron, Mathias AU - Zabalza, Ana AU - Guerrero Pérez, Isabel Ana AU - Penninx, WJH Brenda AU - Siddi, Sara AU - Haro, Maria Josep AU - Myin-Germeys, Inez AU - Rintala, Aki AU - Wykes, Til AU - Narayan, A. Vaibhav AU - Comi, Giancarlo AU - Hotopf, Matthew AU - Dobson, JB Richard AU - PY - 2020/9/25 TI - Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19 JO - J Med Internet Res SP - e19992 VL - 22 IS - 9 KW - mobile health KW - COVID-19 KW - behavioral monitoring KW - smartphones KW - wearable devices KW - mobility KW - phone use N2 - 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. UR - https://www.jmir.org/2020/9/e19992 UR - http://dx.doi.org/10.2196/19992 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877352 ID - info:doi/10.2196/19992 ER - TY - JOUR AU - Mrklas, Kelly AU - Shalaby, Reham AU - Hrabok, Marianne AU - Gusnowski, April AU - Vuong, Wesley AU - Surood, Shireen AU - Urichuk, Liana AU - Li, Daniel AU - Li, Xin-Min AU - Greenshaw, James Andrew AU - Agyapong, Opoku Vincent Israel PY - 2020/9/25 TI - Prevalence of Perceived Stress, Anxiety, Depression, and Obsessive-Compulsive Symptoms in Health Care Workers and Other Workers in Alberta During the COVID-19 Pandemic: Cross-Sectional Survey JO - JMIR Ment Health SP - e22408 VL - 7 IS - 9 KW - health care worker KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - anxiety KW - stress KW - obsessive compulsive N2 - Background: During pandemics, effective containment and mitigation measures may also negatively influence psychological stability. As knowledge about COVID-19 rapidly evolves, global implementation of containment and mitigation measures has varied greatly, with impacts to mental wellness. Assessing the impact of COVID-19 on the mental health needs of health care workers and other workers may help mitigate mental health impacts and secure sustained delivery of health care and other essential goods and services. Objective: This study assessed the self-reported prevalence of stress, anxiety, depression, and obsessive-compulsive symptoms in health care workers and other workers seeking support through Text4Hope, an evidence-based SMS text messaging service supporting the mental health of residents of Alberta, Canada, during the COVID-19 pandemic. Methods: An online cross-sectional survey gathered demographic (age, gender, ethnicity, education, relationship, housing and employment status, employment type, and isolation status) and clinical characteristics using validated tools (self-reported stress, anxiety, depression, and contamination/hand hygiene obsessive-compulsive symptoms). Descriptive statistics and chi-square analysis were used to compare the clinical characteristics of health care workers and other workers. Post hoc analysis was conducted on variables with >3 response categories using adjusted residuals. Logistic regression determined associations between worker type and likelihood of self-reported symptoms of moderate or high stress, generalized anxiety disorder, and major depressive disorder, while controlling for other variables. Results: Overall, 8267 surveys were submitted by 44,992 Text4Hope subscribers (19.39%). Of these, 5990 respondents were employed (72.5%), 958 (11.6%) were unemployed, 454 (5.5%) were students, 559 (6.8%) were retired, 234 (2.8%) selected ?other,? and 72 (0.9%) did not indicate their employment status. Most employed survey respondents were female (n=4621, 86.2%). In the general sample, the 6-week prevalence rates for moderate or high stress, anxiety, and depression symptoms were 85.6%, 47.0%, and 44.0%, respectively. Self-reported symptoms of moderate or high stress, anxiety, and depression were all statistically significantly higher in other workers than in health care workers (P<.001). Other workers reported higher obsessive-compulsive symptoms (worry about contamination and compulsive handwashing behavior) after the onset of the pandemic (P<.001), while health care worker symptoms were statistically significantly higher before and during the COVID-19 pandemic (P<.001). This finding should be interpreted with caution, as it is unclear the extent to which the adaptive behavior of health care workers or the other workers might be misclassified by validated tools during a pandemic. Conclusions: Assessing symptoms of prevalent stress, anxiety, depression, and obsessive-compulsive behavior in health care workers and other workers may enhance our understanding of COVID-19 mental health needs. Research is needed to understand more fully the relationship between worker type, outbreak phase, and mental health changes over time, as well as the utility of validated tools in health care workers and other workers during pandemics. Our findings underscore the importance of anticipating and mitigating the mental health effects of pandemics using integrated implementation strategies. Finally, we demonstrate the ease of safely and rapidly assessing mental health needs using an SMS text messaging platform during a pandemic. International Registered Report Identifier (IRRID): RR2-10.2196/19292 UR - http://mental.jmir.org/2020/9/e22408/ UR - http://dx.doi.org/10.2196/22408 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915764 ID - info:doi/10.2196/22408 ER - TY - JOUR AU - Oehmke, Francis James AU - Oehmke, B. Theresa AU - Singh, Nadya Lauren AU - Post, Ann Lori PY - 2020/9/22 TI - Dynamic Panel Estimate?Based Health Surveillance of SARS-CoV-2 Infection Rates to Inform Public Health Policy: Model Development and Validation JO - J Med Internet Res SP - e20924 VL - 22 IS - 9 KW - COVID-19 KW - models KW - surveillance KW - COVID-19 surveillance system KW - dynamic panel data KW - infectious disease modeling KW - reopening America KW - COVID-19 guidelines KW - COVID-19 health policy N2 - 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 (?210=1489.84, P<.001), and a Sargan chi-square test indicated that the model identification is valid (?2946=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. UR - http://www.jmir.org/2020/9/e20924/ UR - http://dx.doi.org/10.2196/20924 UR - http://www.ncbi.nlm.nih.gov/pubmed/32915762 ID - info:doi/10.2196/20924 ER - TY - JOUR AU - Khurshid, Anjum PY - 2020/9/22 TI - Applying Blockchain Technology to Address the Crisis of Trust During the COVID-19 Pandemic JO - JMIR Med Inform SP - e20477 VL - 8 IS - 9 KW - blockchain KW - privacy KW - trust KW - contact tracing KW - COVID-19 KW - coronavirus N2 - Background: The widespread death and disruption caused by the COVID-19 pandemic has revealed deficiencies of existing institutions regarding the protection of human health and well-being. Both a lack of accurate and timely data and pervasive misinformation are causing increasing harm and growing tension between data privacy and public health concerns. Objective: This aim of this paper is to describe how blockchain, with its distributed trust networks and cryptography-based security, can provide solutions to data-related trust problems. Methods: Blockchain is being applied in innovative ways that are relevant to the current COVID-19 crisis. We describe examples of the challenges faced by existing technologies to track medical supplies and infected patients and how blockchain technology applications may help in these situations. Results: This exploration of existing and potential applications of blockchain technology for medical care shows how the distributed governance structure and privacy-preserving features of blockchain can be used to create ?trustless? systems that can help resolve the tension between maintaining privacy and addressing public health needs in the fight against COVID-19. Conclusions: Blockchain relies on a distributed, robust, secure, privacy-preserving, and immutable record framework that can positively transform the nature of trust, value sharing, and transactions. A nationally coordinated effort to explore blockchain to address the deficiencies of existing systems and a partnership of academia, researchers, business, and industry are suggested to expedite the adoption of blockchain in health care. UR - http://medinform.jmir.org/2020/9/e20477/ UR - http://dx.doi.org/10.2196/20477 UR - http://www.ncbi.nlm.nih.gov/pubmed/32903197 ID - info:doi/10.2196/20477 ER - TY - JOUR AU - Lin, Yu-Hsuan AU - Chiang, Ting-Wei AU - Lin, Yu-Lun PY - 2020/9/21 TI - Increased Internet Searches for Insomnia as an Indicator of Global Mental Health During the COVID-19 Pandemic: Multinational Longitudinal Study JO - J Med Internet Res SP - e22181 VL - 22 IS - 9 KW - internet search KW - Google Trends KW - infodemiology KW - infoveillance KW - COVID-19 KW - insomnia KW - mental health N2 - 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 (?=0.64, P=.003). By contrast, there was no significant correlation between the number of deaths and increases in searches for depression (?=?0.12, P=.63) or suicide (?=?0.07, P=.79). Conclusions: Our analysis suggests that insomnia could be a part of routine mental health screening during the COVID-19 pandemic. UR - http://www.jmir.org/2020/9/e22181/ UR - http://dx.doi.org/10.2196/22181 UR - http://www.ncbi.nlm.nih.gov/pubmed/32924951 ID - info:doi/10.2196/22181 ER - TY - JOUR AU - Guarino, Maria AU - Cossiga, Valentina AU - Fiorentino, Andrea AU - Pontillo, Giuseppina AU - Morisco, Filomena PY - 2020/9/21 TI - Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study JO - J Med Internet Res SP - e20874 VL - 22 IS - 9 KW - telemedicine KW - COVID-19 KW - hepatology KW - telehealth KW - liver disease KW - Italy KW - hospital KW - chronic disease KW - liver N2 - Background: The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. Objective: The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19?mandated lockdown. Methods: From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. Results: During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non?COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. Conclusions: Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules. UR - http://www.jmir.org/2020/9/e20874/ UR - http://dx.doi.org/10.2196/20874 UR - http://www.ncbi.nlm.nih.gov/pubmed/32896833 ID - info:doi/10.2196/20874 ER - TY - JOUR AU - Soriano, B. Joan AU - Fernández, Esteve AU - de Astorza, Álvaro AU - Pérez de Llano, A. Luis AU - Fernández-Villar, Alberto AU - Carnicer-Pont, Dolors AU - Alcázar-Navarrete, Bernardino AU - García, Arturo AU - Morales, Aurelio AU - Lobo, María AU - Maroto, Marcos AU - Ferreras, Eloy AU - Soriano, Cecilia AU - Del Rio-Bermudez, Carlos AU - Vega-Piris, Lorena AU - Basagaña, Xavier AU - Muncunill, Josep AU - Cosio, G. Borja AU - Lumbreras, Sara AU - Catalina, Carlos AU - Alzaga, María José AU - Gómez Quilón, David AU - Valdivia, Alberto Carlos AU - de Lara, Celia AU - Ancochea, Julio PY - 2020/9/21 TI - Hospital Epidemics Tracker (HEpiTracker): Description and Pilot Study of a Mobile App to Track COVID-19 in Hospital Workers JO - JMIR Public Health Surveill SP - e21653 VL - 6 IS - 3 KW - app KW - COVID-19 KW - coronavirus KW - e-medicine KW - monitoring KW - symptoms KW - surveillance N2 - 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 UR - http://publichealth.jmir.org/2020/3/e21653/ UR - http://dx.doi.org/10.2196/21653 UR - http://www.ncbi.nlm.nih.gov/pubmed/32845852 ID - info:doi/10.2196/21653 ER - TY - JOUR AU - Adorni, Fulvio AU - Prinelli, Federica AU - Bianchi, Fabrizio AU - Giacomelli, Andrea AU - Pagani, Gabriele AU - Bernacchia, Dario AU - Rusconi, Stefano AU - Maggi, Stefania AU - Trevisan, Caterina AU - Noale, Marianna AU - Molinaro, Sabrina AU - Bastiani, Luca AU - Fortunato, Loredana AU - Jesuthasan, Nithiya AU - Sojic, Aleksandra AU - Pettenati, Carla AU - Tavio, Marcello AU - Andreoni, Massimo AU - Mastroianni, Claudio AU - Antonelli Incalzi, Raffaele AU - Galli, Massimo PY - 2020/9/18 TI - Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey JO - JMIR Public Health Surveill SP - e21866 VL - 6 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - voluntary respondents KW - web-based survey KW - self-reported symptom KW - nasopharyngeal swab testing KW - cross-sectional N2 - 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 UR - http://publichealth.jmir.org/2020/3/e21866/ UR - http://dx.doi.org/10.2196/21866 UR - http://www.ncbi.nlm.nih.gov/pubmed/32650305 ID - info:doi/10.2196/21866 ER - TY - JOUR AU - Krishnamurthy, Kamalanand AU - Ambikapathy, Bakiya AU - Kumar, Ashwani AU - Britto, De Lourduraj PY - 2020/9/18 TI - Prediction of the Transition From Subexponential to the Exponential Transmission of SARS-CoV-2 in Chennai, India: Epidemic Nowcasting JO - JMIR Public Health Surveill SP - e21152 VL - 6 IS - 3 KW - COVID-19 KW - epidemic KW - mathematical modeling KW - probabilistic models KW - public transport KW - exponential transmission N2 - 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. UR - https://publichealth.jmir.org/2020/3/e21152 UR - http://dx.doi.org/10.2196/21152 UR - http://www.ncbi.nlm.nih.gov/pubmed/32609621 ID - info:doi/10.2196/21152 ER - TY - JOUR AU - Huang, Huaping AU - Zhao, Wen-Jun AU - Li, Gui-Rong PY - 2020/9/18 TI - Knowledge and Psychological Stress Related to COVID-19 Among Nursing Staff in a Hospital in China: Cross-Sectional Survey Study JO - JMIR Form Res SP - e20606 VL - 4 IS - 9 KW - COVID-19 KW - nursing staff KW - knowledge KW - psychological stress N2 - 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. UR - https://formative.jmir.org/2020/9/e20606 UR - http://dx.doi.org/10.2196/20606 UR - http://www.ncbi.nlm.nih.gov/pubmed/32640419 ID - info:doi/10.2196/20606 ER - TY - JOUR AU - Bao, Huanyu AU - Cao, Bolin AU - Xiong, Yuan AU - Tang, Weiming PY - 2020/9/18 TI - Digital Media?s Role in the COVID-19 Pandemic JO - JMIR Mhealth Uhealth SP - e20156 VL - 8 IS - 9 KW - COVID-19 KW - digital health KW - media KW - pandemic KW - public health KW - social media KW - dissemination KW - health information KW - mobile health UR - https://mhealth.jmir.org/2020/9/e20156 UR - http://dx.doi.org/10.2196/20156 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530817 ID - info:doi/10.2196/20156 ER - TY - JOUR AU - Rolland, Benjamin AU - Haesebaert, Frédéric AU - Zante, Elodie AU - Benyamina, Amine AU - Haesebaert, Julie AU - Franck, Nicolas PY - 2020/9/18 TI - 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 JO - JMIR Public Health Surveill SP - e19630 VL - 6 IS - 3 KW - COVID-19 KW - containment KW - eating behaviors KW - screen use KW - internet use KW - substance use KW - public health KW - mental health KW - pandemic KW - lifestyle KW - online survey KW - addiction N2 - 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. UR - http://publichealth.jmir.org/2020/3/e19630/ UR - http://dx.doi.org/10.2196/19630 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589149 ID - info:doi/10.2196/19630 ER - TY - JOUR AU - Al Nsour, Mohannad AU - Khader, Yousef AU - Al Serouri, Abdulwahed AU - Bashier, Haitham AU - Osman, Shahd PY - 2020/9/18 TI - Awareness and Preparedness of Field Epidemiology Training Program Graduates to Respond to COVID-19 in the Eastern Mediterranean Region: Cross-Sectional Study JO - JMIR Med Educ SP - e19047 VL - 6 IS - 1 KW - COVID-19 KW - infection KW - preparedness KW - awareness KW - Jordan KW - Yemen KW - Sudan N2 - 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. UR - http://mededu.jmir.org/2020/1/e19047/ UR - http://dx.doi.org/10.2196/19047 UR - http://www.ncbi.nlm.nih.gov/pubmed/32406852 ID - info:doi/10.2196/19047 ER - TY - JOUR AU - Churches, Timothy AU - Jorm, Louisa PY - 2020/9/18 TI - Flexible, Freely Available Stochastic Individual Contact Model for Exploring COVID-19 Intervention and Control Strategies: Development and Simulation JO - JMIR Public Health Surveill SP - e18965 VL - 6 IS - 3 KW - COVID-19 KW - epidemic curve KW - infection dynamics KW - public health interventions N2 - 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. UR - https://publichealth.jmir.org/2020/3/e18965 UR - http://dx.doi.org/10.2196/18965 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568729 ID - info:doi/10.2196/18965 ER - TY - JOUR AU - Kpozehouen, Benedict Elizabeth AU - Chen, Xin AU - Zhu, Mengyao AU - Macintyre, Raina C. PY - 2020/9/18 TI - Using Open-Source Intelligence to Detect Early Signals of COVID-19 in China: Descriptive Study JO - JMIR Public Health Surveill SP - e18939 VL - 6 IS - 3 KW - COVID-19 KW - infectious disease KW - surveillance KW - epidemiology KW - biosecurity N2 - 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. UR - http://publichealth.jmir.org/2020/3/e18939/ UR - http://dx.doi.org/10.2196/18939 UR - http://www.ncbi.nlm.nih.gov/pubmed/32598290 ID - info:doi/10.2196/18939 ER - TY - JOUR AU - Sacco, Guillaume AU - Lléonart, Sébastien AU - Simon, Romain AU - Noublanche, Frédéric AU - Annweiler, Cédric AU - PY - 2020/9/18 TI - Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study JO - JMIR Mhealth Uhealth SP - e21845 VL - 8 IS - 9 KW - video communication KW - telephone KW - older adults KW - nursing home KW - hospital KW - confinement KW - elderly KW - COVID-19 KW - communication KW - technology KW - social isolation KW - loneliness N2 - 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. UR - http://mhealth.jmir.org/2020/9/e21845/ UR - http://dx.doi.org/10.2196/21845 UR - http://www.ncbi.nlm.nih.gov/pubmed/32896832 ID - info:doi/10.2196/21845 ER - TY - JOUR AU - Mani, R. Vishnu AU - Kalabin, Aleksandr AU - Valdivieso, C. Sebastian AU - Murray-Ramcharan, Max AU - Donaldson, Brian PY - 2020/9/18 TI - New York Inner City Hospital COVID-19 Experience and Current Data: Retrospective Analysis at the Epicenter of the American Coronavirus Outbreak JO - J Med Internet Res SP - e20548 VL - 22 IS - 9 KW - SARS-CoV-2 KW - COVID-19 KW - pandemic KW - New York City KW - coronavirus outbreak KW - American minority KW - outbreak KW - minority KW - mortality KW - patient KW - characteristic KW - mechanical ventilation N2 - 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. UR - https://www.jmir.org/2020/9/e20548 UR - http://dx.doi.org/10.2196/20548 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540837 ID - info:doi/10.2196/20548 ER - TY - JOUR AU - Ramtekkar, Ujjwal AU - Bridge, A. Jeffrey AU - Thomas, Glenn AU - Butter, Eric AU - Reese, Jennifer AU - Logan, Erica AU - Lin, Simon AU - Axelson, David PY - 2020/9/18 TI - Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19 JO - JMIR Ment Health SP - e20157 VL - 7 IS - 9 KW - telepsychiatry KW - telebehavioral health KW - child and adolescent psychiatry KW - COVID-19 UR - https://mental.jmir.org/2020/9/e20157 UR - http://dx.doi.org/10.2196/20157 UR - http://www.ncbi.nlm.nih.gov/pubmed/32525485 ID - info:doi/10.2196/20157 ER - TY - JOUR AU - He, Zonglin AU - Zhang, P. Casper J. AU - Huang, Jian AU - Zhai, Jingyan AU - Zhou, Shuang AU - Chiu, Wai-Ting Joyce AU - Sheng, Jie AU - Tsang, Winghei AU - Akinwunmi, O. Babatunde AU - Ming, Wai-Kit PY - 2020/9/17 TI - A New Era of Epidemiology: Digital Epidemiology for Investigating the COVID-19 Outbreak in China JO - J Med Internet Res SP - e21685 VL - 22 IS - 9 KW - digital epidemiology KW - COVID-19 KW - risk KW - control KW - public health KW - epidemiology KW - China KW - outbreak KW - case study UR - https://www.jmir.org/2020/9/e21685 UR - http://dx.doi.org/10.2196/21685 UR - http://www.ncbi.nlm.nih.gov/pubmed/32805703 ID - info:doi/10.2196/21685 ER - TY - JOUR AU - Ming, Chiau Long AU - Untong, Noorazrina AU - Aliudin, Amalina Nur AU - Osili, Norliza AU - Kifli, Nurolaini AU - Tan, Siang Ching AU - Goh, Wen Khang AU - Ng, Wei Pit AU - Al-Worafi, Mohammed Yaser AU - Lee, Seng Kah AU - Goh, Poh Hui PY - 2020/9/16 TI - Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review JO - JMIR Mhealth Uhealth SP - e19796 VL - 8 IS - 9 KW - coronavirus KW - mobile medical app KW - self-care KW - mHealth KW - health education KW - app KW - COVID-19 KW - content analysis N2 - Background: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes. Objective: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps? assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes. Methods: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities. Results: Of the 223 COVID-19?related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function. Conclusions: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements. UR - https://mhealth.jmir.org/2020/9/e19796 UR - http://dx.doi.org/10.2196/19796 UR - http://www.ncbi.nlm.nih.gov/pubmed/32609622 ID - info:doi/10.2196/19796 ER - TY - JOUR AU - Fridman, Ilona AU - Lucas, Nicole AU - Henke, Debra AU - Zigler, K. Christina PY - 2020/9/15 TI - Association Between Public Knowledge About COVID-19, Trust in Information Sources, and Adherence to Social Distancing: Cross-Sectional Survey JO - JMIR Public Health Surveill SP - e22060 VL - 6 IS - 3 KW - health communication KW - COVID-19 KW - trust in information sources KW - social distancing KW - behavior KW - coronavirus N2 - Background: The success of behavioral interventions and policies designed to reduce the impact of the COVID-19 pandemic depends on how well individuals are informed about both the consequences of infection and the steps that should be taken to reduce the impact of the disease. Objective: The aim of this study was to investigate associations between public knowledge about COVID-19, adherence to social distancing, and public trust in government information sources (eg, the US Centers for Disease Control and Prevention), private sources (eg, FOX and CNN), and social networks (eg, Facebook and Twitter) to inform future policies related to critical information distribution. Methods: We conducted a cross-sectional survey (N=1243) between April 10 and 14, 2020. Data collection was stratified by US region and other demographics to ensure representativeness of the sample. Results: Government information sources were the most trusted among the public. However, we observed trends in the data that suggested variations in trust by age and gender. White and older populations generally expressed higher trust in government sources, while non-White and younger populations expressed higher trust in private sources (eg, CNN) and social networks (eg, Twitter). Trust in government sources was positively associated with accurate knowledge about COVID-19 and adherence to social distancing. However, trust in private sources (eg, FOX and CNN) was negatively associated with knowledge about COVID-19. Similarly, trust in social networks (eg, Facebook and Twitter) was negatively associated with both knowledge and adherence to social distancing. Conclusions: During pandemics such as the COVID-19 outbreak, policy makers should carefully consider the quality of information disseminated through private sources and social networks. Furthermore, when disseminating urgent health information, a variety of information sources should be used to ensure that diverse populations have timely access to critical knowledge. UR - http://publichealth.jmir.org/2020/3/e22060/ UR - http://dx.doi.org/10.2196/22060 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930670 ID - info:doi/10.2196/22060 ER - TY - JOUR AU - Cresswell, Kathrin AU - Sheikh, Aziz PY - 2020/9/15 TI - Can Disinfection Robots Reduce the Risk of Transmission of SARS-CoV-2 in Health Care and Educational Settings? JO - J Med Internet Res SP - e20896 VL - 22 IS - 9 KW - robotics KW - disinfection KW - SARS-CoV-2 KW - COVID-19 KW - risk KW - transmission KW - virus UR - http://www.jmir.org/2020/9/e20896/ UR - http://dx.doi.org/10.2196/20896 UR - http://www.ncbi.nlm.nih.gov/pubmed/32903196 ID - info:doi/10.2196/20896 ER - TY - JOUR AU - Atherly, Adam AU - Van Den Broek-Altenburg, Eline AU - Hart, Victoria AU - Gleason, Kelsey AU - Carney, Jan PY - 2020/9/14 TI - Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e21607 VL - 6 IS - 3 KW - COVID-19 KW - telemedicine KW - deferred care KW - mental health KW - alternative KW - health effect KW - viability N2 - Background: The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. Objective: This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. Methods: We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. Results: Deferred care was widespread?48% (n=812) of respondents deferred care?but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. Conclusions: Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services. UR - http://publichealth.jmir.org/2020/3/e21607/ UR - http://dx.doi.org/10.2196/21607 UR - http://www.ncbi.nlm.nih.gov/pubmed/32833661 ID - info:doi/10.2196/21607 ER - TY - JOUR AU - Nekliudov, A. Nikita AU - Blyuss, Oleg AU - Cheung, Yan Ka AU - Petrou, Loukia AU - Genuneit, Jon AU - Sushentsev, Nikita AU - Levadnaya, Anna AU - Comberiati, Pasquale AU - Warner, O. John AU - Tudor-Williams, Gareth AU - Teufel, Martin AU - Greenhawt, Matthew AU - DunnGalvin, Audrey AU - Munblit, Daniel PY - 2020/9/11 TI - Excessive Media Consumption About COVID-19 is Associated With Increased State Anxiety: Outcomes of a Large Online Survey in Russia JO - J Med Internet Res SP - e20955 VL - 22 IS - 9 KW - anxiety KW - COVID-19 KW - media consumption KW - SARS-CoV-2 KW - STAI KW - state anxiety KW - trait anxiety KW - trust to government KW - trust KW - mental health KW - social media KW - survey N2 - 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. UR - https://www.jmir.org/2020/9/e20955 UR - http://dx.doi.org/10.2196/20955 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788143 ID - info:doi/10.2196/20955 ER - TY - JOUR AU - Mehta, Mihir AU - Julaiti, Juxihong AU - Griffin, Paul AU - Kumara, Soundar PY - 2020/9/11 TI - Early Stage Machine Learning?Based Prediction of US County Vulnerability to the COVID-19 Pandemic: Machine Learning Approach JO - JMIR Public Health Surveill SP - e19446 VL - 6 IS - 3 KW - COVID-19 KW - coronavirus KW - prediction model KW - county-level vulnerability KW - machine learning KW - XGBoost N2 - 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. UR - http://publichealth.jmir.org/2020/3/e19446/ UR - http://dx.doi.org/10.2196/19446 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784193 ID - info:doi/10.2196/19446 ER - TY - JOUR AU - Elmore, G. Joann AU - Wang, Pin-Chieh AU - Kerr, F. Kathleen AU - Schriger, L. David AU - Morrison, E. Douglas AU - Brookmeyer, Ron AU - Pfeffer, A. Michael AU - Payne, H. Thomas AU - Currier, S. Judith PY - 2020/9/10 TI - 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 JO - J Med Internet Res SP - e21562 VL - 22 IS - 9 KW - COVID-19 KW - pandemic KW - electronic health record KW - time-series analysis KW - prediction KW - forecast N2 - 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. UR - https://www.jmir.org/2020/9/e21562 UR - http://dx.doi.org/10.2196/21562 UR - http://www.ncbi.nlm.nih.gov/pubmed/32791492 ID - info:doi/10.2196/21562 ER - TY - JOUR AU - Singh, Parvati AU - Cumberland, G. William AU - Ugarte, Dominic AU - Bruckner, Tim-Allen AU - Young, D. Sean PY - 2020/9/10 TI - Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis JO - J Med Internet Res SP - e21490 VL - 22 IS - 9 KW - online activity KW - COVID-19 KW - anxiety KW - generalized anxiety disorder KW - GAD KW - scores KW - stress KW - internet KW - survey KW - cross-sectional N2 - 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. UR - http://www.jmir.org/2020/9/e21490/ UR - http://dx.doi.org/10.2196/21490 UR - http://www.ncbi.nlm.nih.gov/pubmed/32841152 ID - info:doi/10.2196/21490 ER - TY - JOUR AU - Oliver, Nuria AU - Barber, Xavier AU - Roomp, Kirsten AU - Roomp, Kristof PY - 2020/9/10 TI - Assessing the Impact of the COVID-19 Pandemic in Spain: Large-Scale, Online, Self-Reported Population Survey JO - J Med Internet Res SP - e21319 VL - 22 IS - 9 KW - COVID-19 KW - SARS-CoV-2 KW - public health authorities KW - large-scale online surveys KW - infectious disease KW - outbreak KW - public engagement KW - disease prevalence KW - impact KW - survey KW - spain KW - public health KW - perception N2 - 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. UR - http://www.jmir.org/2020/9/e21319/ UR - http://dx.doi.org/10.2196/21319 UR - http://www.ncbi.nlm.nih.gov/pubmed/32870159 ID - info:doi/10.2196/21319 ER - TY - JOUR AU - Zens, Martin AU - Brammertz, Arne AU - Herpich, Juliane AU - Südkamp, Norbert AU - Hinterseer, Martin PY - 2020/9/9 TI - App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data JO - J Med Internet Res SP - e21956 VL - 22 IS - 9 KW - COVID-19 KW - self-reporting KW - symptom KW - tracking KW - app KW - surveillance KW - distribution KW - digital tool KW - screening N2 - 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. UR - http://www.jmir.org/2020/9/e21956/ UR - http://dx.doi.org/10.2196/21956 UR - http://www.ncbi.nlm.nih.gov/pubmed/32791493 ID - info:doi/10.2196/21956 ER - TY - JOUR AU - Ramaswamy, Ashwin AU - Yu, Miko AU - Drangsholt, Siri AU - Ng, Eric AU - Culligan, J. Patrick AU - Schlegel, N. Peter AU - Hu, C. Jim PY - 2020/9/9 TI - Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study JO - J Med Internet Res SP - e20786 VL - 22 IS - 9 KW - telemedicine KW - medicine KW - pandemics KW - patient satisfaction KW - remote consultation KW - disruptive technology KW - medical informatics KW - health care delivery KW - practice patterns KW - physicians KW - health policy KW - health services research KW - health care reform KW - COVID-19 N2 - Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre?COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE ?2.05; 95% CI ?2.66 to ?1.22), female gender (PE ?0.73; 95% CI ?0.96 to ?0.50), and new visit type (PE ?0.75; 95% CI ?1.00 to ?0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. UR - http://www.jmir.org/2020/9/e20786/ UR - http://dx.doi.org/10.2196/20786 UR - http://www.ncbi.nlm.nih.gov/pubmed/32810841 ID - info:doi/10.2196/20786 ER - TY - JOUR AU - Jung, Young Se AU - Jo, Hyeontae AU - Son, Hwijae AU - Hwang, Ju Hyung PY - 2020/9/9 TI - Real-World Implications of a Rapidly Responsive COVID-19 Spread Model with Time-Dependent Parameters via Deep Learning: Model Development and Validation JO - J Med Internet Res SP - e19907 VL - 22 IS - 9 KW - epidemic models KW - SIR models KW - time-dependent parameters KW - neural networks KW - deep learning KW - COVID-19 KW - modeling KW - spread KW - outbreak N2 - 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. UR - http://www.jmir.org/2020/9/e19907/ UR - http://dx.doi.org/10.2196/19907 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877350 ID - info:doi/10.2196/19907 ER - TY - JOUR AU - Ali, F. Khawla AU - Whitebridge, Simon AU - Jamal, H. Mohammad AU - Alsafy, Mohammad AU - Atkin, L. Stephen PY - 2020/9/8 TI - Perceptions, Knowledge, and Behaviors Related to COVID-19 Among Social Media Users: Cross-Sectional Study JO - J Med Internet Res SP - e19913 VL - 22 IS - 9 KW - COVID-19 KW - social media KW - public health KW - perception KW - knowledge KW - health information KW - health education KW - virus N2 - 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. UR - http://www.jmir.org/2020/9/e19913/ UR - http://dx.doi.org/10.2196/19913 UR - http://www.ncbi.nlm.nih.gov/pubmed/32841153 ID - info:doi/10.2196/19913 ER - TY - JOUR AU - Fan, Tao AU - Hao, Bo AU - Yang, Shuo AU - Shen, Bo AU - Huang, Zhixin AU - Lu, Zilong AU - Xiong, Rui AU - Shen, Xiaokang AU - Jiang, Wenyang AU - Zhang, Lin AU - Li, Donghang AU - He, Ruyuan AU - Meng, Heng AU - Lin, Weichen AU - Feng, Haojie AU - Geng, Qing PY - 2020/9/8 TI - Nomogram for Predicting COVID-19 Disease Progression Based on Single-Center Data: Observational Study and Model Development JO - JMIR Med Inform SP - e19588 VL - 8 IS - 9 KW - coronavirus disease 2019 KW - COVID-19 KW - risk factors KW - nomogram N2 - Background: In late December 2019, a pneumonia caused by SARS-CoV-2 was first reported in Wuhan and spread worldwide rapidly. Currently, no specific medicine is available to treat infection with COVID-19. Objective: The aims of this study were to summarize the epidemiological and clinical characteristics of 175 patients with SARS-CoV-2 infection who were hospitalized in Renmin Hospital of Wuhan University from January 1 to January 31, 2020, and to establish a tool to identify potential critical patients with COVID-19 and help clinical physicians prevent progression of this disease. Methods: In this retrospective study, clinical characteristics of 175 confirmed COVID-19 cases were collected and analyzed. Univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to select variables. Multivariate analysis was applied to identify independent risk factors in COVID-19 progression. We established a nomogram to evaluate the probability of progression of the condition of a patient with COVID-19 to severe within three weeks of disease onset. The nomogram was verified using calibration curves and receiver operating characteristic curves. Results: A total of 18 variables were considered to be risk factors after the univariate regression analysis of the laboratory parameters (P<.05), and LASSO regression analysis screened out 10 risk factors for further study. The six independent risk factors revealed by multivariate Cox regression were age (OR 1.035, 95% CI 1.017-1.054; P<.001), CK level (OR 1.002, 95% CI 1.0003-1.0039; P=.02), CD4 count (OR 0.995, 95% CI 0.992-0.998; P=.002), CD8 % (OR 1.007, 95% CI 1.004-1.012, P<.001), CD8 count (OR 0.881, 95% CI 0.835-0.931; P<.001), and C3 count (OR 6.93, 95% CI 1.945-24.691; P=.003). The areas under the curve of the prediction model for 0.5-week, 1-week, 2-week and 3-week nonsevere probability were 0.721, 0.742, 0.87, and 0.832, respectively. The calibration curves showed that the model had good prediction ability within three weeks of disease onset. Conclusions: This study presents a predictive nomogram of critical patients with COVID-19 based on LASSO and Cox regression analysis. Clinical use of the nomogram may enable timely detection of potential critical patients with COVID-19 and instruct clinicians to administer early intervention to these patients to prevent the disease from worsening. UR - http://medinform.jmir.org/2020/9/e19588/ UR - http://dx.doi.org/10.2196/19588 UR - http://www.ncbi.nlm.nih.gov/pubmed/32866109 ID - info:doi/10.2196/19588 ER - TY - JOUR AU - Okereafor, Kenneth AU - Ekong, Iniobong AU - Okon Markson, Ini AU - Enwere, Kingsley PY - 2020/9/8 TI - Fingerprint Biometric System Hygiene and the Risk of COVID-19 Transmission JO - JMIR Biomed Eng SP - e19623 VL - 5 IS - 1 KW - biometric KW - contact KW - contaminate KW - coronavirus KW - COVID-19 KW - cybersecurity KW - disease KW - fingerprint KW - hygienic KW - infectious KW - pathogen KW - scanner KW - surface KW - verification UR - http://biomedeng.jmir.org/2020/1/e19623/ UR - http://dx.doi.org/10.2196/19623 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/19623 ER - TY - JOUR AU - Chivers, R. Bonnie AU - Garad, M. Rhonda AU - Boyle, A. Jacqueline AU - Skouteris, Helen AU - Teede, J. Helena AU - Harrison, L. Cheryce PY - 2020/9/7 TI - Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum JO - J Med Internet Res SP - e22002 VL - 22 IS - 9 KW - pregnancy KW - perinatal KW - maternal KW - COVID-19 KW - communication KW - social support KW - qualitative research KW - mental health KW - health information KW - online support KW - thematic analysis KW - sentiment analysis KW - word frequency N2 - Background: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. Objective: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. Methods: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included ?COVID,? ?corona,? and ?pandemic.? A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. Results: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including ?worried? (n=165, 19.9%), ?risk? (n=143, 17.2%), ?anxiety? (n=98, 11.8%), ?concerns? (n=74, 8.8%), and ?stress? (n=69, 8.3%). Conclusions: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort. UR - http://www.jmir.org/2020/9/e22002/ UR - http://dx.doi.org/10.2196/22002 UR - http://www.ncbi.nlm.nih.gov/pubmed/32857707 ID - info:doi/10.2196/22002 ER - TY - JOUR AU - Banerjee, Anindita AU - Sarkar, Rakesh AU - Mitra, Suvrotoa AU - Lo, Mahadeb AU - Dutta, Shanta AU - Chawla-Sarkar, Mamta PY - 2020/9/7 TI - The Novel Coronavirus Enigma: Phylogeny and Analyses of Coevolving Mutations Among the SARS-CoV-2 Viruses Circulating in India JO - JMIR Bioinformatics Biotechnol SP - e20735 VL - 1 IS - 1 KW - SARS-CoV-2 KW - Indian isolates KW - phylogeny KW - nucleotide homology KW - novel coevolving mutations KW - NSP12/RdRP secondary structure KW - genetics KW - virus KW - evolution KW - mutation KW - COVID-19 KW - genome KW - epidemiology KW - infectious disease N2 - Background: The RNA genome of the emerging novel coronavirus is rapidly mutating, and its human-to-human transmission rate is increasing. Hence, temporal dissection of their evolutionary dynamics, the nature of variations among different strains, and understanding the single nucleotide polymorphisms in the endemic settings are crucial. Delineating the heterogeneous genomic constellations of this novel virus will help us understand its complex behavior in a particular geographical region. Objective: This is a comprehensive analysis of 95 Indian SARS-CoV-2 genome sequences available from the Global Initiative on Sharing All Influenza Data (GISAID) repository during the first 6 months of 2020 (January through June). Evolutionary dynamics, gene-specific phylogeny, and the emergence of the novel coevolving mutations in 9 structural and nonstructural genes among circulating SARS-CoV-2 strains across 12 different Indian states were analyzed. Methods: A total of 95 SARS-CoV-2 nucleotide sequences submitted from India were downloaded from the GISAID database. Molecular Evolutionary Genetics Analysis, version X software was used to construct the 9 phylogenetic dendrograms based on nucleotide sequences of the SARS-CoV-2 genes. Analyses of the coevolving mutations were done in comparison to the prototype SARS-CoV-2 from Wuhan, China. The secondary structure of the RNA-dependent RNA polymerase/nonstructural protein NSP12 was predicted with respect to the novel A97V mutation. Results: Phylogenetic analyses revealed the evolution of ?genome-type clusters? and adaptive selection of ?L?-type SARS-CoV-2 strains with genetic closeness to the bat severe acute respiratory syndrome?like coronaviruses. These strains were distant to pangolin or Middle East respiratory syndrome?related coronavirus strains. With regard to the novel coevolving mutations, 2 groups have been seen circulating in India at present, the ?major group? (66/95, 69.4%) and the ?minor group? (21/95, 22.1%), harboring 4 and 5 coexisting mutations, respectively. The ?major group? mutations fall in the A2a clade. All the minor group mutations, except 11083G>T (L37F, NSP6 gene), were unique to the Indian isolates. Conclusions: This study highlights the rapidly evolving SARS-CoV-2 virus and the cocirculation of multiple clades and subclades. This comprehensive study is a potential resource for monitoring the novel mutations in the viral genome, interpreting changes in viral pathogenesis, and designing vaccines or other therapeutics. UR - http://bioinform.jmir.org/2020/1/e20735/ UR - http://dx.doi.org/10.2196/20735 UR - http://www.ncbi.nlm.nih.gov/pubmed/33496683 ID - info:doi/10.2196/20735 ER - TY - JOUR AU - Zhang, Weiyu AU - Yang, Xiaoting AU - Zhao, Jinfeng AU - Yang, Fengzhi AU - Jia, Yajing AU - Cui, Can AU - Yang, Xiaoshi PY - 2020/9/4 TI - Depression and Psychological-Behavioral Responses Among the General Public in China During the Early Stages of the COVID-19 Pandemic: Survey Study JO - J Med Internet Res SP - e22227 VL - 22 IS - 9 KW - depression KW - COVID-19 KW - social support KW - the general public N2 - Background: The COVID-19 pandemic has recently spread dramatically worldwide, raising considerable concerns and resulting in detrimental effects on the psychological health of people who are vulnerable to the disease. Therefore, assessment of depression in members of the general public and their psychological and behavioral responses is essential for the maintenance of health. Objective: This study aimed to assess the prevalence of depression and the associated factors among the general public during the early stages of the COVID-19 pandemic in China. Methods: A cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression.aA cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression. Results: The prevalence of depression (PHQ-9 score ?10) among the general public during the COVID-19 pandemic was 182/1342 (13.6%). Regression analysis indicated that feeling stressed, feeling helpless, persistently being worried even with support, never feeling clean after disinfecting, scrubbing hands and items repeatedly, hoarding food, medicine, or daily supplies, and being distracted from work or study were positively associated with depression, while social support and being calm were negatively associated with depression. Conclusions: The general public suffered from high levels of depression during the early stages of the COVID-19 pandemic. Thus, COVID-19?related mood management and social support should be provided to attenuate depression in the general public. UR - https://www.jmir.org/2020/9/e22227 UR - http://dx.doi.org/10.2196/22227 UR - http://www.ncbi.nlm.nih.gov/pubmed/32886066 ID - info:doi/10.2196/22227 ER - TY - JOUR AU - Friesen, John AU - Pelz, F. Peter PY - 2020/9/4 TI - COVID-19 and Slums: A Pandemic Highlights Gaps in Knowledge About Urban Poverty JO - JMIR Public Health Surveill SP - e19578 VL - 6 IS - 3 KW - slums KW - informal settlements KW - COVID-19, pandemic KW - infectious disease KW - living conditions KW - lifestyle KW - risk KW - risk group KW - health information UR - http://publichealth.jmir.org/2020/3/e19578/ UR - http://dx.doi.org/10.2196/19578 UR - http://www.ncbi.nlm.nih.gov/pubmed/32877347 ID - info:doi/10.2196/19578 ER - TY - JOUR AU - Dhala, Atiya AU - Sasangohar, Farzan AU - Kash, Bita AU - Ahmadi, Nima AU - Masud, Faisal PY - 2020/9/3 TI - Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study JO - J Med Internet Res SP - e20143 VL - 22 IS - 9 KW - intensive care units KW - critical care KW - pandemics KW - SARS-CoV-2 KW - telemedicine KW - infection control KW - COVID-19 N2 - 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. UR - http://www.jmir.org/2020/9/e20143/ UR - http://dx.doi.org/10.2196/20143 UR - http://www.ncbi.nlm.nih.gov/pubmed/32795997 ID - info:doi/10.2196/20143 ER - TY - JOUR AU - Son, Changwon AU - Hegde, Sudeep AU - Smith, Alec AU - Wang, Xiaomei AU - Sasangohar, Farzan PY - 2020/9/3 TI - Effects of COVID-19 on College Students? Mental Health in the United States: Interview Survey Study JO - J Med Internet Res SP - e21279 VL - 22 IS - 9 KW - COVID-19 KW - pandemic KW - college student KW - mental health KW - stress KW - anxiety KW - self-management N2 - 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. UR - https://www.jmir.org/2020/9/e21279 UR - http://dx.doi.org/10.2196/21279 UR - http://www.ncbi.nlm.nih.gov/pubmed/32805704 ID - info:doi/10.2196/21279 ER - TY - JOUR AU - Hall, William Eric AU - Luisi, Nicole AU - Zlotorzynska, Maria AU - Wilde, Gretchen AU - Sullivan, Patrick AU - Sanchez, Travis AU - Bradley, Heather AU - Siegler, J. Aaron PY - 2020/9/3 TI - Willingness to Use Home Collection Methods to Provide Specimens for SARS-CoV-2/COVID-19 Research: Survey Study JO - J Med Internet Res SP - e19471 VL - 22 IS - 9 KW - COVID-19 KW - SARS-CoV-2 KW - specimen collection KW - survey KW - research KW - public health KW - infectious disease KW - virus KW - test N2 - 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. UR - https://www.jmir.org/2020/9/e19471 UR - http://dx.doi.org/10.2196/19471 UR - http://www.ncbi.nlm.nih.gov/pubmed/32790639 ID - info:doi/10.2196/19471 ER - TY - JOUR AU - Silven, V. Anna AU - Petrus, J. Annelieke H. AU - Villalobos-Quesada, María AU - Dirikgil, Ebru AU - Oerlemans, R. Carlijn AU - Landstra, P. Cyril AU - Boosman, Hileen AU - van Os, A. Hendrikus J. AU - Blanker, H. Marco AU - Treskes, W. Roderick AU - Bonten, N. Tobias AU - Chavannes, H. Niels AU - Atsma, E. Douwe AU - Teng, Onno Y. K. PY - 2020/9/2 TI - Telemonitoring for Patients With COVID-19: Recommendations for Design and Implementation JO - J Med Internet Res SP - e20953 VL - 22 IS - 9 KW - telemonitoring KW - telemedicine KW - eHealth KW - digital health KW - COVID-19 UR - https://www.jmir.org/2020/9/e20953 UR - http://dx.doi.org/10.2196/20953 UR - http://www.ncbi.nlm.nih.gov/pubmed/32833660 ID - info:doi/10.2196/20953 ER - TY - JOUR AU - Doogan, Caitlin AU - Buntine, Wray AU - Linger, Henry AU - Brunt, Samantha PY - 2020/9/3 TI - Public Perceptions and Attitudes Toward COVID-19 Nonpharmaceutical Interventions Across Six Countries: A Topic Modeling Analysis of Twitter Data JO - J Med Internet Res SP - e21419 VL - 22 IS - 9 KW - COVID-19 KW - SARS-CoV-2 KW - topic modeling KW - nonpharmaceutical interventions KW - social media KW - public health KW - machine learning KW - social distancing KW - lockdown KW - face masks KW - infodemiology N2 - 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. UR - https://www.jmir.org/2020/9/e21419 UR - http://dx.doi.org/10.2196/21419 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784190 ID - info:doi/10.2196/21419 ER - TY - JOUR AU - Roomi, Sohaib AU - Ullah, Waqas AU - Ahmed, Faizan AU - Farooq, Soban AU - Sadiq, Usama AU - Chohan, Asad AU - Jafar, Munnam AU - Saddique, Maryum AU - Khanal, Shristi AU - Watson, Robert AU - Boigon, Margot PY - 2020/9/1 TI - Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review JO - J Med Internet Res SP - e21758 VL - 22 IS - 9 KW - COVID-19 KW - hydroxychloroquine KW - tocilizumab N2 - Background: During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. Objective: The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. Methods: A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. Results: The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. Conclusions: In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic. UR - https://www.jmir.org/2020/9/e21758 UR - http://dx.doi.org/10.2196/21758 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784192 ID - info:doi/10.2196/21758 ER - TY - JOUR AU - Hassounah, Marwah AU - Raheel, Hafsa AU - Alhefzi, Mohammed PY - 2020/9/1 TI - Digital Response During the COVID-19 Pandemic in Saudi Arabia JO - J Med Internet Res SP - e19338 VL - 22 IS - 9 KW - digital response KW - COVID-19 KW - Saudi Arabia KW - digital health KW - containment KW - public health KW - pandemic KW - prevention N2 - Background: The first case of COVID-19 in Saudi Arabia was confirmed on March 3, 2020. Saudi Arabia, like many other countries worldwide, implemented lockdown of most public and private services in response to the pandemic and established population movement restrictions nationwide. With the implementation of these strict mitigation regulations, technology and digital solutions have enabled the provision of essential services. Objective: The aim of this paper is to highlight how Saudi Arabia has used digital technology during the COVID-19 pandemic in the domains of public health, health care services, education, telecommunication, commerce, and risk communication. Methods: We documented the use of digital technology in Saudi Arabia during the pandemic using publicly available official announcements, press briefings and releases, news clips, published data, peer-reviewed literature, and professional discussions. Results: Saudi Arabia?s government and private sectors combined developed and launched approximately 19 apps and platforms that serve public health functions and provide health care services. A detailed account of each is provided. Education processes continued using an established electronic learning infrastructure with a promising direction toward wider adoption in the future. Telecommunication companies exhibited smooth collaboration as well as innovative initiatives to support ongoing efforts. Risk communication activities using social media, websites, and SMS text messaging followed best practice guides. Conclusions: The Saudi Vision 2030 framework, released in 2017, has paved the path for digital transformation. COVID-19 enabled the promotion and testing of this transition. In Saudi Arabia, the use of artificial intelligence in integrating different data sources during future outbreaks could be further explored. Also, decreasing the number of mobile apps and merging their functions could increase and facilitate their use. UR - https://www.jmir.org/2020/9/e19338 UR - http://dx.doi.org/10.2196/19338 UR - http://www.ncbi.nlm.nih.gov/pubmed/32790642 ID - info:doi/10.2196/19338 ER - TY - JOUR AU - Walrave, Michel AU - Waeterloos, Cato AU - Ponnet, Koen PY - 2020/9/1 TI - Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach JO - JMIR Public Health Surveill SP - e20572 VL - 6 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - health belief model KW - contact tracing KW - proximity tracing KW - privacy N2 - 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. UR - http://publichealth.jmir.org/2020/3/e20572/ UR - http://dx.doi.org/10.2196/20572 UR - http://www.ncbi.nlm.nih.gov/pubmed/32755882 ID - info:doi/10.2196/20572 ER - TY - JOUR AU - Birkeland, Kade AU - Zimmer, Raymond AU - Kimchi, Asher AU - Kedan, Ilan PY - 2020/9/1 TI - Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review JO - Interact J Med Res SP - e22768 VL - 9 IS - 3 KW - VTE KW - COVID-19 KW - anticoagulation KW - SARS-CoV-2 KW - review KW - heart KW - morbidity KW - hospital KW - incidence KW - treatment N2 - 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. UR - http://www.i-jmr.org/2020/3/e22768/ UR - http://dx.doi.org/10.2196/22768 UR - http://www.ncbi.nlm.nih.gov/pubmed/32805702 ID - info:doi/10.2196/22768 ER - TY - JOUR AU - Quinn, M. Lauren AU - Davies, J. Melanie AU - Hadjiconstantinou, Michelle PY - 2020/8/28 TI - Virtual Consultations and the Role of Technology During the COVID-19 Pandemic for People With Type 2 Diabetes: The UK Perspective JO - J Med Internet Res SP - e21609 VL - 22 IS - 8 KW - diabetes KW - virtual clinic KW - technology KW - COVID-19 KW - United Kingdom KW - pandemic KW - feasibility KW - effective KW - telehealth UR - http://www.jmir.org/2020/8/e21609/ UR - http://dx.doi.org/10.2196/21609 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716898 ID - info:doi/10.2196/21609 ER - TY - JOUR AU - Smith, Katharine AU - Ostinelli, Edoardo AU - Macdonald, Orla AU - Cipriani, Andrea PY - 2020/8/28 TI - COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians JO - JMIR Ment Health SP - e21108 VL - 7 IS - 8 KW - digital mental health KW - telepsychiatry KW - evidence-based guidance KW - systematic review KW - mental health KW - COVID-19 N2 - Background: The coronavirus disease (COVID-19) presents unique challenges in health care, including mental health care provision. Telepsychiatry can provide an alternative to face-to-face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. Objective: The aim of this paper is to produce an open-access, easy-to-consult, and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach. Methods: We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre?COVID-19 guidelines and other digital mental health topics where relevant. We summarized the data we extracted as answers to specific clinical questions. Results: Findings from this study are presented as both a short practical checklist for clinicians and detailed textboxes with a full summary of all the guidelines. The summary textboxes are also available on an open-access webpage, which is regularly updated. These findings reflected the strong evidence base for the use of telepsychiatry and included guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance, and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focused on practical implementation and US guidelines more expansive and detailed. Guidelines on possible combinations with other digital technologies such as apps (eg, from the US Food and Drug Administration, the National Health Service Apps Library, and the National Institute for Health and Care Excellence) are less detailed. Several key areas were not represented. Although some special populations such as child and adolescent, and older adult, and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder, and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, the initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines. Conclusions: We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organizations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organizational change in the short- and long-term. Providing easily accessible guidance is a first step but will need cultural change to implement as clinicians start to view telepsychiatry not just as a replacement but as a parallel and complementary form of delivering therapy with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post?COVID-19, and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment. UR - https://mental.jmir.org/2020/8/e21108 UR - http://dx.doi.org/10.2196/21108 UR - http://www.ncbi.nlm.nih.gov/pubmed/32658857 ID - info:doi/10.2196/21108 ER - TY - JOUR AU - Altmann, Samuel AU - Milsom, Luke AU - Zillessen, Hannah AU - Blasone, Raffaele AU - Gerdon, Frederic AU - Bach, Ruben AU - Kreuter, Frauke AU - Nosenzo, Daniele AU - Toussaert, Séverine AU - Abeler, Johannes PY - 2020/8/28 TI - Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study JO - JMIR Mhealth Uhealth SP - e19857 VL - 8 IS - 8 KW - COVID-19 KW - contact tracing KW - proximity tracing KW - app KW - digital KW - user acceptability KW - mHealth KW - epidemiology N2 - 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. UR - http://mhealth.jmir.org/2020/8/e19857/ UR - http://dx.doi.org/10.2196/19857 UR - http://www.ncbi.nlm.nih.gov/pubmed/32759102 ID - info:doi/10.2196/19857 ER - TY - JOUR AU - Pobiruchin, Monika AU - Zowalla, Richard AU - Wiesner, Martin PY - 2020/8/28 TI - Temporal and Location Variations, and Link Categories for the Dissemination of COVID-19?Related Information on Twitter During the SARS-CoV-2 Outbreak in Europe: Infoveillance Study JO - J Med Internet Res SP - e19629 VL - 22 IS - 8 KW - COVID-19 KW - SARS-CoV-2 KW - social media KW - public health KW - Twitter KW - infoveillance KW - infodemiology KW - infodemic KW - health informatics KW - disease surveillance N2 - Background: The spread of the 2019 novel coronavirus disease, COVID-19, across Asia and Europe sparked a significant increase in public interest and media coverage, including on social media platforms such as Twitter. In this context, the origin of information plays a central role in the dissemination of evidence-based information about the SARS-CoV-2 virus and COVID-19. On February 2, 2020, the World Health Organization (WHO) constituted a ?massive infodemic? and argued that this situation ?makes it hard for people to find trustworthy sources and reliable guidance when they need it.? Objective: This infoveillance study, conducted during the early phase of the COVID-19 pandemic, focuses on the social media platform Twitter. It allows monitoring of the dynamic pandemic situation on a global scale for different aspects and topics, languages, as well as regions and even whole countries. Of particular interest are temporal and geographical variations of COVID-19?related tweets, the situation in Europe, and the categories and origin of shared external resources. Methods: Twitter?s Streaming application programming interface was used to filter tweets based on 16 prevalent hashtags related to the COVID-19 outbreak. Each tweet?s text and corresponding metadata as well as the user?s profile information were extracted and stored into a database. Metadata included links to external resources. A link categorization scheme?introduced in a study by Chew and Eysenbach in 2009?was applied onto the top 250 shared resources to analyze the relative proportion for each category. Moreover, temporal variations of global tweet volumes were analyzed and a specific analysis was conducted for the European region. Results: Between February 9 and April 11, 2020, a total of 21,755,802 distinct tweets were collected, posted by 4,809,842 distinct Twitter accounts. The volume of #covid19-related tweets increased after the WHO announced the name of the new disease on February 11, 2020, and stabilized at the end of March at a high level. For the regional analysis, a higher tweet volume was observed in the vicinity of major European capitals or in densely populated areas. The most frequently shared resources originated from various social media platforms (ranks 1-7). The most prevalent category in the top 50 was ?Mainstream or Local News.? For the category ?Government or Public Health,? only two information sources were found in the top 50: US Centers for Disease Control and Prevention at rank 25 and the WHO at rank 27. The first occurrence of a prevalent scientific source was Nature (rank 116). Conclusions: The naming of the disease by the WHO was a major signal to address the public audience with public health response via social media platforms such as Twitter. Future studies should focus on the origin and trustworthiness of shared resources, as monitoring the spread of fake news during a pandemic situation is of particular importance. In addition, it would be beneficial to analyze and uncover bot networks spreading COVID-19?related misinformation. UR - http://www.jmir.org/2020/8/e19629/ UR - http://dx.doi.org/10.2196/19629 UR - http://www.ncbi.nlm.nih.gov/pubmed/32790641 ID - info:doi/10.2196/19629 ER - TY - JOUR AU - Kaspar, Kai PY - 2020/8/27 TI - Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study JO - J Med Internet Res SP - e21613 VL - 22 IS - 8 KW - COVID-19 KW - protection motivation theory KW - social distancing KW - contact tracing app KW - data donation app KW - social trust KW - data security N2 - 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. UR - http://www.jmir.org/2020/8/e21613/ UR - http://dx.doi.org/10.2196/21613 UR - http://www.ncbi.nlm.nih.gov/pubmed/32759100 ID - info:doi/10.2196/21613 ER - TY - JOUR AU - Becker, Regina AU - Thorogood, Adrian AU - Ordish, Johan AU - Beauvais, J.S. Michael PY - 2020/8/27 TI - COVID-19 Research: Navigating the European General Data Protection Regulation JO - J Med Internet Res SP - e19799 VL - 22 IS - 8 KW - COVID-19 KW - GDPR KW - health research KW - pandemic KW - data privacy KW - data protection KW - regulation UR - http://www.jmir.org/2020/8/e19799/ UR - http://dx.doi.org/10.2196/19799 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784191 ID - info:doi/10.2196/19799 ER - TY - JOUR AU - Hu, Guangyu AU - Li, Peiyi AU - Yuan, Changzheng AU - Tao, Chenglin AU - Wen, Hai AU - Liu, Qiannan AU - Qiu, Wuqi PY - 2020/8/27 TI - Information Disclosure During the COVID-19 Epidemic in China: City-Level Observational Study JO - J Med Internet Res SP - e19572 VL - 22 IS - 8 KW - information disclosure KW - COVID-19 KW - website KW - risk KW - communication KW - China KW - disclosure KW - pandemic KW - health information KW - public health N2 - Background: Information disclosure is a top priority for official responses to the COVID-19 pandemic. The timely and standardized information published by authorities as a response to the crisis can better inform the public and enable better preparations for the pandemic; however, there is limited evidence of any systematic analyses of the disclosed epidemic information. This in turn has important implications for risk communication. Objective: This study aimed to describe and compare the officially released content regarding local epidemic situations as well as analyze the characteristics of information disclosure through local communication in major cities in China. Methods: The 31 capital cities in mainland China were included in this city-level observational study. Data were retrieved from local municipalities and health commission websites as of March 18, 2020. A checklist was employed as a rapid qualitative assessment tool to analyze the information disclosure performance of each city. Descriptive analyses and data visualizations were produced to present and compare the comparative performances of the cities. Results: In total, 29 of 31 cities (93.5%) established specific COVID-19 webpages to disclose information. Among them, 12 of the city webpages were added to their corresponding municipal websites. A majority of the cities (21/31, 67.7%) published their first cases of infection in a timely manner on the actual day of confirmation. Regarding the information disclosures highlighted on the websites, news updates from local media or press briefings were the most prevalent (28/29, 96.6%), followed by epidemic surveillance (25/29, 86.2%), and advice for the public (25/29, 86.2%). Clarifications of misinformation and frequently asked questions were largely overlooked as only 2 cities provided this valuable information. The median daily update frequency of epidemic surveillance summaries was 1.2 times per day (IQR 1.0-1.3 times), and the majority of these summaries (18/25, 72.0%) also provided detailed information regarding confirmed cases. The reporting of key indicators in the epidemic surveillance summaries, as well as critical facts included in the confirmed case reports, varied substantially between cities. In general, the best performance in terms of timely reporting and the transparency of information disclosures were observed in the municipalities directly administered by the central government compared to the other cities. Conclusions: Timely and effective efforts to disclose information related to the COVID-19 epidemic have been made in major cities in China. Continued improvements to local authority reporting will contribute to more effective public communication and efficient public health research responses. The development of protocols and the standardization of epidemic message templates?as well as the use of uniform operating procedures to provide regular information updates?should be prioritized to ensure a coordinated national response. UR - http://www.jmir.org/2020/8/e19572/ UR - http://dx.doi.org/10.2196/19572 UR - http://www.ncbi.nlm.nih.gov/pubmed/32790640 ID - info:doi/10.2196/19572 ER - TY - JOUR AU - Mackey, Ken Tim AU - Li, Jiawei AU - Purushothaman, Vidya AU - Nali, Matthew AU - Shah, Neal AU - Bardier, Cortni AU - Cai, Mingxiang AU - Liang, Bryan PY - 2020/8/25 TI - Big Data, Natural Language Processing, and Deep Learning to Detect and Characterize Illicit COVID-19 Product Sales: Infoveillance Study on Twitter and Instagram JO - JMIR Public Health Surveill SP - e20794 VL - 6 IS - 3 KW - COVID-19 KW - coronavirus KW - infectious disease KW - social media KW - surveillance KW - infoveillance KW - infodemiology KW - infodemic KW - fraud KW - cybercrime N2 - 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. UR - http://publichealth.jmir.org/2020/3/e20794/ UR - http://dx.doi.org/10.2196/20794 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750006 ID - info:doi/10.2196/20794 ER - TY - JOUR AU - Rovetta, Alessandro AU - Bhagavathula, Srikanth Akshaya PY - 2020/8/25 TI - Global Infodemiology of COVID-19: Analysis of Google Web Searches and Instagram Hashtags JO - J Med Internet Res SP - e20673 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus KW - Google KW - Instagram KW - infodemiology KW - infodemic KW - social media N2 - 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. UR - http://www.jmir.org/2020/8/e20673/ UR - http://dx.doi.org/10.2196/20673 UR - http://www.ncbi.nlm.nih.gov/pubmed/32748790 ID - info:doi/10.2196/20673 ER - TY - JOUR AU - Evanoff, A. Bradley AU - Strickland, R. Jaime AU - Dale, Marie Ann AU - Hayibor, Lisa AU - Page, Emily AU - Duncan, G. Jennifer AU - Kannampallil, Thomas AU - Gray, L. Diana PY - 2020/8/25 TI - Work-Related and Personal Factors Associated With Mental Well-Being During the COVID-19 Response: Survey of Health Care and Other Workers JO - J Med Internet Res SP - e21366 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus KW - pandemic KW - mental health KW - health care workers KW - remote work KW - worker well-being KW - occupational health N2 - 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. UR - http://www.jmir.org/2020/8/e21366/ UR - http://dx.doi.org/10.2196/21366 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763891 ID - info:doi/10.2196/21366 ER - TY - JOUR AU - Lee, Won Seung AU - Yuh, Tak Woon AU - Yang, Myung Jee AU - Cho, Yoon-Sik AU - Yoo, Kyung In AU - Koh, Yong Hyun AU - Marshall, Dominic AU - Oh, Donghwan AU - Ha, Kyo Eun AU - Han, Yong Man AU - Yon, Keon Dong PY - 2020/8/25 TI - Nationwide Results of COVID-19 Contact Tracing in South Korea: Individual Participant Data From an Epidemiological Survey JO - JMIR Med Inform SP - e20992 VL - 8 IS - 8 KW - COVID-19 KW - contact tracing KW - coronavirus KW - South Korea KW - survey KW - health data KW - epidemiology KW - transmission N2 - 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. UR - http://medinform.jmir.org/2020/8/e20992/ UR - http://dx.doi.org/10.2196/20992 UR - http://www.ncbi.nlm.nih.gov/pubmed/32784189 ID - info:doi/10.2196/20992 ER - TY - JOUR AU - Yanover, Chen AU - Mizrahi, Barak AU - Kalkstein, Nir AU - Marcus, Karni AU - Akiva, Pinchas AU - Barer, Yael AU - Shalev, Varda AU - Chodick, Gabriel PY - 2020/8/25 TI - What Factors Increase the Risk of Complications in SARS-CoV-2?Infected Patients? A Cohort Study in a Nationwide Israeli Health Organization JO - JMIR Public Health Surveill SP - e20872 VL - 6 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - risk factors KW - complications N2 - Background: Reliably identifying patients at increased risk for coronavirus disease (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (eg, hospitalized patients) or had limited access to patients? medical history, thus, investigating related questions and, potentially, obtaining biased results. Objective: This study aimed to identify factors associated with COVID-19 complications from the complete medical records of a nationally representative cohort of patients, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: We studied a cohort of all SARS-CoV-2?positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (ie, experienced moderate or severe symptoms of COVID-19, admitted to the intensive care unit, or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and noncomplicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata. Results: Of the 4353 SARS-CoV-2?positive individuals, 173 (4%) patients suffered from COVID-19 complications (all age ?18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications. It also indicates that depression (eg, males ?65 years: odds ratio [OR] 2.94, 95% CI 1.55-5.58; P=.01) as well as cognitive and neurological disorders (eg, individuals ?65 years old: OR 2.65, 95% CI 1.69-4.17; P<.001) are significant risk factors. Smoking and presence of respiratory diseases do not significantly increase the risk of complications. Conclusions: Our analysis agrees with previous studies on multiple risk factors, including hypertension and obesity. It also finds depression as well as cognitive and neurological disorders, but not smoking and respiratory diseases, to be significantly associated with COVID-19 complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts. UR - http://publichealth.jmir.org/2020/3/e20872/ UR - http://dx.doi.org/10.2196/20872 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750009 ID - info:doi/10.2196/20872 ER - TY - JOUR AU - Wilmink, Gerald AU - Summer, Ilyssa AU - Marsyla, David AU - Sukhu, Subhashree AU - Grote, Jeffrey AU - Zobel, Gregory AU - Fillit, Howard AU - Movva, Satish PY - 2020/8/25 TI - Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities JO - JMIR Public Health Surveill SP - e20828 VL - 6 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - contact tracing KW - nursing homes KW - long term care KW - care homes KW - digital contact tracing N2 - 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. UR - http://publichealth.jmir.org/2020/3/e20828/ UR - http://dx.doi.org/10.2196/20828 UR - http://www.ncbi.nlm.nih.gov/pubmed/32745013 ID - info:doi/10.2196/20828 ER - TY - JOUR AU - Hu, Zhao AU - Lin, Xuhui AU - Chiwanda Kaminga, Atipatsa AU - Xu, Huilan PY - 2020/8/25 TI - 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 JO - J Med Internet Res SP - e21176 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus disease KW - subjective well-being KW - lifestyle behaviors N2 - 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. UR - http://www.jmir.org/2020/8/e21176/ UR - http://dx.doi.org/10.2196/21176 UR - http://www.ncbi.nlm.nih.gov/pubmed/32759103 ID - info:doi/10.2196/21176 ER - TY - JOUR AU - Abdulaal, Ahmed AU - Patel, Aatish AU - Charani, Esmita AU - Denny, Sarah AU - Mughal, Nabeela AU - Moore, Luke PY - 2020/8/25 TI - Prognostic Modeling of COVID-19 Using Artificial Intelligence in the United Kingdom: Model Development and Validation JO - J Med Internet Res SP - e20259 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus KW - machine learning KW - deep learning KW - modeling KW - artificial intelligence KW - neural network KW - prediction N2 - 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. UR - http://www.jmir.org/2020/8/e20259/ UR - http://dx.doi.org/10.2196/20259 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735549 ID - info:doi/10.2196/20259 ER - TY - JOUR AU - McRae, P. Michael AU - Dapkins, P. Isaac AU - Sharif, Iman AU - Anderman, Judd AU - Fenyo, David AU - Sinokrot, Odai AU - Kang, K. Stella AU - Christodoulides, J. Nicolaos AU - Vurmaz, Deniz AU - Simmons, W. Glennon AU - Alcorn, M. Timothy AU - Daoura, J. Marco AU - Gisburne, Stu AU - Zar, David AU - McDevitt, T. John PY - 2020/8/24 TI - Managing COVID-19 With a Clinical Decision Support Tool in a Community Health Network: Algorithm Development and Validation JO - J Med Internet Res SP - e22033 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus KW - clinical decision support system KW - point of care KW - mobile app KW - disease severity KW - biomarkers KW - artificial intelligence KW - app KW - family health center N2 - 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. UR - http://www.jmir.org/2020/8/e22033/ UR - http://dx.doi.org/10.2196/22033 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750010 ID - info:doi/10.2196/22033 ER - TY - JOUR AU - Ngai, Bik Cindy Sing AU - Singh, Gill Rita AU - Lu, Wenze AU - Koon, Chun Alex PY - 2020/8/24 TI - Grappling With the COVID-19 Health Crisis: Content Analysis of Communication Strategies and Their Effects on Public Engagement on Social Media JO - J Med Internet Res SP - e21360 VL - 22 IS - 8 KW - COVID-19 KW - communication KW - public engagement KW - social media KW - infodemiology KW - infodemic KW - message style KW - health content frames KW - interactive features KW - framework KW - content analysis N2 - Background: The coronavirus disease (COVID-19) has posed an unprecedented challenge to governments worldwide. Effective government communication of COVID-19 information with the public is of crucial importance. Objective: We investigate how the most-read state-owned newspaper in China, People?s Daily, used an online social networking site, Sina Weibo, to communicate about COVID-19 and whether this could engage the public. The objective of this study is to develop an integrated framework to examine the content, message style, and interactive features of COVID-19?related posts and determine their effects on public engagement in the largest social media network in China. Methods: Content analysis was employed to scrutinize 608 COVID-19 posts, and coding was performed on three main dimensions: content, message style, and interactive features. The content dimension was coded into six subdimensions: action, new evidence, reassurance, disease prevention, health care services, and uncertainty, and the style dimension was coded into the subdimensions of narrative and nonnarrative. As for interactive features, they were coded into links to external sources, use of hashtags, use of questions to solicit feedback, and use of multimedia. Public engagement was measured in the form of the number of shares, comments, and likes on the People?s Daily?s Sina Weibo account from January 20, 2020, to March 11, 2020, to reveal the association between different levels of public engagement and communication strategies. A one-way analysis of variance followed by a post-hoc Tukey test and negative binomial regression analysis were employed to generate the results. Results: We found that although the content frames of action, new evidence, and reassurance delivered in a nonnarrative style were predominant in COVID-19 communication by the government, posts related to new evidence and a nonnarrative style were strong negative predictors of the number of shares. In terms of generating a high number of shares, it was found that disease prevention posts delivered in a narrative style were able to achieve this purpose. Additionally, an interaction effect was found between content and style. The use of a narrative style in disease prevention posts had a significant positive effect on generating comments and likes by the Chinese public, while links to external sources fostered sharing. Conclusions: These results have implications for governments, health organizations, medical professionals, the media, and researchers on their epidemic communication to engage the public. Selecting suitable communication strategies may foster active liking and sharing of posts on social media, which in turn, might raise the public?s awareness of COVID-19 and motivate them to take preventive measures. The sharing of COVID-19 posts is particularly important because this action can reach out to a large audience, potentially helping to contain the spread of the virus. UR - http://www.jmir.org/2020/8/e21360/ UR - http://dx.doi.org/10.2196/21360 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750013 ID - info:doi/10.2196/21360 ER - TY - JOUR AU - Wei, Lijie AU - Gao, Xuan AU - Chen, Suhua AU - Zeng, Wanjiang AU - Wu, Jianli AU - Lin, Xingguang AU - Zhang, Huiting AU - Mwamaka Sharifu, Lali AU - Chen, Ling AU - Feng, Ling AU - Wang, Shaoshuai PY - 2020/8/24 TI - Clinical Characteristics and Outcomes of Childbearing-Age Women With COVID-19 in Wuhan: Retrospective, Single-Center Study JO - J Med Internet Res SP - e19642 VL - 22 IS - 8 KW - COVID-19 KW - SARS-CoV-2 KW - childbearing age KW - pregnancy KW - clinical characteristics KW - outcomes KW - women KW - health information KW - epidemiology KW - diagnosis KW - symptom N2 - 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 0.3?g/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. UR - http://www.jmir.org/2020/8/e19642/ UR - http://dx.doi.org/10.2196/19642 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750000 ID - info:doi/10.2196/19642 ER - TY - JOUR AU - Suppan, Laurent AU - Abbas, Mohamed AU - Stuby, Loric AU - Cottet, Philippe AU - Larribau, Robert AU - Golay, Eric AU - Iten, Anne AU - Harbarth, Stephan AU - Gartner, Birgit AU - Suppan, Mélanie PY - 2020/8/21 TI - Effect of an E-Learning Module on Personal Protective Equipment Proficiency Among Prehospital Personnel: Web-Based Randomized Controlled Trial JO - J Med Internet Res SP - e21265 VL - 22 IS - 8 KW - personal protective equipment KW - COVID-19 KW - electronic learning KW - prehospital KW - randomized controlled trial KW - protection KW - equipment KW - safety KW - gamified KW - online learning KW - communication N2 - Background: To avoid misuse of personal protective equipment (PPE), ensure health care workers? safety, and avoid shortages, effective communication of up-to-date infection control guidelines is essential. As prehospital teams are particularly at risk of contamination given their challenging work environment, a specific gamified electronic learning (e-learning) module targeting this audience might provide significant advantages as it requires neither the presence of learners nor the repetitive use of equipment for demonstration. Objective: The aim of this study was to evaluate whether a gamified e-learning module could improve the rate of adequate PPE choice by prehospital personnel in the context of the coronavirus disease (COVID-19) pandemic. Methods: This was an individual-level randomized, controlled, quadruple-blind (investigators, participants, outcome assessors, and data analysts) closed web-based trial. All emergency prehospital personnel working in Geneva, Switzerland, were eligible for inclusion, and were invited to participate by email in April 2020. Participants were informed that the study aim was to assess their knowledge regarding PPE, and that they would be presented with both the guidelines and the e-learning module, though they were unaware that there were two different study paths. All participants first answered a preintervention quiz designed to establish their profile and baseline knowledge. The control group then accessed the guidelines before answering a second set of questions, and were then granted access to the e-learning module. The e-learning group was shown the e-learning module right after the guidelines and before answering the second set of questions. Results: Of the 291 randomized participants, 176 (60.5%) completed the trial. There was no significant difference in baseline knowledge between groups. Though the baseline proportion of adequate PPE choice was high (75%, IQR 50%-75%), participants? description of the donning sequence was in most cases incorrect. After either intervention, adequate choice of PPE increased significantly in both groups (P<.001). Though the median of the difference in the proportion of correct answers was slightly higher in the e-learning group (17%, IQR 8%-33% versus 8%, IQR 8%-33%), the difference was not statistically significant (P=.27). Confidence in the ability to use PPE was maintained in the e-learning group (P=.27) but significantly decreased in the control group (P=.04). Conclusions: Among prehospital personnel with an already relatively high knowledge of and experience with PPE use, both web-based study paths increased the rate of adequate choice of PPE. There was no major added value of the gamified e-learning module apart from preserving participants' confidence in their ability to correctly use PPE. UR - http://www.jmir.org/2020/8/e21265/ UR - http://dx.doi.org/10.2196/21265 UR - http://www.ncbi.nlm.nih.gov/pubmed/32747329 ID - info:doi/10.2196/21265 ER - TY - JOUR AU - Deng, Qi PY - 2020/8/21 TI - Dynamics and Development of the COVID-19 Epidemic in the United States: A Compartmental Model Enhanced With Deep Learning Techniques JO - J Med Internet Res SP - e21173 VL - 22 IS - 8 KW - epidemiology KW - COVID-19 KW - compartmental models KW - deep learning KW - model KW - modeling KW - transmission KW - estimation KW - virus KW - simulate N2 - Background: Compartmental models dominate epidemic modeling. Transmission parameters between compartments are typically estimated through stochastic parameterization processes that depends on detailed statistics of transmission characteristics, which are economically and resource-wise expensive to collect. Objective: We aim to apply deep learning techniques as a lower data dependency alternative to estimate transmission parameters of a customized compartmental model, for the purpose of simulating the dynamics of the US coronavirus disease (COVID-19) epidemic and projecting its further development. Methods: We constructed a compartmental model and developed a multistep deep learning methodology to estimate the model?s transmission parameters. We then fed the estimated transmission parameters to the model to predict development of the US COVID-19 epidemic for 35 and 42 days. Epidemics are considered suppressed when the basic reproduction number (R0) is less than 1. Results: The deep learning?enhanced compartmental model predicts that R0 will fall to <1 around August 17-19, 2020, at which point the epidemic will effectively start to die out, and that the US ?infected? population will peak around August 16-18, 2020, at 3,228,574 to 3,308,911 individual cases. The model also predicted that the number of accumulative confirmed cases will cross the 5 million mark around August 7, 2020. Conclusions: Current compartmental models require stochastic parameterization to estimate the transmission parameters. These models? effectiveness depends upon detailed statistics on transmission characteristics. As an alternative, deep learning techniques are effective in estimating these stochastic parameters with greatly reduced dependency on data particularity. UR - http://www.jmir.org/2020/8/e21173/ UR - http://dx.doi.org/10.2196/21173 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763892 ID - info:doi/10.2196/21173 ER - TY - JOUR AU - Gates, Elaine Lyndsey AU - Hamed, Abdeen Ahmed PY - 2020/8/20 TI - The Anatomy of the SARS-CoV-2 Biomedical Literature: Introducing the CovidX Network Algorithm for Drug Repurposing Recommendation JO - J Med Internet Res SP - e21169 VL - 22 IS - 8 KW - health KW - informatics KW - COVID-19 treatment KW - drug repurposing KW - network algorithm KW - ranking KW - drug KW - biomedical KW - antiviral KW - COVID-19 N2 - Background: Driven by the COVID-19 pandemic and the dire need to discover an antiviral drug, we explored the landscape of the SARS-CoV-2 biomedical publications to identify potential treatments. Objective: The aims of this study are to identify off-label drugs that may have benefits for the coronavirus disease pandemic, present a novel ranking algorithm called CovidX to recommend existing drugs for potential repurposing, and validate the literature-based outcome with drug knowledge available in clinical trials. Methods: To achieve such objectives, we applied natural language processing techniques to identify drugs and linked entities (eg, disease, gene, protein, chemical compounds). When such entities are linked, they form a map that can be further explored using network science tools. The CovidX algorithm was based upon a notion that we called ?diversity.? A diversity score for a given drug was calculated by measuring how ?diverse? a drug is calculated using various biological entities (regardless of the cardinality of actual instances in each category). The algorithm validates the ranking and awards those drugs that are currently being investigated in open clinical trials. The rationale behind the open clinical trial is to provide a validating mechanism of the PubMed results. This ensures providing up to date evidence of the fast development of this disease. Results: From the analyzed biomedical literature, the algorithm identified 30 possible drug candidates for repurposing, ranked them accordingly, and validated the ranking outcomes against evidence from clinical trials. The top 10 candidates according to our algorithm are hydroxychloroquine, azithromycin, chloroquine, ritonavir, losartan, remdesivir, favipiravir, methylprednisolone, rapamycin, and tilorone dihydrochloride. Conclusions: The ranking shows both consistency and promise in identifying drugs that can be repurposed. We believe, however, the full treatment to be a multifaceted, adjuvant approach where multiple drugs may need to be taken at the same time. UR - http://www.jmir.org/2020/8/e21169/ UR - http://dx.doi.org/10.2196/21169 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735546 ID - info:doi/10.2196/21169 ER - TY - JOUR AU - Niu, Zhaomeng AU - Wang, Tingting AU - Hu, Pengwei AU - Mei, Jing AU - Tang, Zhihan PY - 2020/8/21 TI - Chinese Public?s Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study JO - J Med Internet Res SP - e19995 VL - 22 IS - 8 KW - COVID-19 KW - China KW - preventive health behaviors KW - intervening health behaviors KW - psychosocial KW - health literacy KW - behavior KW - prevention KW - cross-sectional N2 - 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. UR - http://www.jmir.org/2020/8/e19995/ UR - http://dx.doi.org/10.2196/19995 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716897 ID - info:doi/10.2196/19995 ER - TY - JOUR AU - Zhang, Melvyn AU - Smith, Elizabeth Helen PY - 2020/8/21 TI - Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review JO - J Med Internet Res SP - e19706 VL - 22 IS - 8 KW - COVID-19 KW - digital tool KW - psychiatry KW - mental health KW - digital health KW - psychology KW - distress KW - stress KW - anxiety KW - depression N2 - Background: In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. Objective: The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. Methods: To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: ?NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID? and ?mHealth OR eHealth OR text?. Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Conclusions: The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms. UR - http://www.jmir.org/2020/8/e19706/ UR - http://dx.doi.org/10.2196/19706 UR - http://www.ncbi.nlm.nih.gov/pubmed/32721922 ID - info:doi/10.2196/19706 ER - TY - JOUR AU - van Deursen, JAM Alexander PY - 2020/8/20 TI - Digital Inequality During a Pandemic: Quantitative Study of Differences in COVID-19?Related Internet Uses and Outcomes Among the General Population JO - J Med Internet Res SP - e20073 VL - 22 IS - 8 KW - COVID-19 KW - digital inequality KW - internet use KW - survey KW - personality KW - literacy KW - internet skills KW - information KW - communication N2 - Background: The World Health Organization considers coronavirus disease (COVID-19) to be a public emergency threatening global health. During the crisis, the public?s need for web-based information and communication is a subject of focus. Digital inequality research has shown that internet access is not evenly distributed among the general population. Objective: The aim of this study was to provide a timely understanding of how different people use the internet to meet their information and communication needs and the outcomes they gain from their internet use in relation to the COVID-19 pandemic. We also sought to reveal the extent to which gender, age, personality, health, literacy, education, economic and social resources, internet attitude, material access, internet access, and internet skills remain important factors in obtaining internet outcomes after people engage in the corresponding uses. Methods: We used a web-based survey to draw upon a sample collected in the Netherlands. We obtained a dataset with 1733 respondents older than 18 years. Results: Men are more likely to engage in COVID-19?related communication uses. Age is positively related to COVID-19?related information uses and negatively related to information and communication outcomes. Agreeableness is negatively related to both outcomes and to information uses. Neuroticism is positively related to both uses and to communication outcomes. Conscientiousness is not related to any of the uses or outcomes. Introversion is negatively related to communication outcomes. Finally, openness relates positively to all information uses and to both outcomes. Physical health has negative relationships with both outcomes. Health perception contributes positively to information uses and both outcomes. Traditional literacy has a positive relationship with information uses and both outcomes. Education has a positive relationship with information and communication uses. Economic and social resources played no roles. Internet attitude is positively related to information uses and outcomes but negatively related to communication uses and outcomes. Material access and internet access contributed to all uses and outcomes. Finally, several of the indicators and outcomes became insignificant after accounting for engagement in internet uses. Conclusions: Digital inequality is a major concern among national and international scholars and policy makers. This contribution aimed to provide a broader understanding in the case of a major health pandemic by using the ongoing COVID-19 crisis as a context for empirical work. Several groups of people were identified as vulnerable, such as older people, less educated people, and people with physical health problems, low literacy levels, or low levels of internet skills. Generally, people who are already relatively advantaged are more likely to use the information and communication opportunities provided by the internet to their benefit in a health pandemic, while less advantaged individuals are less likely to benefit. Therefore, the COVID-19 crisis is also enforcing existing inequalities. UR - http://www.jmir.org/2020/8/e20073/ UR - http://dx.doi.org/10.2196/20073 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750005 ID - info:doi/10.2196/20073 ER - TY - JOUR AU - Chiu, Nan-Chang AU - Chi, Hsin AU - Tai, Yu-Lin AU - Peng, Chun-Chih AU - Tseng, Cheng-Yin AU - Chen, Chung-Chu AU - Tan, Fatt Boon AU - Lin, Chien-Yu PY - 2020/8/20 TI - 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 JO - J Med Internet Res SP - e21257 VL - 22 IS - 8 KW - novel coronavirus KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - influenza KW - pneumonia KW - hygiene KW - social distancing KW - prevention KW - incidence KW - surveillance N2 - 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. UR - http://www.jmir.org/2020/8/e21257/ UR - http://dx.doi.org/10.2196/21257 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750008 ID - info:doi/10.2196/21257 ER - TY - JOUR AU - Al-Dmour, Hani AU - Masa?deh, Ra?ed AU - Salman, Amer AU - Abuhashesh, Mohammad AU - Al-Dmour, Rand PY - 2020/8/19 TI - Influence of Social Media Platforms on Public Health Protection Against the COVID-19 Pandemic via the Mediating Effects of Public Health Awareness and Behavioral Changes: Integrated Model JO - J Med Internet Res SP - e19996 VL - 22 IS - 8 KW - social media platforms KW - Interventions KW - public health KW - awareness KW - public health protection KW - coronavirus KW - COVID-19 KW - pandemic KW - behavioral change KW - Jordan KW - behavior KW - social media N2 - Background: Despite the growing body of literature examining social media in health contexts, including public health communication, promotion, and surveillance, limited insight has been provided into how the utility of social media may vary depending on the particular public health objectives governing an intervention. For example, the extent to which social media platforms contribute to enhancing public health awareness and prevention during epidemic disease transmission is currently unknown. Doubtlessly, coronavirus disease (COVID-19) represents a great challenge at the global level, aggressively affecting large cities and public gatherings and thereby having substantial impacts on many health care systems worldwide as a result of its rapid spread. Each country has its capacity and reacts according to its perception of threat, economy, health care policy, and the health care system structure. Furthermore, we noted a lack of research focusing on the role of social media campaigns in public health awareness and public protection against the COVID-19 pandemic in Jordan as a developing country. Objective: The purpose of this study was to examine the influence of social media platforms on public health protection against the COVID-19 pandemic via public health awareness and public health behavioral changes as mediating factors in Jordan. Methods: A quantitative approach and several social media platforms were used to collect data via web questionnaires in Jordan, and a total of 2555 social media users were sampled. This study used structural equation modeling to analyze and verify the study variables. Results: The main findings revealed that the use of social media platforms had a significant positive influence on public health protection against COVID-19 as a pandemic. Public health awareness and public health behavioral changes significantly acted as partial mediators in this relationship. Therefore, a better understanding of the effects of the use of social media interventions on public health protection against COVID-19 while taking public health awareness and behavioral changes into account as mediators should be helpful when developing any health promotion strategy plan. Conclusions: Our findings suggest that the use of social media platforms can positively influence awareness of public health behavioral changes and public protection against COVID-19. Public health authorities may use social media platforms as an effective tool to increase public health awareness through dissemination of brief messages to targeted populations. However, more research is needed to validate how social media channels can be used to improve health knowledge and adoption of healthy behaviors in a cross-cultural context. UR - http://www.jmir.org/2020/8/e19996/ UR - http://dx.doi.org/10.2196/19996 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750004 ID - info:doi/10.2196/19996 ER - TY - JOUR AU - Windisch, Olivier AU - Zamberg, Ido AU - Zanella, Marie-Céline AU - Gayet-Ageron, Angèle AU - Blondon, Katherine AU - Schiffer, Eduardo AU - Agoritsas, Thomas PY - 2020/8/19 TI - Using mHealth to Increase the Reach of Local Guidance to Health Professionals as Part of an Institutional Response Plan to the COVID-19 Outbreak: Usage Analysis Study JO - JMIR Mhealth Uhealth SP - e20025 VL - 8 IS - 8 KW - COVID-19 KW - smartphone KW - mHealth KW - information dissemination KW - health professionals KW - health administration KW - health apps N2 - Background: The ongoing coronavirus disease (COVID-19) pandemic forced health jurisdictions worldwide to significantly restructure and reorganize their medical activities. In response to the rapidly evolving body of evidence, a solid communication strategy is needed to increase the reach of and adherence to locally drafted and validated guidance to aide medical staff with COVID-19?related clinical decisions. Objective: We present a usage analysis of a dedicated mobile health (mHealth) platform as part of an institutional knowledge dissemination strategy of COVID-19?related guidance to all health care workers (HCWs) in a large academic hospital. Methods: A multidisciplinary team of experts drafted local guidance related to COVID-19. In total, 60 documents and 17 external links were made available through the platform. Documents were disseminated using a recently deployed mHealth platform for HCWs. Targeted dissemination of COVID-19?related content began on March 22, 2020. Using a third-party statistics tool, data concerning user activity and content use was anonymously collected. A quantitative analysis of user activity was performed over a 4-month period, separated into 3 periods: 2 months before (Period A), 2 weeks after (Period B), and 6 weeks following (Period C) targeted dissemination. Regional epidemiological data (daily new COVID-19 cases and total COVID-19?related hospitalizations) was extracted from an official registry. Results: During the study period, the platform was downloaded by 1233 new users. Consequently, the total number of users increased from 1766 users before Period A to a total of 2999 users at the end of Period C. We observed 27,046 document views, of which 12,728 (47.1%) were COVID-19?related. The highest increase in activity occurred in Period B, rapidly following targeted dissemination, with 7740 COVID-19?related content views, representing 71.2% of total content views within the abovementioned period and 550 daily views of COVID-19?related documents. Total documents consulted per day increased from 117 (IQR 74-160) to 657 (IQR 481-1051), P<.001. This increase in activity followed the epidemiological curbing of newly diagnosed COVID-19 cases, which peaked during Period B. Total active devices doubled from 684 to 1400, daily user activity increased fourfold, and the number of active devices rose from 53 (IQR 40-70) to 210 (IQR 167-297), P<.001. In addition, the number of sessions per day rose from 166 (IQR 110-246) to 704 (IQR 517-1028), P<.001. A persistent but reduced increase in total documents consulted per day (172 [IQR 131-251] versus 117 [IQR 74-160], P<.001) and active devices (71 [IQR 64-89] versus 53 [IQR 40-70]) was observed in Period C compared to Period A, while only 29.8% of the content accessed was COVID-19?related. After targeted dissemination, an immediate increase in activity was observed after push notifications were sent to users. Conclusions: The use of an mHealth solution to disseminate time-sensitive medical knowledge seemed to be an effective solution to increase the reach of validated content to a targeted audience. UR - http://mhealth.jmir.org/2020/8/e20025/ UR - http://dx.doi.org/10.2196/20025 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749996 ID - info:doi/10.2196/20025 ER - TY - JOUR AU - Hung, Man AU - Lauren, Evelyn AU - Hon, S. Eric AU - Birmingham, C. Wendy AU - Xu, Julie AU - Su, Sharon AU - Hon, D. Shirley AU - Park, Jungweon AU - Dang, Peter AU - Lipsky, S. Martin PY - 2020/8/18 TI - Social Network Analysis of COVID-19 Sentiments: Application of Artificial Intelligence JO - J Med Internet Res SP - e22590 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus KW - sentiment KW - social network KW - Twitter KW - infodemiology KW - infodemic KW - pandemic KW - crisis KW - public health KW - business economy KW - artificial intelligence N2 - 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. UR - http://www.jmir.org/2020/8/e22590/ UR - http://dx.doi.org/10.2196/22590 UR - http://www.ncbi.nlm.nih.gov/pubmed/32750001 ID - info:doi/10.2196/22590 ER - TY - JOUR AU - Veiga e Silva, Lena AU - de Andrade Abi Harb, Penha Maria Da AU - Teixeira Barbosa dos Santos, Milene Aurea AU - de Mattos Teixeira, André Carlos AU - Macedo Gomes, Hugo Vitor AU - Silva Cardoso, Helena Evelin AU - S da Silva, Marcelino AU - Vijaykumar, L. N. AU - Venâncio Carvalho, Solon AU - Ponce de Leon Ferreira de Carvalho, André AU - Lisboa Frances, Renato Carlos PY - 2020/8/18 TI - COVID-19 Mortality Underreporting in Brazil: Analysis of Data From Government Internet Portals JO - J Med Internet Res SP - e21413 VL - 22 IS - 8 KW - Brazil KW - COVID-19 KW - mortality KW - underreporting KW - respiratory system diseases KW - public health KW - pandemic KW - time series KW - forecasting N2 - 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. UR - http://www.jmir.org/2020/8/e21413/ UR - http://dx.doi.org/10.2196/21413 UR - http://www.ncbi.nlm.nih.gov/pubmed/32730219 ID - info:doi/10.2196/21413 ER - TY - JOUR AU - Liu, Dianbo AU - Clemente, Leonardo AU - Poirier, Canelle AU - Ding, Xiyu AU - Chinazzi, Matteo AU - Davis, Jessica AU - Vespignani, Alessandro AU - Santillana, Mauricio PY - 2020/8/17 TI - Real-Time Forecasting of the COVID-19 Outbreak in Chinese Provinces: Machine Learning Approach Using Novel Digital Data and Estimates From Mechanistic Models JO - J Med Internet Res SP - e20285 VL - 22 IS - 8 KW - COVID-19 KW - coronavirus KW - digital epidemiology KW - modeling KW - modeling disease outbreaks KW - emerging outbreak KW - machine learning KW - precision public health KW - machine learning in public health KW - forecasting KW - digital data KW - mechanistic model KW - hybrid simulation KW - hybrid model KW - simulation N2 - Background: The inherent difficulty of identifying and monitoring emerging outbreaks caused by novel pathogens can lead to their rapid spread; and if left unchecked, they may become major public health threats to the planet. The ongoing coronavirus disease (COVID-19) outbreak, which has infected over 2,300,000 individuals and caused over 150,000 deaths, is an example of one of these catastrophic events. Objective: We present a timely and novel methodology that combines disease estimates from mechanistic models and digital traces, via interpretable machine learning methodologies, to reliably forecast COVID-19 activity in Chinese provinces in real time. Methods: Our method uses the following as inputs: (a) official health reports, (b) COVID-19?related internet search activity, (c) news media activity, and (d) daily forecasts of COVID-19 activity from a metapopulation mechanistic model. Our machine learning methodology uses a clustering technique that enables the exploitation of geospatial synchronicities of COVID-19 activity across Chinese provinces and a data augmentation technique to deal with the small number of historical disease observations characteristic of emerging outbreaks. Results: Our model is able to produce stable and accurate forecasts 2 days ahead of the current time and outperforms a collection of baseline models in 27 out of 32 Chinese provinces. Conclusions: Our methodology could be easily extended to other geographies currently affected by COVID-19 to aid decision makers with monitoring and possibly prevention. UR - http://www.jmir.org/2020/8/e20285/ UR - http://dx.doi.org/10.2196/20285 UR - http://www.ncbi.nlm.nih.gov/pubmed/32730217 ID - info:doi/10.2196/20285 ER - TY - JOUR AU - Martin, Guy AU - Koizia, Louis AU - Kooner, Angad AU - Cafferkey, John AU - Ross, Clare AU - Purkayastha, Sanjay AU - Sivananthan, Arun AU - Tanna, Anisha AU - Pratt, Philip AU - Kinross, James AU - PY - 2020/8/14 TI - Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation JO - J Med Internet Res SP - e21486 VL - 22 IS - 8 KW - COVID-19 KW - mixed reality KW - telemedicine KW - protection KW - acceptability KW - feasibility KW - impact KW - headset KW - virtual reality KW - augmented reality KW - pilot N2 - 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. UR - http://www.jmir.org/2020/8/e21486/ UR - http://dx.doi.org/10.2196/21486 UR - http://www.ncbi.nlm.nih.gov/pubmed/32730222 ID - info:doi/10.2196/21486 ER - TY - JOUR AU - Qu, Hui-Qi AU - Cheng, Jason Zhangkai AU - Duan, Zhifeng AU - Tian, Lifeng AU - Hakonarson, Hakon PY - 2020/8/14 TI - The Infection Rate of COVID-19 in Wuhan, China: Combined Analysis of Population Samples JO - J Med Internet Res SP - e20914 VL - 22 IS - 8 KW - infectious disease KW - COVID-19 KW - infection rate KW - China KW - Wuhan KW - fatality KW - public health KW - diagnosis N2 - 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. UR - https://www.jmir.org/2020/8/e20914 UR - http://dx.doi.org/10.2196/20914 UR - http://www.ncbi.nlm.nih.gov/pubmed/32707538 ID - info:doi/10.2196/20914 ER - TY - JOUR AU - Neuraz, Antoine AU - Lerner, Ivan AU - Digan, William AU - Paris, Nicolas AU - Tsopra, Rosy AU - Rogier, Alice AU - Baudoin, David AU - Cohen, Bretonnel Kevin AU - Burgun, Anita AU - Garcelon, Nicolas AU - Rance, Bastien AU - PY - 2020/8/14 TI - Natural Language Processing for Rapid Response to Emergent Diseases: Case Study of Calcium Channel Blockers and Hypertension in the COVID-19 Pandemic JO - J Med Internet Res SP - e20773 VL - 22 IS - 8 KW - medication information KW - natural language processing KW - electronic health records KW - COVID-19 KW - public health KW - response KW - emergent disease KW - informatics N2 - 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. UR - http://www.jmir.org/2020/8/e20773/ UR - http://dx.doi.org/10.2196/20773 UR - http://www.ncbi.nlm.nih.gov/pubmed/32759101 ID - info:doi/10.2196/20773 ER - TY - JOUR AU - Quirch, Miguel AU - Lee, Jeannie AU - Rehman, Shabnam PY - 2020/8/13 TI - Hazards of the Cytokine Storm and Cytokine-Targeted Therapy in Patients With COVID-19: Review JO - J Med Internet Res SP - e20193 VL - 22 IS - 8 KW - coronavirus KW - COVID-19 KW - convalescent plasma therapy KW - cytokine storm KW - SARS-CoV-2 KW - cytokine KW - immunology KW - review KW - mortality KW - inflammation KW - therapy N2 - 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-?, 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. UR - http://www.jmir.org/2020/8/e20193/ UR - http://dx.doi.org/10.2196/20193 UR - http://www.ncbi.nlm.nih.gov/pubmed/32707537 ID - info:doi/10.2196/20193 ER - TY - JOUR AU - Liu, Dong AU - Wang, Yuyan AU - Wang, Juan AU - Liu, Jue AU - Yue, Yongjie AU - Liu, Wenjun AU - Zhang, Fuhai AU - Wang, Ziping PY - 2020/8/13 TI - Characteristics and Outcomes of a Sample of Patients With COVID-19 Identified Through Social Media in Wuhan, China: Observational Study JO - J Med Internet Res SP - e20108 VL - 22 IS - 8 KW - COVID-19 KW - risk factors KW - web-based data KW - outcome KW - infectious disease KW - clinical characteristic KW - mortality KW - social media KW - prognosis, China KW - coronavirus N2 - 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. UR - http://www.jmir.org/2020/8/e20108/ UR - http://dx.doi.org/10.2196/20108 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716901 ID - info:doi/10.2196/20108 ER - TY - JOUR AU - Kassaye, G. Seble AU - Spence, Blair Amanda AU - Lau, Edwin AU - Bridgeland, M. David AU - Cederholm, John AU - Dimolitsas, Spiros AU - Smart, JC PY - 2020/8/13 TI - Rapid Deployment of a Free, Privacy-Assured COVID-19 Symptom Tracker for Public Safety During Reopening: System Development and Feasibility Study JO - JMIR Public Health Surveill SP - e19399 VL - 6 IS - 3 KW - COVID-19 KW - SARS-CoV-2 KW - home isolation KW - quarantine KW - symptom monitoring KW - information systems KW - privacy KW - contact tracing KW - virus KW - transmission KW - public health KW - eHealth N2 - Background: Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of cases of coronavirus disease (COVID-19) in the United States has exponentially increased. Identifying and monitoring individuals with COVID-19 and individuals who have been exposed to the disease is critical to prevent transmission. Traditional contact tracing mechanisms are not structured on the scale needed to address this pandemic. As businesses reopen, institutions and agencies not traditionally engaged in disease prevention are being tasked with ensuring public safety. Systems to support organizations facing these new challenges are critically needed. Most currently available symptom trackers use a direct-to-consumer approach and use personal identifiers, which raises privacy concerns. Objective: Our aim was to develop a monitoring and reporting system for COVID-19 to support institutions conducting monitoring activities without compromising privacy. Methods: Our multidisciplinary team designed a symptom tracking system after consultation with experts. The system was designed in the Georgetown University AvesTerra knowledge management environment, which supports data integration and synthesis to identify actionable events and maintain privacy. We conducted a beta test for functionality among consenting Georgetown University medical students. Results: The symptom tracker system was designed based on guiding principles developed during peer consultations. Institutions are provided access to the system through an efficient onboarding process that uses clickwrap technology to document agreement to limited terms of use to rapidly enable free access. Institutions provide their constituents with a unique identifier to enter data through a web-based user interface to collect vetted symptoms as well as clinical and epidemiologic data. The website also provides individuals with educational information through links to the COVID-19 prevention recommendations from the US Centers for Disease Control and Prevention. Safety features include instructions for people with new or worsening symptoms to seek care. No personal identifiers are collected in the system. The reporter mechanism safeguards data access so that institutions can only access their own data, and it provides institutions with on-demand access to the data entered by their constituents, organized in summary reports that highlight actionable data. Development of the system began on March 15, 2020, and it was launched on March 20, 2020. In the beta test, 48 Georgetown University School of Medicine students or their social contacts entered data into the system from March 31 to April 5, 2020. One of the 48 users (2%) reported active COVID-19 infection and had no symptoms by the end of the monitoring period. No other participants reported symptoms. Only data with the unique entity identifier for our beta test were generated in our summary reports. Conclusions: This system harnesses insights into privacy and data sharing to avoid regulatory and legal hurdles to rapid adaption by entities tasked with maintaining public safety. Our pilot study demonstrated feasibility and ease of use. Refinements based on feedback from early adapters included release of a Spanish language version. These systems provide technological advances to complement the traditional contact tracing and digital tracing applications being implemented to limit SARS-CoV-2 transmission during reopening. UR - http://publichealth.jmir.org/2020/3/e19399/ UR - http://dx.doi.org/10.2196/19399 UR - http://www.ncbi.nlm.nih.gov/pubmed/32788148 ID - info:doi/10.2196/19399 ER - TY - JOUR AU - Moon, Hana AU - Lee, Ho Geon PY - 2020/8/12 TI - Evaluation of Korean-Language COVID-19?Related Medical Information on YouTube: Cross-Sectional Infodemiology Study JO - J Med Internet Res SP - e20775 VL - 22 IS - 8 KW - COVID-19 KW - YouTube KW - social media KW - misinformation KW - public health surveillance KW - health communication KW - consumer health information KW - health education KW - infectious disease outbreaks KW - infodemiology KW - infoveillance KW - infodemic KW - internet KW - multimedia N2 - Background: In South Korea, the number of coronavirus disease (COVID-19) cases has declined rapidly and much sooner than in other countries. South Korea is one of the most digitalized countries in the world, and YouTube may have served as a rapid delivery mechanism for increasing public awareness of COVID-19. Thus, the platform may have helped the South Korean public fight the spread of the disease. Objective: The aim of this study is to compare the reliability, overall quality, title?content consistency, and content coverage of Korean-language YouTube videos on COVID-19, which have been uploaded by different sources. Methods: A total of 200 of the most viewed YouTube videos from January 1, 2020, to April 30, 2020, were screened, searching in Korean for the terms ?Coronavirus,? ?COVID,? ?Corona,? ?Wuhan virus,? and ?Wuhan pneumonia.? Non-Korean videos and videos that were duplicated, irrelevant, or livestreamed were excluded. Source and video metrics were collected. The videos were scored based on the following criteria: modified DISCERN index, Journal of the American Medical Association Score (JAMAS) benchmark criteria, global quality score (GQS), title?content consistency index (TCCI), and medical information and content index (MICI). Results: Of the 105 total videos, 37.14% (39/105) contained misleading information; independent user?generated videos showed the highest proportion of misleading information at 68.09% (32/47), while all of the government-generated videos were useful. Government agency?generated videos achieved the highest median score of DISCERN (5.0, IQR 5.0-5.0), JAMAS (4.0, IQR 4.0-4.0), GQS (4.0, IQR 3.0-4.5), and TCCI (5.0, IQR 5.0-5.0), while independent user?generated videos achieved the lowest median score of DISCERN (2.0, IQR 1.0-3.0), JAMAS (2.0, IQR 1.5-2.0), GQS (2.0, IQR 1.5-2.0), and TCCI (3.0, IQR 3.0-4.0). However, the total MICI was not significantly different among sources. ?Transmission and precautionary measures? were the most commonly covered content by government agencies, news agencies, and independent users. In contrast, the most mentioned content by news agencies was ?prevalence,? followed by ?transmission and precautionary measures.? Conclusions: Misleading videos had more likes, fewer comments, and longer running times than useful videos. Korean-language YouTube videos on COVID-19 uploaded by different sources varied significantly in terms of reliability, overall quality, and title?content consistency, but the content coverage was not significantly different. Government-generated videos had higher reliability, overall quality, and title?content consistency than independent user?generated videos. UR - http://www.jmir.org/2020/8/e20775/ UR - http://dx.doi.org/10.2196/20775 UR - http://www.ncbi.nlm.nih.gov/pubmed/32730221 ID - info:doi/10.2196/20775 ER - TY - JOUR AU - Ghosh, Palash AU - Ghosh, Rik AU - Chakraborty, Bibhas PY - 2020/8/12 TI - COVID-19 in India: Statewise Analysis and Prediction JO - JMIR Public Health Surveill SP - e20341 VL - 6 IS - 3 KW - COVID-19 KW - disease modeling KW - 30-day prediction KW - logistic model KW - exponential model KW - SIS model KW - daily infection rate N2 - Background: The highly infectious coronavirus disease (COVID-19) was first detected in Wuhan, China in December 2019 and subsequently spread to 212 countries and territories around the world, infecting millions of people. In India, a large country of about 1.3 billion people, the disease was first detected on January 30, 2020, in a student returning from Wuhan. The total number of confirmed infections in India as of May 3, 2020, is more than 37,000 and is currently growing fast. Objective: Most of the prior research and media coverage focused on the number of infections in the entire country. However, given the size and diversity of India, it is important to look at the spread of the disease in each state separately, wherein the situations are quite different. In this paper, we aim to analyze data on the number of infected people in each Indian state (restricted to only those states with enough data for prediction) and predict the number of infections for that state in the next 30 days. We hope that such statewise predictions would help the state governments better channelize their limited health care resources. Methods: Since predictions from any one model can potentially be misleading, we considered three growth models, namely, the logistic, the exponential, and the susceptible-infectious-susceptible models, and finally developed a data-driven ensemble of predictions from the logistic and the exponential models using functions of the model-free maximum daily infection rate (DIR) over the last 2 weeks (a measure of recent trend) as weights. The DIR is used to measure the success of the nationwide lockdown. We jointly interpreted the results from all models along with the recent DIR values for each state and categorized the states as severe, moderate, or controlled. Results: We found that 7 states, namely, Maharashtra, Delhi, Gujarat, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, and West Bengal are in the severe category. Among the remaining states, Tamil Nadu, Rajasthan, Punjab, and Bihar are in the moderate category, whereas Kerala, Haryana, Jammu and Kashmir, Karnataka, and Telangana are in the controlled category. We also tabulated actual predicted numbers from various models for each state. All the R2 values corresponding to the logistic and the exponential models are above 0.90, indicating a reasonable goodness of fit. We also provide a web application to see the forecast based on recent data that is updated regularly. Conclusions: States with nondecreasing DIR values need to immediately ramp up the preventive measures to combat the COVID-19 pandemic. On the other hand, the states with decreasing DIR can maintain the same status to see the DIR slowly become zero or negative for a consecutive 14 days to be able to declare the end of the pandemic. UR - http://publichealth.jmir.org/2020/3/e20341/ UR - http://dx.doi.org/10.2196/20341 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763888 ID - info:doi/10.2196/20341 ER - TY - JOUR AU - Cresswell, Kathrin AU - Ramalingam, Sandeep AU - Sheikh, Aziz PY - 2020/8/12 TI - Can Robots Improve Testing Capacity for SARS-CoV-2? JO - J Med Internet Res SP - e20169 VL - 22 IS - 8 KW - robotics KW - testing KW - SARS-CoV-2 KW - COVID-19 KW - pandemic KW - virus KW - infectious disease UR - http://www.jmir.org/2020/8/e20169/ UR - http://dx.doi.org/10.2196/20169 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735547 ID - info:doi/10.2196/20169 ER - TY - JOUR AU - Portz, D. Jennifer AU - Brungardt, Adreanne AU - Shanbhag, Prajakta AU - Staton, W. Elizabeth AU - Bose-Brill, Seuli AU - Lin, Chen-Tan AU - Kutner, S. Jean AU - Lum, D. Hillary PY - 2020/8/11 TI - Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study JO - J Med Internet Res SP - e21385 VL - 22 IS - 8 KW - advance care planning KW - electronic health records KW - pandemic KW - COVID-19 KW - advance directives KW - patient portal KW - planning KW - web-based tool KW - health system N2 - Background: Advance care planning is the process of discussing health care treatment preferences based on patients? personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non?face-to-face methods to conduct advance care planning via patient portals has increased. Objective: The aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system?based electronic patient portal both before and in the early months of the COVID-19 pandemic. Methods: In 2017, we implemented web-based tools through the patient portal of UCHealth?s electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients? date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020). Results: Over a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P<.001). The mean age of the advance care planning portal users was 47.7 years (SD 16.1), and 2206/3292 (67.0%) were female. Women were more likely than men to complete an MDPOA, particularly in younger age groups (P<.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (3138/3292, 95.3%), compared to sending an electronic message (148/3292, 4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR. Conclusions: Use of a web-based patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government shelter-in-place orders as well as public health reports of increased numbers of COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure that medical treatment aligns with patient goals and values. UR - http://www.jmir.org/2020/8/e21385/ UR - http://dx.doi.org/10.2196/21385 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716900 ID - info:doi/10.2196/21385 ER - TY - JOUR AU - Al-Hasan, Abrar AU - Yim, Dobin AU - Khuntia, Jiban PY - 2020/8/11 TI - Citizens? Adherence to COVID-19 Mitigation Recommendations by the Government: A 3-Country Comparative Evaluation Using Web-Based Cross-Sectional Survey Data JO - J Med Internet Res SP - e20634 VL - 22 IS - 8 KW - COVID-19 KW - adherence KW - social distancing KW - government perception KW - information sources KW - social media KW - knowledge N2 - 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. UR - http://www.jmir.org/2020/8/e20634/ UR - http://dx.doi.org/10.2196/20634 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716896 ID - info:doi/10.2196/20634 ER - TY - JOUR AU - Warin, Thierry PY - 2020/8/11 TI - Global Research on Coronaviruses: An R Package JO - J Med Internet Res SP - e19615 VL - 22 IS - 8 KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - R package KW - bibliometric KW - virus KW - infectious disease KW - reference KW - informatics N2 - Background: In these trying times, we developed an R package about bibliographic references on coronaviruses. Working with reproducible research principles based on open science, disseminating scientific information, providing easy access to scientific production on this particular issue, and offering a rapid integration in researchers? workflows may help save time in this race against the virus, notably in terms of public health. Objective: The goal is to simplify the workflow of interested researchers, with multidisciplinary research in mind. With more than 60,500 medical bibliographic references at the time of publication, this package is among the largest about coronaviruses. Methods: This package could be of interest to epidemiologists, researchers in scientometrics, biostatisticians, as well as data scientists broadly defined. This package collects references from PubMed and organizes the data in a data frame. We then built functions to sort through this collection of references. Researchers can also integrate the data into their pipeline and implement them in R within their code libraries. Results: We provide a short use case in this paper based on a bibliometric analysis of the references made available by this package. Classification techniques can also be used to go through the large volume of references and allow researchers to save time on this part of their research. Network analysis can be used to filter the data set. Text mining techniques can also help researchers calculate similarity indices and help them focus on the parts of the literature that are relevant for their research. Conclusions: This package aims at accelerating research on coronaviruses. Epidemiologists can integrate this package into their workflow. It is also possible to add a machine learning layer on top of this package to model the latest advances in research about coronaviruses, as we update this package daily. It is also the only one of this size, to the best of our knowledge, to be built in the R language. UR - http://www.jmir.org/2020/8/e19615/ UR - http://dx.doi.org/10.2196/19615 UR - http://www.ncbi.nlm.nih.gov/pubmed/32730218 ID - info:doi/10.2196/19615 ER - TY - JOUR AU - Brar Prayaga, Rena AU - Prayaga, S. Ram PY - 2020/8/10 TI - Mobile Fotonovelas Within a Text Message Outreach: An Innovative Tool to Build Health Literacy and Influence Behaviors in Response to the COVID-19 Pandemic JO - JMIR Mhealth Uhealth SP - e19529 VL - 8 IS - 8 KW - text messaging KW - SMS KW - mobile fotonovelas KW - COVID-19 KW - social isolation KW - social support KW - health behaviors KW - health literacy KW - health plans UR - http://mhealth.jmir.org/2020/8/e19529/ UR - http://dx.doi.org/10.2196/19529 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716894 ID - info:doi/10.2196/19529 ER - TY - JOUR AU - Sousa-Pinto, Bernardo AU - Anto, Aram AU - Czarlewski, Wienia AU - Anto, M. Josep AU - Fonseca, Almeida João AU - Bousquet, Jean PY - 2020/8/10 TI - Assessment of the Impact of Media Coverage on COVID-19?Related Google Trends Data: Infodemiology Study JO - J Med Internet Res SP - e19611 VL - 22 IS - 8 KW - COVID-19 KW - infodemiology KW - infodemic KW - Google Trends KW - media coverage KW - media KW - coronavirus KW - symptom KW - monitoring KW - trend KW - pandemic N2 - Background: The influence of media coverage on web-based searches may hinder the role of Google Trends (GT) in monitoring coronavirus disease (COVID-19). Objective: The aim of this study was to assess whether COVID-19?related GT data, particularly those related to ageusia and anosmia, were primarily related to media coverage or to epidemic trends. Methods: We retrieved GT query data for searches on coronavirus, cough, anosmia, and ageusia and plotted them over a period of 5 years. In addition, we analyzed the trends of those queries for 17 countries throughout the year 2020 with a particular focus on the rises and peaks of the searches. For anosmia and ageusia, we assessed whether the respective GT data correlated with COVID-19 cases and deaths both throughout 2020 and specifically before March 16, 2020 (ie, the date when the media started reporting that these symptoms can be associated with COVID-19). Results: Over the last five years, peaks for coronavirus searches in GT were only observed during the winter of 2020. Rises and peaks in coronavirus searches appeared at similar times in the 17 different assessed countries irrespective of their epidemic situations. In 15 of these countries, rises in anosmia and ageusia searches occurred in the same week or 1 week after they were identified in the media as symptoms of COVID-19. When data prior to March 16, 2020 were analyzed, anosmia and ageusia GT data were found to have variable correlations with COVID-19 cases and deaths in the different countries. Conclusions: Our results indicate that COVID-19?related GT data are more closely related to media coverage than to epidemic trends. UR - https://www.jmir.org/2020/8/e19611 UR - http://dx.doi.org/10.2196/19611 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530816 ID - info:doi/10.2196/19611 ER - TY - JOUR AU - Adly, Sedky Aya AU - Adly, Sedky Afnan AU - Adly, Sedky Mahmoud PY - 2020/8/10 TI - Approaches Based on Artificial Intelligence and the Internet of Intelligent Things to Prevent the Spread of COVID-19: Scoping Review JO - J Med Internet Res SP - e19104 VL - 22 IS - 8 KW - SARS-CoV-2 KW - COVID-19 KW - novel coronavirus KW - artificial intelligence KW - internet of things KW - telemedicine KW - machine learning KW - modeling KW - simulation KW - robotics N2 - 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. UR - https://www.jmir.org/2020/8/e19104 UR - http://dx.doi.org/10.2196/19104 UR - http://www.ncbi.nlm.nih.gov/pubmed/32584780 ID - info:doi/10.2196/19104 ER - TY - JOUR AU - Liu, Na AU - Huang, Robin AU - Baldacchino, Tanya AU - Sud, Archana AU - Sud, Kamal AU - Khadra, Mohamed AU - Kim, Jinman PY - 2020/8/7 TI - Telehealth for Noncritical Patients With Chronic Diseases During the COVID-19 Pandemic JO - J Med Internet Res SP - e19493 VL - 22 IS - 8 KW - telehealth KW - chronic diseases KW - COVID-19 KW - coronavirus KW - pandemic KW - remote monitoring KW - copresence UR - http://www.jmir.org/2020/8/e19493/ UR - http://dx.doi.org/10.2196/19493 UR - http://www.ncbi.nlm.nih.gov/pubmed/32721925 ID - info:doi/10.2196/19493 ER - TY - JOUR AU - Li, Guanjian AU - Tang, Dongdong AU - Song, Bing AU - Wang, Chao AU - Qunshan, Shen AU - Xu, Chuan AU - Geng, Hao AU - Wu, Huan AU - He, Xiaojin AU - Cao, Yunxia PY - 2020/8/6 TI - Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study JO - J Med Internet Res SP - e20961 VL - 22 IS - 8 KW - COVID-19 KW - survey KW - novel coronavirus KW - sexual behavior KW - sexual health KW - reproductive health KW - young adults KW - youth KW - China N2 - Background: In the past few months, the coronavirus disease (COVID-19) pandemic has caused extensive economic and social damage. Objective: The purpose of this study was to assess the impact of COVID-19?related measures on partner relationships and sexual and reproductive health in China. Methods: From May 1 to 5, 2020, 3500 young Chinese individuals were recruited through WeChat or Weibo to participate in a survey to obtain information on sexual and reproductive health (eg, sexual desire, frequency of sexual intercourse, sexual satisfaction, etc). The questionnaire also collected demographic data (eg, age, race, education, current financial status, sexual orientation, relationship status, etc). Results: In total, 967 participants were included in the sexual health analysis. Due to the COVID-19 pandemic and related containment measures, 22% of participants (n=212) reported a decrease in sexual desire; 41% (n=396) experienced a decrease in the sexual intercourse frequency; 30% (n=291) reported an increase in the frequency of masturbation; 20% (n=192) reported a decrease in alcohol consumption before or during sexual activities, and 31% (n=298) reported a deterioration in partner relationships during the pandemic. The logistic regression analysis indicated that the following influenced partner relationships: accommodations during the pandemic (P=.046; odds ratio [OR] 0.59; 95% CI 0.30-0.86); exclusive relationship status (yes or no) (P<.001; OR 0.44; 95 % CI?0.27-0.73); sexual desire (P=.02; OR 2.01; 95% CI?1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95% CI?1.54-2.50). COVID-19 also caused disruptions in reproductive health services such as prenatal and postnatal care, childbirth and abortion services, contraception availability, and the management of sexually transmitted infections. Conclusions: Our results show that many young people have wide-ranging issues affecting their sexual and reproductive health due to the COVID-19 pandemic and related containment measures. Strategies and guidelines are needed to safeguard the sexual and reproductive health of young people during this pandemic. UR - https://www.jmir.org/2020/8/e20961 UR - http://dx.doi.org/10.2196/20961 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716895 ID - info:doi/10.2196/20961 ER - TY - JOUR AU - Guo, Yan AU - Cheng, Chao AU - Zeng, Yu AU - Li, Yiran AU - Zhu, Mengting AU - Yang, Weixiong AU - Xu, He AU - Li, Xiaohua AU - Leng, Jinhang AU - Monroe-Wise, Aliza AU - Wu, Shaomin PY - 2020/8/6 TI - Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study JO - J Med Internet Res SP - e20328 VL - 22 IS - 8 KW - COVID-19 KW - anxiety or depressive symptoms KW - quarantine KW - risk and protective factors N2 - 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. UR - http://www.jmir.org/2020/8/e20328/ UR - http://dx.doi.org/10.2196/20328 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716899 ID - info:doi/10.2196/20328 ER - TY - JOUR AU - Ding, Liang AU - She, Qiuru AU - Chen, Fengxian AU - Chen, Zitong AU - Jiang, Meifang AU - Huang, Huasi AU - Li, Yujin AU - Liao, Chaofeng PY - 2020/8/6 TI - The Internet Hospital Plus Drug Delivery Platform for Health Management During the COVID-19 Pandemic: Observational Study JO - J Med Internet Res SP - e19678 VL - 22 IS - 8 KW - internet hospital KW - drug delivery KW - internet hospital plus drug delivery KW - IHDD KW - health management KW - COVID-19 N2 - Background: Widespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called ?internet hospital plus drug delivery? (IHDD) has been developed in China, but little is known about this platform. Objective: The aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South China Methods: The total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients? gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis. Results: A total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China. Conclusions: The IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service. UR - http://www.jmir.org/2020/8/e19678/ UR - http://dx.doi.org/10.2196/19678 UR - http://www.ncbi.nlm.nih.gov/pubmed/32716892 ID - info:doi/10.2196/19678 ER - TY - JOUR AU - Peine, Arne AU - Paffenholz, Pia AU - Martin, Lukas AU - Dohmen, Sandra AU - Marx, Gernot AU - Loosen, H. Sven PY - 2020/8/5 TI - Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey JO - J Med Internet Res SP - e19745 VL - 22 IS - 8 KW - telemedicine KW - coronavirus KW - COVID-19 KW - telehealth KW - SARS-CoV-2 KW - pandemic KW - survey KW - medical professional KW - availability KW - acceptance KW - burden N2 - 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 (?=?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. UR - https://www.jmir.org/2020/8/e19745 UR - http://dx.doi.org/10.2196/19745 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568724 ID - info:doi/10.2196/19745 ER - TY - JOUR AU - Li, Lin AU - Liu, Gang AU - Xu, Weiguo AU - Zhang, Yun AU - He, Mei PY - 2020/8/4 TI - Effects of Internet Hospital Consultations on Psychological Burdens and Disease Knowledge During the Early Outbreak of COVID-19 in China: Cross-Sectional Survey Study JO - J Med Internet Res SP - e19551 VL - 22 IS - 8 KW - internet hospital KW - telemedicine KW - novel coronavirus disease KW - pandemic KW - psychological burden KW - disease cognition KW - coronavirus KW - COVID-19 KW - public health KW - infectious disease N2 - Background: Coronavirus disease (COVID-19) has become a global threat to human health. Internet hospitals have emerged as a critical technology to bring epidemic-related web-based services and medical support to the public. However, only a few very recent scientific literature reports have explored the effects of internet hospitals on psychological burden and disease knowledge in major public health emergencies such as the COVID-19 pandemic. Objective: The aim of this study was to explore the role of internet hospitals in relieving psychological burden and increasing disease knowledge during the early outbreak of the COVID-19 pandemic. Methods: This survey was conducted from January 26 to February 1, 2020, during the early outbreak of COVID-19 in China. The platform used for the consultation was the WeChat public account of our hospital. To participate in the study, the patient was required to answer a list of questions to exclude the possibility of COVID-19 infection and confirm their willingness to participate voluntarily. Next, the participant was directed to complete the self-report questionnaire. After the internet consultation, the participant was directed to complete the self-report questionnaire again. The questionnaire included sections on general information, the General Health Questionnaire-28 (GHQ-28), and the participant?s worries, disease knowledge, and need for hospital treatment. Results: The total number of internet consultations was 4120. The consultation topics mainly included respiratory symptoms such as cough, expectoration, and fever (2489/4120, 60.4%) and disease knowledge, anxiety, and fear (1023/4120, 24.8%). A total of 1530 people filled out the questionnaires before and after the internet consultation. Of these people, 1398/1530 (91.4%) experienced psychological stress before the internet consultation, which significantly decreased after consultation (260/1530, 17.0%) (?21=1704.8, P<.001). There was no significant difference in the number of people who expressed concern about the COVID-19 pandemic before and after the internet consultation (?21=0.7, P=.43). However, the degree of concern after the internet consultation was significantly alleviated (t2699=90.638, P<.001). The main worries before and after consultation were the dangers posed by the disease and the risk of infection of family members. The scores of the self-assessment risk after the internet consultation were significantly lower than those before consultation (t3058=95.694, P<.001). After the consultation, the participants? knowledge of the symptoms, transmission routes, and preventive measures of COVID-19 was significantly higher than before the consultation (t3058=?106.105, ?80.456, and ?152.605, respectively; all P<.001). The hospital treatment need score after the internet consultation decreased from 3.3 (SD 1.2) to 1.6 (SD 0.8), and the difference was statistically significant (t3058=45.765, P<.001). Conclusions: During the early outbreak of COVID-19, internet hospitals could help relieve psychological burdens and increase disease awareness through timely and rapid spread of knowledge regarding COVID-19 prevention and control. Internet hospitals should be an important aspect of a new medical model in public health emergency systems. UR - https://www.jmir.org/2020/8/e19551 UR - http://dx.doi.org/10.2196/19551 UR - http://www.ncbi.nlm.nih.gov/pubmed/32687061 ID - info:doi/10.2196/19551 ER - TY - JOUR AU - Hou, Zhiyuan AU - Du, Fanxing AU - Zhou, Xinyu AU - Jiang, Hao AU - Martin, Sam AU - Larson, Heidi AU - Lin, Leesa PY - 2020/8/3 TI - Cross-Country Comparison of Public Awareness, Rumors, and Behavioral Responses to the COVID-19 Epidemic: Infodemiology Study JO - J Med Internet Res SP - e21143 VL - 22 IS - 8 KW - COVID-19 KW - internet KW - surveillance KW - infodemic KW - infodemiology KW - infoveillance KW - Google Trends KW - public response KW - behavior KW - rumor KW - trend N2 - Background: Understanding public behavioral responses to the coronavirus disease (COVID-19) epidemic and the accompanying infodemic is crucial to controlling the epidemic. Objective: The aim of this study was to assess real-time public awareness and behavioral responses to the COVID-19 epidemic across 12 selected countries. Methods: Internet surveillance was used to collect real-time data from the general public to assess public awareness and rumors (China: Baidu; worldwide: Google Trends) and behavior responses (China: Ali Index; worldwide: Google Shopping). These indices measured the daily number of searches or purchases and were compared with the numbers of daily COVID-19 cases. The trend comparisons across selected countries were observed from December 1, 2019 (prepandemic baseline) to April 11, 2020 (at least one month after the governments of selected countries took actions for the pandemic). Results: We identified missed windows of opportunity for early epidemic control in 12 countries, when public awareness was very low despite the emerging epidemic. China's epidemic and the declaration of a public health emergency of international concern did not prompt a worldwide public reaction to adopt health-protective measures; instead, most countries and regions only responded to the epidemic after their own case counts increased. Rumors and misinformation led to a surge of sales in herbal remedies in China and antimalarial drugs worldwide, and timely clarification of rumors mitigated the rush to purchase unproven remedies. Conclusions: Our comparative study highlights the urgent need for international coordination to promote mutual learning about epidemic characteristics and effective control measures as well as to trigger early and timely responses in individual countries. Early release of official guidelines and timely clarification of rumors led by governments are necessary to guide the public to take rational action. UR - https://www.jmir.org/2020/8/e21143 UR - http://dx.doi.org/10.2196/21143 UR - http://www.ncbi.nlm.nih.gov/pubmed/32701460 ID - info:doi/10.2196/21143 ER - TY - JOUR AU - Sayers, R. David AU - Hulse, T. Scott AU - Webber, J. Bryant AU - Burns, A. Timothy AU - Denicoff, L. Anne PY - 2020/7/31 TI - 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 JO - JMIR Public Health Surveill SP - e22331 VL - 6 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - public health KW - surveillance KW - prediction KW - emergency medical service KW - EMS KW - pulse oximetry KW - testing UR - http://publichealth.jmir.org/2020/3/e22331/ UR - http://dx.doi.org/10.2196/22331 UR - http://www.ncbi.nlm.nih.gov/pubmed/32678799 ID - info:doi/10.2196/22331 ER - TY - JOUR AU - Kaxiras, Efthimios AU - Neofotistos, Georgios PY - 2020/7/30 TI - Multiple Epidemic Wave Model of the COVID-19 Pandemic: Modeling Study JO - J Med Internet Res SP - e20912 VL - 22 IS - 7 KW - COVID-19 KW - multiple waves KW - transmission KW - intervention measures KW - simulations KW - modeling KW - pandemic response index KW - pandemic KW - virus KW - intervention N2 - 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. UR - http://www.jmir.org/2020/7/e20912/ UR - http://dx.doi.org/10.2196/20912 UR - http://www.ncbi.nlm.nih.gov/pubmed/32692690 ID - info:doi/10.2196/20912 ER - TY - JOUR AU - Cousins, C. Henry AU - Cousins, C. Clara AU - Harris, Alon AU - Pasquale, R. Louis PY - 2020/7/30 TI - Regional Infoveillance of COVID-19 Case Rates: Analysis of Search-Engine Query Patterns JO - J Med Internet Res SP - e19483 VL - 22 IS - 7 KW - epidemiology KW - infoveillance KW - COVID-19 KW - internet activity KW - Google Trends KW - infectious disease KW - surveillance KW - public health N2 - 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. UR - http://www.jmir.org/2020/7/e19483/ UR - http://dx.doi.org/10.2196/19483 UR - http://www.ncbi.nlm.nih.gov/pubmed/32692691 ID - info:doi/10.2196/19483 ER - TY - JOUR AU - Emezue, Chuka PY - 2020/7/30 TI - Digital or Digitally Delivered Responses to Domestic and Intimate Partner Violence During COVID-19 JO - JMIR Public Health Surveill SP - e19831 VL - 6 IS - 3 KW - COVID-19 KW - pandemic KW - mental health KW - digital interventions KW - technology KW - coronavirus KW - domestic violence KW - prevention KW - abuse KW - intimate partner violence UR - http://publichealth.jmir.org/2020/3/e19831/ UR - http://dx.doi.org/10.2196/19831 UR - http://www.ncbi.nlm.nih.gov/pubmed/32678797 ID - info:doi/10.2196/19831 ER - TY - JOUR AU - Ye, Jiancheng PY - 2020/7/28 TI - Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19 JO - JMIR Pediatr Parent SP - e19867 VL - 3 IS - 2 KW - pediatrics KW - mental health KW - stay-at-home orders KW - health technology KW - digital interventions KW - social distancing KW - COVID-19 UR - http://pediatrics.jmir.org/2020/2/e19867/ UR - http://dx.doi.org/10.2196/19867 UR - http://www.ncbi.nlm.nih.gov/pubmed/32634105 ID - info:doi/10.2196/19867 ER - TY - JOUR AU - Fortuna, L. Karen AU - Myers, L. Amanda AU - Walsh, Danielle AU - Walker, Robert AU - Mois, George AU - Brooks, M. Jessica PY - 2020/7/23 TI - Strategies to Increase Peer Support Specialists? Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study JO - JMIR Ment Health SP - e20429 VL - 7 IS - 7 KW - COVID-19 KW - peer support KW - telemental health KW - mental health KW - training N2 - Background: Prior to the outbreak of coronavirus disease (COVID-19), telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. For the first the time in history, peer support specialists are offering Medicaid-reimbursable telemental health services during the COVID-19 crisis; however, little effort has been made to train peer support specialists on telehealth practice and delivery. Objective: The aim of this study was to explore the impact of the Digital Peer Support Certification on peer support specialists? capacity to use digital peer support technology. Methods: The Digital Peer Support Certification was co-produced with peer support specialists and included an education and simulation training session, synchronous and asynchronous support services, and audit and feedback. Participants included 9 certified peer support specialists between the ages of 25 and 54 years (mean 39 years) who were employed as peer support specialists for 1 to 11 years (mean 4.25 years) and had access to a work-funded smartphone device and data plan. A pre-post design was implemented to examine the impact of the Digital Peer Support Certification on peer support specialists? capacity to use technology over a 3-month timeframe. Data were collected at baseline, 1 month, 2 months, and 3 months. Results: Overall, an upward trend in peer support specialists? capacity to offer digital peer support occurred during the 3-month certification period. Conclusions: The Digital Peer Support Certification shows promising evidence of increasing the capacity of peer support specialists to use specific digital peer support technology features. Our findings also highlighted that this capacity was less likely to increase with training alone and that a combinational knowledge translation approach that includes both training and management will be more successful. UR - http://mental.jmir.org/2020/7/e20429/ UR - http://dx.doi.org/10.2196/20429 UR - http://www.ncbi.nlm.nih.gov/pubmed/32629424 ID - info:doi/10.2196/20429 ER - TY - JOUR AU - Wu, Huailiang AU - Sun, Weiwei AU - Huang, Xinyu AU - Yu, Shinning AU - Wang, Hao AU - Bi, Xiaoyu AU - Sheng, Jie AU - Chen, Sihan AU - Akinwunmi, Babatunde AU - Zhang, P. Casper J. AU - Ming, Wai-Kit PY - 2020/7/22 TI - Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges JO - J Med Internet Res SP - e19916 VL - 22 IS - 7 KW - coronavirus disease KW - COVID-19 KW - SARS-CoV-2 KW - online prenatal education KW - pregnancy KW - online education KW - antenatal KW - telehealth KW - convenience KW - inequality UR - http://www.jmir.org/2020/7/e19916/ UR - http://dx.doi.org/10.2196/19916 UR - http://www.ncbi.nlm.nih.gov/pubmed/32658860 ID - info:doi/10.2196/19916 ER - TY - JOUR AU - Wong, H. Carlos K. AU - Wong, H. Janet Y. AU - Tang, M. Eric H. AU - Au, Ho Chi AU - Lau, K. Kristy T. AU - Wai, C. Abraham K. PY - 2020/7/22 TI - 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 JO - J Med Internet Res SP - e19904 VL - 22 IS - 7 KW - COVID-19 KW - national containment KW - lockdown KW - curfew KW - stay-at-home KW - epidemic curve N2 - 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. UR - http://www.jmir.org/2020/7/e19904/ UR - http://dx.doi.org/10.2196/19904 UR - http://www.ncbi.nlm.nih.gov/pubmed/32658858 ID - info:doi/10.2196/19904 ER - TY - JOUR AU - AlQutob, Raeda AU - Moonesar, Azaad Immanuel AU - Tarawneh, Rasoul Mohammad AU - Al Nsour, Mohannad AU - Khader, Yousef PY - 2020/7/21 TI - Public Health Strategies for the Gradual Lifting of the Public Sector Lockdown in Jordan and the United Arab Emirates During the COVID-19 Crisis JO - JMIR Public Health Surveill SP - e20478 VL - 6 IS - 3 KW - COVID-19 KW - health policies KW - lockdown KW - recovery KW - exit strategy KW - public sector KW - Jordan KW - United Arab Emirates UR - http://publichealth.jmir.org/2020/3/e20478/ UR - http://dx.doi.org/10.2196/20478 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589151 ID - info:doi/10.2196/20478 ER - TY - JOUR AU - Halalau, Alexandra AU - Ditkoff, Jeffrey AU - Hamilton, Jessica AU - Sharrak, Aryana AU - Vanood, Aimen AU - Abbas, Amr AU - Ziadeh, James PY - 2020/7/21 TI - Emergency Center Curbside Screening During the COVID-19 Pandemic: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e20040 VL - 6 IS - 3 KW - COVID-19 KW - emergency center KW - curbside testing KW - drive-through testing KW - pandemic KW - public health N2 - 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. UR - http://publichealth.jmir.org/2020/3/e20040/ UR - http://dx.doi.org/10.2196/20040 UR - http://www.ncbi.nlm.nih.gov/pubmed/32619184 ID - info:doi/10.2196/20040 ER - TY - JOUR AU - Chen, Xi AU - Zhang, X. Stephen AU - Jahanshahi, Afshar Asghar AU - Alvarez-Risco, Aldo AU - Dai, Huiyang AU - Li, Jizhen AU - Ibarra, García Verónica PY - 2020/7/21 TI - Belief in a COVID-19 Conspiracy Theory as a Predictor of Mental Health and Well-Being of Health Care Workers in Ecuador: Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e20737 VL - 6 IS - 3 KW - coronavirus KW - 2019-nCoV KW - mental health KW - psychiatric identification KW - Latin America KW - COVID-19 KW - conspiracy KW - well-being KW - health care worker KW - social media KW - prediction N2 - Background: During the coronavirus disease (COVID-19) pandemic, social media platforms have become active sites for the dissemination of conspiracy theories that provide alternative explanations of the cause of the pandemic, such as secret plots by powerful and malicious groups. However, the association of individuals? beliefs in conspiracy theories about COVID-19 with mental health and well-being issues has not been investigated. This association creates an assessable channel to identify and provide assistance to people with mental health and well-being issues during the pandemic. Objective: Our aim was to provide the first evidence that belief in conspiracy theories regarding the COVID-19 pandemic is a predictor of the mental health and well-being of health care workers. Methods: We conducted a survey of 252 health care workers in Ecuador from April 10 to May 2, 2020. We analyzed the data regarding distress and anxiety caseness with logistic regression and the data regarding life and job satisfaction with linear regression. Results: Among the 252 sampled health care workers in Ecuador, 61 (24.2%) believed that the virus was developed intentionally in a lab; 82 (32.5%) experienced psychological distress, and 71 (28.2%) had anxiety disorder. Compared to health care workers who were not sure where the virus originated, those who believed the virus was developed intentionally in a lab were more likely to report psychological distress and anxiety disorder and to have lower levels of job satisfaction and life satisfaction. Conclusions: This paper identifies belief in COVID-19 conspiracy theories as an important predictor of distress, anxiety, and job and life satisfaction among health care workers. This finding will enable mental health services to better target and provide help to mentally vulnerable health care workers during the ongoing COVID-19 pandemic. UR - http://publichealth.jmir.org/2020/3/e20737/ UR - http://dx.doi.org/10.2196/20737 UR - http://www.ncbi.nlm.nih.gov/pubmed/32658859 ID - info:doi/10.2196/20737 ER - TY - JOUR AU - He, Shuhan AU - Ojo, Ayotomiwa AU - Beckman, L. Adam AU - Gondi, Suhas AU - Ranney, Megan AU - Betz, Marian AU - Faust, S. Jeremy AU - Choo, Esther AU - Kass, Dara AU - Raja, S. Ali PY - 2020/7/20 TI - The Story of #GetMePPE and GetUsPPE.org to Mobilize Health Care Response to COVID-19 : Rapidly Deploying Digital Tools for Better Health Care JO - J Med Internet Res SP - e20469 VL - 22 IS - 7 KW - digital health KW - getusppe KW - getmeppe KW - COVID-19 KW - personal protective equipment KW - protection KW - Twitter KW - pandemic KW - health care worker UR - https://www.jmir.org/2020/7/e20469 UR - http://dx.doi.org/10.2196/20469 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530813 ID - info:doi/10.2196/20469 ER - TY - JOUR AU - Lin, Yulan AU - Hu, Zhijian AU - Alias, Haridah AU - Wong, Ping Li PY - 2020/7/20 TI - 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 JO - J Med Internet Res SP - e19982 VL - 22 IS - 7 KW - psychobehavioral KW - COVID-19 KW - mass media KW - social media KW - medical students KW - China N2 - 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. UR - https://www.jmir.org/2020/7/e19982 UR - http://dx.doi.org/10.2196/19982 UR - http://www.ncbi.nlm.nih.gov/pubmed/32584779 ID - info:doi/10.2196/19982 ER - TY - JOUR AU - Iancu, Magen Ariella AU - Kemp, Thomas Michael AU - Alam, Badre Hasan PY - 2020/7/20 TI - Unmuting Medical Students? Education: Utilizing Telemedicine During the COVID-19 Pandemic and Beyond JO - J Med Internet Res SP - e19667 VL - 22 IS - 7 KW - telemedicine KW - medical education KW - medical school KW - COVID-19 KW - education, medical, undergraduate KW - curriculum UR - http://www.jmir.org/2020/7/e19667/ UR - http://dx.doi.org/10.2196/19667 UR - http://www.ncbi.nlm.nih.gov/pubmed/32614776 ID - info:doi/10.2196/19667 ER - TY - JOUR AU - Echeverría, Patricia AU - Mas Bergas, Angel Miquel AU - Puig, Jordi AU - Isnard, Mar AU - Massot, Mireia AU - Vedia, Cristina AU - Peiró, Ricardo AU - Ordorica, Yolanda AU - Pablo, Sara AU - Ulldemolins, María AU - Iruela, Mercé AU - Balart, Dolors AU - Ruiz, María José AU - Herms, Jordi AU - Clotet Sala, Bonaventura AU - Negredo, Eugenia PY - 2020/7/17 TI - COVIDApp as an Innovative Strategy for the Management and Follow-Up of COVID-19 Cases in Long-Term Care Facilities in Catalonia: Implementation Study JO - JMIR Public Health Surveill SP - e21163 VL - 6 IS - 3 KW - COVID-19 KW - mobile health KW - app KW - COVIDApp KW - long-term care facilities KW - institutionalized individuals KW - mHealth KW - elderly KW - long-term KW - care KW - public health KW - management KW - surveillance N2 - Background: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. Objective: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. Methods: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase?polymerase chain reaction; absence of symptoms for ?14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. Results: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for ?14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). Conclusions: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies. UR - http://publichealth.jmir.org/2020/3/e21163/ UR - http://dx.doi.org/10.2196/21163 UR - http://www.ncbi.nlm.nih.gov/pubmed/32629425 ID - info:doi/10.2196/21163 ER - TY - JOUR AU - Husain, Iltifat AU - Briggs, Blake AU - Lefebvre, Cedric AU - Cline, M. David AU - Stopyra, P. Jason AU - O'Brien, Claire Mary AU - Vaithi, Ramupriya AU - Gilmore, Scott AU - Countryman, Chase PY - 2020/7/17 TI - Fluctuation of Public Interest in COVID-19 in the United States: Retrospective Analysis of Google Trends Search Data JO - JMIR Public Health Surveill SP - e19969 VL - 6 IS - 3 KW - Infodemiology KW - COVID-19 KW - SARS-CoV-2 KW - digital health KW - Google Trends KW - trend KW - internet KW - public health N2 - Background: In the absence of vaccines and established treatments, nonpharmaceutical interventions (NPIs) are fundamental tools to control coronavirus disease (COVID-19) transmission. NPIs require public interest to be successful. In the United States, there is a lack of published research on the factors that influence public interest in COVID-19. Using Google Trends, we examined the US level of public interest in COVID-19 and how it correlated to testing and with other countries. Objective: The aim of this study was to determine how public interest in COVID-19 in the United States changed over time and the key factors that drove this change, such as testing. US public interest in COVID-19 was compared to that in countries that have been more successful in their containment and mitigation strategies. Methods: In this retrospective study, Google Trends was used to analyze the volume of internet searches within the United States relating to COVID-19, focusing on dates between December 31, 2019, and March 24, 2020. The volume of internet searches related to COVID-19 was compared to that in other countries. Results: Throughout January and February 2020, there was limited search interest in COVID-19 within the United States. Interest declined for the first 21 days of February. A similar decline was seen in geographical regions that were later found to be experiencing undetected community transmission in February. Between March 9 and March 12, 2020, there was a rapid rise in search interest. This rise in search interest was positively correlated with the rise of positive tests for SARS-CoV-2 (6.3, 95% CI ?2.9 to 9.7; P<.001). Within the United States, it took 52 days for search interest to rise substantially after the first positive case; in countries with more successful outbreak control, search interest rose in less than 15 days. Conclusions: Containment and mitigation strategies require public interest to be successful. The initial level of COVID-19 public interest in the United States was limited and even decreased during a time when containment and mitigation strategies were being established. A lack of public interest in COVID-19 existed in the United States when containment and mitigation policies were in place. Based on our analysis, it is clear that US policy makers need to develop novel methods of communicating COVID-19 public health initiatives. UR - https://publichealth.jmir.org/2020/3/e19969 UR - http://dx.doi.org/10.2196/19969 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501806 ID - info:doi/10.2196/19969 ER - TY - JOUR AU - Remtulla, Ridhaa PY - 2020/7/17 TI - The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic JO - JMIR Med Educ SP - e20190 VL - 6 IS - 2 KW - medical education KW - technology KW - coronavirus KW - medical students KW - COVID-19 KW - pandemic KW - online lecture KW - virtual reality UR - http://mededu.jmir.org/2020/2/e20190/ UR - http://dx.doi.org/10.2196/20190 UR - http://www.ncbi.nlm.nih.gov/pubmed/32634107 ID - info:doi/10.2196/20190 ER - TY - JOUR AU - Rajan, Anjana AU - Sharaf, Ravi AU - Brown, S. Robert AU - Sharaiha, Z. Reem AU - Lebwohl, Benjamin AU - Mahadev, SriHari PY - 2020/7/17 TI - Association of Search Query Interest in Gastrointestinal Symptoms With COVID-19 Diagnosis in the United States: Infodemiology Study JO - JMIR Public Health Surveill SP - e19354 VL - 6 IS - 3 KW - COVID-19 KW - diarrhea KW - internet search queries KW - Google Trends KW - gastrointestinal KW - symptom KW - health information KW - pandemic KW - infectious disease KW - virus N2 - Background: Coronavirus disease (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to one-third of confirmed cases, and patients may have mild symptoms that do not prompt them to seek medical attention. Internet-based infodemiology offers an approach to studying symptoms at a population level, even in individuals who do not seek medical care. Objective: This study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and the confirmed case count of COVID-19 in the United States. Methods: The search terms chosen for analysis in this study included common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, the search terms fever and cough were used as positive controls, and constipation was used as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all US states. These shares were divided into two time periods: pre?COVID-19 (prior to March 1) and post?COVID-19 (March 1-June 15). Confirmed COVID-19 case numbers were obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre?COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship. Results: The relative search query shares of many symptoms, including nausea, vomiting, abdominal pain, and constipation, remained near or below baseline throughout the time period studied; however, there were notable increases in searches for the positive control symptoms of fever and cough as well as for diarrhea. These increases in daily search queries for fever, cough, and diarrhea preceded the rapid rise in number of cases by approximately 10 to 14 days. The search volumes for these terms began declining after mid-March despite the continued rises in cumulative cases and daily new case counts. Conclusions: Google searches for symptoms may precede the actual rises in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increased prior to the increased confirmed case count by available testing during the early weeks of the pandemic in the United States. While the search volumes eventually decreased significantly as the number of cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks. UR - http://publichealth.jmir.org/2020/3/e19354/ UR - http://dx.doi.org/10.2196/19354 UR - http://www.ncbi.nlm.nih.gov/pubmed/32640418 ID - info:doi/10.2196/19354 ER - TY - JOUR AU - Bashir, Ayisha PY - 2020/7/17 TI - Stroke and Telerehabilitation: A Brief Communication JO - JMIR Rehabil Assist Technol SP - e18919 VL - 7 IS - 2 KW - telerehabilitation KW - rehabilitation KW - nursing KW - stroke KW - telehealth UR - https://rehab.jmir.org/2020/2/e18919 UR - http://dx.doi.org/10.2196/18919 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706739 ID - info:doi/10.2196/18919 ER - TY - JOUR AU - Sesagiri Raamkumar, Aravind AU - Tan, Guan Soon AU - Wee, Lin Hwee PY - 2020/7/14 TI - Use of Health Belief Model?Based Deep Learning Classifiers for COVID-19 Social Media Content to Examine Public Perceptions of Physical Distancing: Model Development and Case Study JO - JMIR Public Health Surveill SP - e20493 VL - 6 IS - 3 KW - health belief model KW - physical distancing KW - COVID-19 KW - text classification KW - deep learning KW - recurrent neural network KW - social media N2 - Background: Public health authorities have been recommending interventions such as physical distancing and face masks, to curtail the transmission of coronavirus disease (COVID-19) within the community. Public perceptions toward such interventions should be identified to enable public health authorities to effectively address valid concerns. The Health Belief Model (HBM) has been used to characterize user-generated content from social media during previous outbreaks, with the aim of understanding the health behaviors of the public. Objective: This study is aimed at developing and evaluating deep learning?based text classification models for classifying social media content posted during the COVID-19 outbreak, using the four key constructs of the HBM. We will specifically focus on content related to the physical distancing interventions put forth by public health authorities. We intend to test the model with a real-world case study. Methods: The data set for this study was prepared by analyzing Facebook comments that were posted by the public in response to the COVID-19?related posts of three public health authorities: the Ministry of Health of Singapore (MOH), the Centers for Disease Control and Prevention, and Public Health England. The comments made in the context of physical distancing were manually classified with a Yes/No flag for each of the four HBM constructs: perceived severity, perceived susceptibility, perceived barriers, and perceived benefits. Using a curated data set of 16,752 comments, gated recurrent unit?based recurrent neural network models were trained and validated for text classification. Accuracy and binary cross-entropy loss were used to evaluate the model. Specificity, sensitivity, and balanced accuracy were used to evaluate the classification results in the MOH case study. Results: The HBM text classification models achieved mean accuracy rates of 0.92, 0.95, 0.91, and 0.94 for the constructs of perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, respectively. In the case study with MOH Facebook comments, specificity was above 96% for all HBM constructs. Sensitivity was 94.3% and 90.9% for perceived severity and perceived benefits, respectively. In addition, sensitivity was 79.6% and 81.5% for perceived susceptibility and perceived barriers, respectively. The classification models were able to accurately predict trends in the prevalence of the constructs for the time period examined in the case study. Conclusions: The deep learning?based text classifiers developed in this study help to determine public perceptions toward physical distancing, using the four key constructs of HBM. Health officials can make use of the classification model to characterize the health behaviors of the public through the lens of social media. In future studies, we intend to extend the model to study public perceptions of other important interventions by public health authorities. UR - https://publichealth.jmir.org/2020/3/e20493 UR - http://dx.doi.org/10.2196/20493 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540840 ID - info:doi/10.2196/20493 ER - TY - JOUR AU - Ye, Jiancheng PY - 2020/7/14 TI - The Role of Health Technology and Informatics in a Global Public Health Emergency: Practices and Implications From the COVID-19 Pandemic JO - JMIR Med Inform SP - e19866 VL - 8 IS - 7 KW - health technology KW - health information system KW - COVID-19 KW - artificial intelligence KW - telemedicine KW - big data KW - privacy UR - http://medinform.jmir.org/2020/7/e19866/ UR - http://dx.doi.org/10.2196/19866 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568725 ID - info:doi/10.2196/19866 ER - TY - JOUR AU - Jones, Jeb AU - Sullivan, S. Patrick AU - Sanchez, H. Travis AU - Guest, L. Jodie AU - Hall, W. Eric AU - Luisi, Nicole AU - Zlotorzynska, Maria AU - Wilde, Gretchen AU - Bradley, Heather AU - Siegler, J. Aaron PY - 2020/7/10 TI - Similarities and Differences in COVID-19 Awareness, Concern, and Symptoms by Race and Ethnicity in the United States: Cross-Sectional Survey JO - J Med Internet Res SP - e20001 VL - 22 IS - 7 KW - COVID-19 KW - SARS-CoV-2 KW - race KW - ethnicity KW - awareness KW - concern KW - symptom KW - cross-sectional KW - knowledge KW - health disparity KW - inequality N2 - 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. UR - http://www.jmir.org/2020/7/e20001/ UR - http://dx.doi.org/10.2196/20001 UR - http://www.ncbi.nlm.nih.gov/pubmed/32614778 ID - info:doi/10.2196/20001 ER - TY - JOUR AU - Yin, Guosheng AU - Zhang, Chenyang AU - Jin, Huaqing PY - 2020/7/10 TI - Statistical Issues and Lessons Learned From COVID-19 Clinical Trials With Lopinavir-Ritonavir and Remdesivir JO - JMIR Public Health Surveill SP - e19538 VL - 6 IS - 3 KW - coronavirus KW - COVID-19 KW - cure rate model KW - sample size adjustment KW - terminal event KW - type I error rate KW - restricted mean survival time N2 - Background: Recently, three randomized clinical trials on coronavirus disease (COVID-19) treatments were completed: one for lopinavir-ritonavir and two for remdesivir. One trial reported that remdesivir was superior to placebo in shortening the time to recovery, while the other two showed no benefit of the treatment under investigation. Objective: The aim of this paper is to, from a statistical perspective, identify several key issues in the design and analysis of three COVID-19 trials and reanalyze the data from the cumulative incidence curves in the three trials using more appropriate statistical methods. Methods: The lopinavir-ritonavir trial enrolled 39 additional patients due to insignificant results after the sample size reached the planned number, which led to inflation of the type I error rate. The remdesivir trial of Wang et al failed to reach the planned sample size due to a lack of eligible patients, and the bootstrap method was used to predict the quantity of clinical interest conditionally and unconditionally if the trial had continued to reach the originally planned sample size. Moreover, we used a terminal (or cure) rate model and a model-free metric known as the restricted mean survival time or the restricted mean time to improvement (RMTI) to analyze the reconstructed data. The remdesivir trial of Beigel et al reported the median recovery time of the remdesivir and placebo groups, and the rate ratio for recovery, while both quantities depend on a particular time point representing local information. We use the restricted mean time to recovery (RMTR) as a global and robust measure for efficacy. Results: For the lopinavir-ritonavir trial, with the increase of sample size from 160 to 199, the type I error rate was inflated from 0.05 to 0.071. The difference of RMTIs between the two groups evaluated at day 28 was ?1.67 days (95% CI ?3.62 to 0.28; P=.09) in favor of lopinavir-ritonavir but not statistically significant. For the remdesivir trial of Wang et al, the difference of RMTIs at day 28 was ?0.89 days (95% CI ?2.84 to 1.06; P=.37). The planned sample size was 453, yet only 236 patients were enrolled. The conditional prediction shows that the hazard ratio estimates would reach statistical significance if the target sample size had been maintained. For the remdesivir trial of Beigel et al, the difference of RMTRs between the remdesivir and placebo groups at day 30 was ?2.7 days (95% CI ?4.0 to ?1.2; P<.001), confirming the superiority of remdesivir. The difference in the recovery time at the 25th percentile (95% CI ?3 to 0; P=.65) was insignificant, while the differences became more statistically significant at larger percentiles. Conclusions: Based on the statistical issues and lessons learned from the recent three clinical trials on COVID-19 treatments, we suggest more appropriate approaches for the design and analysis of ongoing and future COVID-19 trials. UR - https://publichealth.jmir.org/2020/3/e19538 UR - http://dx.doi.org/10.2196/19538 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589146 ID - info:doi/10.2196/19538 ER - TY - JOUR AU - Alqutob, Raeda AU - Al Nsour, Mohannad AU - Tarawneh, Rasoul Mohammed AU - Ajlouni, Musa AU - Khader, Yousef AU - Aqel, Ibrahim AU - Kharabsheh, Saad AU - Obeidat, Nathir PY - 2020/7/7 TI - COVID-19 Crisis in Jordan: Response, Scenarios, Strategies, and Recommendations JO - JMIR Public Health Surveill SP - e19332 VL - 6 IS - 3 KW - infection KW - prevention KW - public health KW - pandemic KW - Jordan KW - virus KW - COVID-19 UR - https://publichealth.jmir.org/2020/3/e19332 UR - http://dx.doi.org/10.2196/19332 UR - http://www.ncbi.nlm.nih.gov/pubmed/32407289 ID - info:doi/10.2196/19332 ER - TY - JOUR AU - Lonergan, E. Peter AU - Washington III, L. Samuel AU - Branagan, Linda AU - Gleason, Nathaniel AU - Pruthi, S. Raj AU - Carroll, R. Peter AU - Odisho, Y. Anobel PY - 2020/7/6 TI - Rapid Utilization of Telehealth in a Comprehensive Cancer Center as a Response to COVID-19: Cross-Sectional Analysis JO - J Med Internet Res SP - e19322 VL - 22 IS - 7 KW - health informatics KW - telehealth KW - video visits KW - COVID-19 KW - video consultation KW - pandemic KW - electronic health record KW - EHR N2 - 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. UR - https://www.jmir.org/2020/7/e19322 UR - http://dx.doi.org/10.2196/19322 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568721 ID - info:doi/10.2196/19322 ER - TY - JOUR AU - Campos-Castillo, Celeste AU - Laestadius, I. Linnea PY - 2020/7/3 TI - Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis JO - J Med Internet Res SP - e20472 VL - 22 IS - 7 KW - COVID-19 KW - digital divides KW - user characteristics KW - race KW - ethnicity KW - algorithm bias KW - social media KW - bias KW - surveillance KW - public health N2 - Background: Public health surveillance experts are leveraging user-generated content on social media to track the spread and effects of COVID-19. However, racial and ethnic digital divides, which are disparities among people who have internet access and post on social media, can bias inferences. This bias is particularly problematic in the context of the COVID-19 pandemic because due to structural inequalities, members of racial and ethnic minority groups are disproportionately vulnerable to contracting the virus and to the deleterious economic and social effects from mitigation efforts. Further, important demographic intersections with race and ethnicity, such as gender and age, are rarely investigated in work characterizing social media users; however, they reflect additional axes of inequality shaping differential exposure to COVID-19 and its effects. Objective: The aim of this study was to characterize how the race and ethnicity of US adults are associated with their odds of posting COVID-19 content on social media and how gender and age modify these odds. Methods: We performed a secondary analysis of a survey conducted by the Pew Research Center from March 19 to 24, 2020, using a national probability sample (N=10,510). Respondents were recruited from an online panel, where panelists without an internet-enabled device were given one to keep at no cost. The binary dependent variable was responses to an item asking whether respondents ?used social media to share or post information about the coronavirus.? We used survey-weighted logistic regressions to estimate the odds of responding in the affirmative based on the race and ethnicity of respondents (white, black, Latino, other race/ethnicity), adjusted for covariates measuring sociodemographic background and COVID-19 experiences. We examined how gender (female, male) and age (18 to 30 years, 31 to 50 years, 51 to 64 years, and 65 years and older) intersected with race and ethnicity by estimating interactions. Results: Respondents who identified as black (odds ratio [OR] 1.29, 95% CI 1.02-1.64; P=.03), Latino (OR 1.66, 95% CI 1.36-2.04; P<.001), or other races/ethnicities (OR 1.33, 95% CI 1.02-1.72; P=.03) had higher odds than respondents who identified as white of reporting that they posted COVID-19 content on social media. Women had higher odds of posting than men regardless of race and ethnicity (OR 1.58, 95% CI 1.39-1.80; P<.001). Among men, respondents who identified as black, Latino, or members of other races/ethnicities were significantly more likely to post than respondents who identified as white. Older adults (65 years or older) had significantly lower odds (OR 0.73, 95% CI 0.57-0.94; P=.01) of posting compared to younger adults (18-29 years), particularly among those identifying as other races/ethnicities. Latino respondents were the most likely to report posting across all age groups. Conclusions: In the United States, members of racial and ethnic minority groups are most likely to contribute to COVID-19 content on social media, particularly among groups traditionally less likely to use social media (older adults and men). The next step is to ensure that data collection procedures capture this diversity by encompassing a breadth of search criteria and social media platforms. UR - https://www.jmir.org/2020/7/e20472 UR - http://dx.doi.org/10.2196/20472 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568726 ID - info:doi/10.2196/20472 ER - TY - JOUR AU - Liu, Luwen AU - Gu, Jianqin AU - Shao, Fengmin AU - Liang, Xinliang AU - Yue, Lixia AU - Cheng, Qiaomei AU - Zhang, Lianzhong PY - 2020/7/3 TI - Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study JO - JMIR Mhealth Uhealth SP - e19417 VL - 8 IS - 7 KW - coronavirus disease KW - COVID-19 KW - remote diagnosis and treatment KW - telemedicine KW - online outpatient visit KW - offline drug delivery KW - pandemic management KW - China KW - Henan Province N2 - 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. UR - https://mhealth.jmir.org/2020/7/e19417 UR - http://dx.doi.org/10.2196/19417 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568722 ID - info:doi/10.2196/19417 ER - TY - JOUR AU - Zhan, Choujun AU - Tse, Kong Chi AU - Lai, Zhikang AU - Chen, Xiaoyun AU - Mo, Mingshen PY - 2020/7/3 TI - 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 JO - JMIR Public Health Surveill SP - e18880 VL - 6 IS - 3 KW - pandemic spreading KW - SEICR model KW - COVID-19 KW - prediction KW - effect of intervention N2 - 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. UR - https://publichealth.jmir.org/2020/3/e18880 UR - http://dx.doi.org/10.2196/18880 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589145 ID - info:doi/10.2196/18880 ER - TY - JOUR AU - de Lusignan, Simon AU - Jones, Nicholas AU - Dorward, Jienchi AU - Byford, Rachel AU - Liyanage, Harshana AU - Briggs, John AU - Ferreira, Filipa AU - Akinyemi, Oluwafunmi AU - Amirthalingam, Gayatri AU - Bates, Chris AU - Lopez Bernal, Jamie AU - Dabrera, Gavin AU - Eavis, Alex AU - Elliot, J. Alex AU - Feher, Michael AU - Krajenbrink, Else AU - Hoang, Uy AU - Howsam, Gary AU - Leach, Jonathan AU - Okusi, Cecilia AU - Nicholson, Brian AU - Nieri, Philip AU - Sherlock, Julian AU - Smith, Gillian AU - Thomas, Mark AU - Thomas, Nicholas AU - Tripathy, Manasa AU - Victor, William AU - Williams, John AU - Wood, Ian AU - Zambon, Maria AU - Parry, John AU - O?Hanlon, Shaun AU - Joy, Mark AU - Butler, Chris AU - Marshall, Martin AU - Hobbs, Richard F. D. PY - 2020/7/2 TI - The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms JO - JMIR Public Health Surveill SP - e19773 VL - 6 IS - 3 KW - primary health care KW - general practice KW - medical record systems, computerized KW - sentinel surveillance KW - public health surveillance KW - clinical trials as a topic KW - adaptive clinical trials KW - severe acute respiratory syndrome coronavirus 2 KW - COVID-19 N2 - 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 UR - https://publichealth.jmir.org/2020/3/e19773 UR - http://dx.doi.org/10.2196/19773 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484782 ID - info:doi/10.2196/19773 ER - TY - JOUR AU - Xu, Hui AU - Huang, Sufang AU - Qiu, Chun AU - Liu, Shangkun AU - Deng, Juan AU - Jiao, Bo AU - Tan, Xi AU - Ai, Ling AU - Xiao, Yaru AU - Belliato, Mirko AU - Yan, Li PY - 2020/7/2 TI - Monitoring and Management of Home-Quarantined Patients With COVID-19 Using a WeChat-Based Telemedicine System: Retrospective Cohort Study JO - J Med Internet Res SP - e19514 VL - 22 IS - 7 KW - telemedicine system KW - home quarantine KW - quarantine management assessment KW - progressive COVID-19 patients KW - COVID-19 N2 - 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. UR - https://www.jmir.org/2020/7/e19514 UR - http://dx.doi.org/10.2196/19514 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568727 ID - info:doi/10.2196/19514 ER - TY - JOUR AU - Xu, Chenjie AU - Zhang, Xinyu AU - Wang, Yaogang PY - 2020/7/2 TI - Mapping of Health Literacy and Social Panic Via Web Search Data During the COVID-19 Public Health Emergency: Infodemiological Study JO - J Med Internet Res SP - e18831 VL - 22 IS - 7 KW - COVID-19 KW - China KW - Baidu KW - infodemiology KW - web search KW - internet KW - public health KW - emergency KW - outbreak KW - infectious disease KW - pandemic KW - health literacy N2 - 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. UR - https://www.jmir.org/2020/7/e18831 UR - http://dx.doi.org/10.2196/18831 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540844 ID - info:doi/10.2196/18831 ER - TY - JOUR AU - Li, Jitian AU - Chen, Zhe AU - Nie, Yifei AU - Ma, Yan AU - Guo, Qiaoyun AU - Dai, Xiaofeng PY - 2020/6/30 TI - Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province JO - J Med Internet Res SP - e19636 VL - 22 IS - 6 KW - prognostic symptoms KW - COVID-19 KW - severity KW - CVD KW - Henan Province N2 - 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. UR - https://www.jmir.org/2020/6/e19636 UR - http://dx.doi.org/10.2196/19636 UR - http://www.ncbi.nlm.nih.gov/pubmed/32544071 ID - info:doi/10.2196/19636 ER - TY - JOUR AU - Liu, Ying AU - Wang, Zhixiao AU - Ren, Jingjing AU - Tian, Yu AU - Zhou, Min AU - Zhou, Tianshu AU - Ye, Kangli AU - Zhao, Yinghao AU - Qiu, Yunqing AU - Li, Jingsong PY - 2020/6/29 TI - A COVID-19 Risk Assessment Decision Support System for General Practitioners: Design and Development Study JO - J Med Internet Res SP - e19786 VL - 22 IS - 6 KW - COVID-19 KW - dynamic risk stratification KW - decision support system KW - telemedicine triage system KW - multiclass logistic regression N2 - Background: The coronavirus disease (COVID-19) has become an urgent and serious global public health crisis. Community engagement is the first line of defense in the fight against infectious diseases, and general practitioners (GPs) play an important role in it. GPs are facing unique challenges from disasters and pandemics in delivering health care. However, there is still no suitable mobile management system that can help GPs collect data, dynamically assess risks, and effectively triage or follow-up with patients with COVID-19. Objective: The aim of this study is to design, develop, and deploy a mobile-based decision support system for COVID-19 (DDC19) to assist GPs in collecting data, assessing risk, triaging, managing, and following up with patients during the COVID-19 outbreak. Methods: Based on the actual scenarios and the process of patients using health care, we analyzed the key issues that need to be solved and designed the main business flowchart of DDC19. We then constructed a COVID-19 dynamic risk stratification model with high recall and clinical interpretability, which was based on a multiclass logistic regression algorithm. Finally, through a 10-fold cross-validation to quantitatively evaluate the risk stratification ability of the model, a total of 2243 clinical data consisting of 36 dimension clinical features from fever clinics were used for training and evaluation of the model. Results: DDC19 is composed of three parts: mobile terminal apps for the patient-end and GP-end, and the database system. All mobile terminal devices were wirelessly connected to the back end data center to implement request sending and data transmission. We used low risk, moderate risk, and high risk as labels, and adopted a 10-fold cross-validation method to evaluate and test the COVID-19 dynamic risk stratification model in different scenarios (different dimensions of personal clinical data accessible at an earlier stage). The data set dimensions were (2243, 15) when only using the data of patients? demographic information, clinical symptoms, and contact history; (2243, 35) when the results of blood tests were added; and (2243, 36) after obtaining the computed tomography imaging results of the patient. The average value of the three classification results of the macro?area under the curve were all above 0.71 in each scenario. Conclusions: DCC19 is a mobile decision support system designed and developed to assist GPs in providing dynamic risk assessments for patients with suspected COVID-19 during the outbreak, and the model had a good ability to predict risk levels in any scenario it covered. UR - http://www.jmir.org/2020/6/e19786/ UR - http://dx.doi.org/10.2196/19786 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540845 ID - info:doi/10.2196/19786 ER - TY - JOUR AU - Ko, Hoon AU - Chung, Heewon AU - Kang, Seong Wu AU - Kim, Won Kyung AU - Shin, Youngbin AU - Kang, Ji Seung AU - Lee, Hoon Jae AU - Kim, Jun Young AU - Kim, Yeol Nan AU - Jung, Hyunseok AU - Lee, Jinseok PY - 2020/6/29 TI - COVID-19 Pneumonia Diagnosis Using a Simple 2D Deep Learning Framework With a Single Chest CT Image: Model Development and Validation JO - J Med Internet Res SP - e19569 VL - 22 IS - 6 KW - COVID-19 KW - deep learning KW - convolutional neural networks, transfer learning KW - chest CT KW - CT KW - neural network KW - pneumonia KW - artificial intelligence KW - diagnosis KW - scan N2 - Background: Coronavirus disease (COVID-19) has spread explosively worldwide since the beginning of 2020. According to a multinational consensus statement from the Fleischner Society, computed tomography (CT) is a relevant screening tool due to its higher sensitivity for detecting early pneumonic changes. However, physicians are extremely occupied fighting COVID-19 in this era of worldwide crisis. Thus, it is crucial to accelerate the development of an artificial intelligence (AI) diagnostic tool to support physicians. Objective: We aimed to rapidly develop an AI technique to diagnose COVID-19 pneumonia in CT images and differentiate it from non?COVID-19 pneumonia and nonpneumonia diseases. Methods: A simple 2D deep learning framework, named the fast-track COVID-19 classification network (FCONet), was developed to diagnose COVID-19 pneumonia based on a single chest CT image. FCONet was developed by transfer learning using one of four state-of-the-art pretrained deep learning models (VGG16, ResNet-50, Inception-v3, or Xception) as a backbone. For training and testing of FCONet, we collected 3993 chest CT images of patients with COVID-19 pneumonia, other pneumonia, and nonpneumonia diseases from Wonkwang University Hospital, Chonnam National University Hospital, and the Italian Society of Medical and Interventional Radiology public database. These CT images were split into a training set and a testing set at a ratio of 8:2. For the testing data set, the diagnostic performance of the four pretrained FCONet models to diagnose COVID-19 pneumonia was compared. In addition, we tested the FCONet models on an external testing data set extracted from embedded low-quality chest CT images of COVID-19 pneumonia in recently published papers. Results: Among the four pretrained models of FCONet, ResNet-50 showed excellent diagnostic performance (sensitivity 99.58%, specificity 100.00%, and accuracy 99.87%) and outperformed the other three pretrained models in the testing data set. In the additional external testing data set using low-quality CT images, the detection accuracy of the ResNet-50 model was the highest (96.97%), followed by Xception, Inception-v3, and VGG16 (90.71%, 89.38%, and 87.12%, respectively). Conclusions: FCONet, a simple 2D deep learning framework based on a single chest CT image, provides excellent diagnostic performance in detecting COVID-19 pneumonia. Based on our testing data set, the FCONet model based on ResNet-50 appears to be the best model, as it outperformed other FCONet models based on VGG16, Xception, and Inception-v3. UR - http://www.jmir.org/2020/6/e19569/ UR - http://dx.doi.org/10.2196/19569 UR - http://www.ncbi.nlm.nih.gov/pubmed/32568730 ID - info:doi/10.2196/19569 ER - TY - JOUR AU - Eysenbach, Gunther PY - 2020/6/29 TI - How to Fight an Infodemic: The Four Pillars of Infodemic Management JO - J Med Internet Res SP - e21820 VL - 22 IS - 6 KW - infodemiology KW - infodemic KW - COVID-19 KW - infoveillance KW - pandemic KW - epidemics KW - emergency management KW - public health UR - http://www.jmir.org/2020/6/e21820/ UR - http://dx.doi.org/10.2196/21820 UR - http://www.ncbi.nlm.nih.gov/pubmed/32589589 ID - info:doi/10.2196/21820 ER - TY - JOUR AU - Tangcharoensathien, Viroj AU - Calleja, Neville AU - Nguyen, Tim AU - Purnat, Tina AU - D?Agostino, Marcelo AU - Garcia-Saiso, Sebastian AU - Landry, Mark AU - Rashidian, Arash AU - Hamilton, Clayton AU - AbdAllah, Abdelhalim AU - Ghiga, Ioana AU - Hill, Alexandra AU - Hougendobler, Daniel AU - van Andel, Judith AU - Nunn, Mark AU - Brooks, Ian AU - Sacco, Luigi Pier AU - De Domenico, Manlio AU - Mai, Philip AU - Gruzd, Anatoliy AU - Alaphilippe, Alexandre AU - Briand, Sylvie PY - 2020/6/26 TI - Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation JO - J Med Internet Res SP - e19659 VL - 22 IS - 6 KW - COVID-19 KW - infodemic KW - knowledge translation KW - message amplification KW - misinformation KW - information-seeking behavior KW - access to information KW - information literacy KW - communications media KW - internet KW - risk communication KW - evidence synthesis N2 - 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. UR - http://www.jmir.org/2020/6/e19659/ UR - http://dx.doi.org/10.2196/19659 UR - http://www.ncbi.nlm.nih.gov/pubmed/32558655 ID - info:doi/10.2196/19659 ER - TY - JOUR AU - Badawy, M. Sherif AU - Radovic, Ana PY - 2020/6/25 TI - Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research JO - JMIR Pediatr Parent SP - e20049 VL - 3 IS - 1 KW - coronavirus KW - COVID-19 KW - SARS-CoV-2 KW - pandemic KW - outbreak KW - public health KW - pediatric KW - children KW - adolescents KW - telehealth KW - telemedicine KW - digital KW - interventions KW - digital health KW - digital medicine KW - mobile health KW - mHealth KW - eHealth KW - health care delivery UR - http://pediatrics.jmir.org/2020/1/e20049/ UR - http://dx.doi.org/10.2196/20049 UR - http://www.ncbi.nlm.nih.gov/pubmed/32540841 ID - info:doi/10.2196/20049 ER - TY - JOUR AU - Vandekerckhove, Pieter AU - Vandekerckhove, Yves AU - Tavernier, Rene AU - De Jaegher, Kelly AU - de Mul, Marleen PY - 2020/6/25 TI - Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights JO - J Med Internet Res SP - e19771 VL - 22 IS - 6 KW - telemedicine KW - design thinking KW - cardiology KW - patient KW - COVID-19 KW - user experience UR - http://www.jmir.org/2020/6/e19771/ UR - http://dx.doi.org/10.2196/19771 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519964 ID - info:doi/10.2196/19771 ER - TY - JOUR AU - Guest, L. Jodie AU - Sullivan, S. Patrick AU - Valentine-Graves, Mariah AU - Valencia, Rachel AU - Adam, Elizabeth AU - Luisi, Nicole AU - Nakano, Mariko AU - Guarner, Jeannette AU - del Rio, Carlos AU - Sailey, Charles AU - Goedecke, Zoe AU - Siegler, J. Aaron AU - Sanchez, H. Travis PY - 2020/6/25 TI - Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study JO - JMIR Public Health Surveill SP - e19731 VL - 6 IS - 2 KW - COVID-19 KW - testing KW - home testing KW - telehealth KW - pilot study KW - diagnostic KW - diagnosis N2 - 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 UR - http://publichealth.jmir.org/2020/2/e19731/ UR - http://dx.doi.org/10.2196/19731 UR - http://www.ncbi.nlm.nih.gov/pubmed/32479412 ID - info:doi/10.2196/19731 ER - TY - JOUR AU - Olayiwola, Nwando J. AU - Magaña, Candy AU - Harmon, Ashley AU - Nair, Shalina AU - Esposito, Erica AU - Harsh, Christine AU - Forrest, Arick L. AU - Wexler, Randy PY - 2020/6/25 TI - Telehealth as a Bright Spot of the COVID-19 Pandemic: Recommendations From the Virtual Frontlines ("Frontweb") JO - JMIR Public Health Surveill SP - e19045 VL - 6 IS - 2 KW - telehealth KW - telemedicine KW - primary care KW - COVID-19 KW - pandemic KW - outbreak KW - public health KW - infectious disease UR - http://publichealth.jmir.org/2020/2/e19045/ UR - http://dx.doi.org/10.2196/19045 UR - http://www.ncbi.nlm.nih.gov/pubmed/32479413 ID - info:doi/10.2196/19045 ER - TY - JOUR AU - Tashkandi, Emad AU - Zeeneldin, Ahmed AU - AlAbdulwahab, Amal AU - Elemam, Omima AU - Elsamany, Shereef AU - Jastaniah, Wasil AU - Abdullah, Shaker AU - Alfayez, Mohammad AU - Jazieh, Rahman Abdul AU - Al-Shamsi, O. Humaid PY - 2020/6/24 TI - Virtual Management of Patients With Cancer During the COVID-19 Pandemic: Web-Based Questionnaire Study JO - J Med Internet Res SP - e19691 VL - 22 IS - 6 KW - teleoncology KW - telemedicine KW - eHealth KW - cancer KW - COVID-19 KW - public health N2 - 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. UR - http://www.jmir.org/2020/6/e19691/ UR - http://dx.doi.org/10.2196/19691 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501807 ID - info:doi/10.2196/19691 ER - TY - JOUR AU - Lin, Chien-Hao AU - Tseng, Wen-Pin AU - Wu, Jhong-Lin AU - Tay, Joyce AU - Cheng, Ming-Tai AU - Ong, Hooi-Nee AU - Lin, Hao-Yang AU - Chen, Yi-Ying AU - Wu, Chih-Hsien AU - Chen, Jiun-Wei AU - Chen, Shey-Ying AU - Chan, Chang-Chuan AU - Huang, Chien-Hua AU - Chen, Shyr-Chyr PY - 2020/6/23 TI - A Double Triage and Telemedicine Protocol to Optimize Infection Control in an Emergency Department in Taiwan During the COVID-19 Pandemic: Retrospective Feasibility Study JO - J Med Internet Res SP - e20586 VL - 22 IS - 6 KW - COVID-19 KW - triage KW - emergency department KW - health care workers KW - infection control KW - telemedicine N2 - 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. UR - http://www.jmir.org/2020/6/e20586/ UR - http://dx.doi.org/10.2196/20586 UR - http://www.ncbi.nlm.nih.gov/pubmed/32544072 ID - info:doi/10.2196/20586 ER - TY - JOUR AU - de Leeuw, Adrianus Robert AU - Burger, Birgit Nicole AU - Ceccaroni, Marcello AU - Zhang, Jian AU - Tuynman, Jurriaan AU - Mabrouk, Mohamed AU - Barri Soldevila, Pere AU - Bonjer, Jaap Hendrik AU - Ankum, Pim AU - Huirne, Judith PY - 2020/6/23 TI - COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise JO - JMIR Public Health Surveill SP - e18928 VL - 6 IS - 2 KW - laparoscopy KW - COVID-19 KW - surgical procedures, operative KW - corona 2019 KW - surgery KW - pandemic KW - outbreak KW - infectious disease KW - health care provider KW - physician N2 - Background: The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. Objective: We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. Methods: We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. Results: The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. Conclusions: There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO2 deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment. UR - http://publichealth.jmir.org/2020/2/e18928/ UR - http://dx.doi.org/10.2196/18928 UR - http://www.ncbi.nlm.nih.gov/pubmed/32406853 ID - info:doi/10.2196/18928 ER - TY - JOUR AU - Cheng, Weibin AU - Hao, Chun PY - 2020/6/22 TI - Case-Initiated COVID-19 Contact Tracing Using Anonymous Notifications JO - JMIR Mhealth Uhealth SP - e20369 VL - 8 IS - 6 KW - COVID-19 KW - surveillance KW - contact tracing KW - digital contact tracing KW - notification KW - anonymous KW - labor-saving KW - stigma KW - privacy protection UR - http://mhealth.jmir.org/2020/6/e20369/ UR - http://dx.doi.org/10.2196/20369 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501802 ID - info:doi/10.2196/20369 ER - TY - JOUR AU - Agyapong, Opoku Vincent Israel AU - Hrabok, Marianne AU - Vuong, Wesley AU - Gusnowski, April AU - Shalaby, Reham AU - Mrklas, Kelly AU - Li, Daniel AU - Urichuk, Liana AU - Snaterse, Mark AU - Surood, Shireen AU - Cao, Bo AU - Li, Xin-Min AU - Greiner, Russ AU - Greenshaw, James Andrew PY - 2020/6/22 TI - Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation JO - JMIR Res Protoc SP - e19292 VL - 9 IS - 6 KW - COVID-19 KW - Text4Hope KW - mobile phones KW - text KW - anxiety KW - depression KW - stress KW - pandemic KW - e-mental health N2 - 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 UR - http://www.researchprotocols.org/2020/6/e19292/ UR - http://dx.doi.org/10.2196/19292 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501805 ID - info:doi/10.2196/19292 ER - TY - JOUR AU - Olum, Ronald AU - Kajjimu, Jonathan AU - Kanyike, Marvin Andrew AU - Chekwech, Gaudencia AU - Wekha, Godfrey AU - Nassozi, Rhoda Dianah AU - Kemigisa, Juliet AU - Mulyamboga, Paul AU - Muhoozi, Kabagambe Oscar AU - Nsenga, Lauryn AU - Lyavala, Musilim AU - Asiimwe, Asaph AU - Bongomin, Felix PY - 2020/6/19 TI - Perspective of Medical Students on the COVID-19 Pandemic: Survey of Nine Medical Schools in Uganda JO - JMIR Public Health Surveill SP - e19847 VL - 6 IS - 2 KW - knowledge KW - attitude KW - practices KW - COVID-19 KW - medical students KW - Uganda KW - medical education KW - perspective N2 - Background: The coronavirus disease (COVID-19) pandemic is a global public health concern affecting over 5 million people and posing a great burden on health care systems worldwide. Objective: The aim of this study is to determine the knowledge, attitude, and practices of medical students in Uganda on the COVID-19 pandemic. Methods: We conducted an online, descriptive cross-sectional study in mid-April 2020, using WhatsApp Messenger. Medical students in 9 of the 10 medical schools in Uganda were approached through convenience sampling. Bloom?s cut-off of 80% was used to determine good knowledge (?12 out of 15), positive attitude (?20 out of 25), and good practice (?12 out of 15). Results: The data of 741 first- to fifth-year medical students, consisting of 468 (63%) males with a mean age of 24 (SD 4) years, were analyzed. The majority (n=626, 84%) were pursuing Bachelor of Medicine and Bachelor of Surgery degrees. Overall, 671 (91%) had good knowledge, 550 (74%) had a positive attitude, and 426 (57%) had good practices. Knowledge was associated with the 4th year of study (adjusted odds ratio [aOR] 4.1, 95% CI 1.6-10.3; P<.001). Attitude was associated with the female sex (aOR 0.7, 95% CI 0.5-1; P=.04) and TV or radio shows (aOR 1.1, 95% CI 0.6-2.1; P=.01). Practices were associated with the ?24 years age category (aOR 1.5, 95% CI 1.1-2.1; P=.02) and online courses (aOR 1.8, 95% CI 1.1-3.2; P=.03). In total, 592 (80%) medical students were willing to participate in frontline care if called upon. Conclusions: Medical students in Uganda have sufficient knowledge of COVID-19 and will be a large reservoir for health care response when the need arises. UR - http://publichealth.jmir.org/2020/2/e19847/ UR - http://dx.doi.org/10.2196/19847 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530815 ID - info:doi/10.2196/19847 ER - TY - JOUR AU - Pépin, Louis Jean AU - Bruno, Maria Rosa AU - Yang, Rui-Yi AU - Vercamer, Vincent AU - Jouhaud, Paul AU - Escourrou, Pierre AU - Boutouyrie, Pierre PY - 2020/6/19 TI - Wearable Activity Trackers for Monitoring Adherence to Home Confinement During the COVID-19 Pandemic Worldwide: Data Aggregation and Analysis JO - J Med Internet Res SP - e19787 VL - 22 IS - 6 KW - wearable activity trackers KW - pandemic KW - COVID-19 KW - home confinement KW - lockdown KW - monitoring KW - wearables KW - tracking N2 - Background: In the context of home confinement during the coronavirus disease (COVID-19) pandemic, objective, real-time data are needed to assess populations? adherence to home confinement to adapt policies and control measures accordingly. Objective: The aim of this study was to determine whether wearable activity trackers could provide information regarding users' adherence to home confinement policies because of their capacity for seamless and continuous monitoring of individuals? natural activity patterns regardless of their location. Methods: We analyzed big data from individuals using activity trackers (Withings) that count the wearer?s average daily numberof steps in a number of representative nations that adopted different modalities of restriction of citizens? activities. Results: Data on the number of steps per day from over 740,000 individuals around the world were analyzed. We demonstrate the physical activity patterns in several representative countries with total, partial, or no home confinement. The decrease in steps per day in regions with strict total home confinement ranged from 25% to 54%. Partial lockdown (characterized by social distancing measures such as school closures, bar and restaurant closures, and cancellation of public meetings but without strict home confinement) does not appear to have a significant impact on people?s activity compared to the pre-pandemic period. The absolute level of physical activity under total home confinement in European countries is around twofold that inChina. In some countries, such as France and Spain, physical activity started to gradually decrease even before official commitmentto lockdown as a result of initial less stringent restriction orders or self-quarantine. However, physical activity began to increaseagain in the last 2 weeks, suggesting a decrease in compliance with confinement orders. Conclusions: Aggregate analysis of activity tracker data with the potential for daily updates can provide information regarding adherence to home confinement policies. UR - http://www.jmir.org/2020/6/e19787/ UR - http://dx.doi.org/10.2196/19787 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501803 ID - info:doi/10.2196/19787 ER - TY - JOUR AU - Turk, J. Philip AU - Chou, Shih-Hsiung AU - Kowalkowski, A. Marc AU - Palmer, P. Pooja AU - Priem, S. Jennifer AU - Spencer, D. Melanie AU - Taylor, J. Yhenneko AU - McWilliams, D. Andrew PY - 2020/6/19 TI - Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e19353 VL - 6 IS - 2 KW - COVID-19 KW - public health surveillance KW - novel coronavirus 2019 KW - pandemic KW - forecasting KW - SIR model KW - detection probability KW - latent prevalence N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19353/ UR - http://dx.doi.org/10.2196/19353 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427104 ID - info:doi/10.2196/19353 ER - TY - JOUR AU - Smith-Ray, Renae AU - Roberts, E. Erin AU - Littleton, E. Devonee AU - Singh, Tanya AU - Sandberg, Thomas AU - Taitel, Michael PY - 2020/6/18 TI - Distribution of Patients at Risk for Complications Related to COVID-19 in the United States: Model Development Study JO - JMIR Public Health Surveill SP - e19606 VL - 6 IS - 2 KW - COVID-19 KW - modeling KW - chronic conditions KW - older adults N2 - Background: Coronavirus disease (COVID-19) has spread exponentially across the United States. Older adults with underlying health conditions are at an especially high risk of developing life-threatening complications if infected. Most intensive care unit (ICU) admissions and non-ICU hospitalizations have been among patients with at least one underlying health condition. Objective: The aim of this study was to develop a model to estimate the risk status of the patients of a nationwide pharmacy chain in the United States, and to identify the geographic distribution of patients who have the highest risk of severe COVID-19 complications. Methods: A risk model was developed using a training test split approach to identify patients who are at high risk of developing serious complications from COVID-19. Adult patients (aged ?18 years) were identified from the Walgreens pharmacy electronic data warehouse. Patients were considered eligible to contribute data to the model if they had at least one prescription filled at a Walgreens location between October 27, 2019, and March 25, 2020. Risk parameters included age, whether the patient is being treated for a serious or chronic condition, and urban density classification. Parameters were differentially weighted based on their association with severe complications, as reported in earlier cases. An at-risk rate per 1000 people was calculated at the county level, and ArcMap was used to depict the rate of patients at high risk for severe complications from COVID-19. Real-time COVID-19 cases captured by the Johns Hopkins University Center for Systems Science and Engineering (CSSE) were layered in the risk map to show where cases exist relative to the high-risk populations. Results: Of the 30,100,826 adults included in this study, the average age is 50 years, 15% have at least one specialty medication, and the average patient has 2 to 3 comorbidities. Nearly 28% of patients have the greatest risk score, and an additional 34.64% of patients are considered high-risk, with scores ranging from 8 to 10. Age accounts for 53% of a patient?s total risk, followed by the number of comorbidities (29%); inferred chronic obstructive pulmonary disease, hypertension, or diabetes (15%); and urban density classification (5%). Conclusions: This risk model utilizes data from approximately 10% of the US population. Currently, this is the most comprehensive US model to estimate and depict the county-level prognosis of COVID-19 infection. This study shows that there are counties across the United States whose residents are at high risk of developing severe complications from COVID-19. Our county-level risk estimates may be used alongside other data sets to improve the accuracy of anticipated health care resource needs. The interactive map can also aid in proactive planning and preparations among employers that are deemed critical, such as pharmacies and grocery stores, to prevent the spread of COVID-19 within their facilities. UR - https://publichealth.jmir.org/2020/2/e19606 UR - http://dx.doi.org/10.2196/19606 UR - http://www.ncbi.nlm.nih.gov/pubmed/32511100 ID - info:doi/10.2196/19606 ER - TY - JOUR AU - Wahbeh, Abdullah AU - Nasralah, Tareq AU - Al-Ramahi, Mohammad AU - El-Gayar, Omar PY - 2020/6/18 TI - Mining Physicians? Opinions on Social Media to Obtain Insights Into COVID-19: Mixed Methods Analysis JO - JMIR Public Health Surveill SP - e19276 VL - 6 IS - 2 KW - pandemic KW - coronavirus KW - COVID-19 KW - social media KW - infodemiology KW - infoveillance KW - medical professionals KW - opinion analysis N2 - Background: The coronavirus disease (COVID-19) pandemic is considered to be the most daunting public health challenge in decades. With no effective treatments and with time needed to develop a vaccine, alternative approaches are being used to control this pandemic. Objective: The objective of this paper was to identify topics, opinions, and recommendations about the COVID-19 pandemic discussed by medical professionals on the Twitter social medial platform. Methods: Using a mixed methods approach blending the capabilities of social media analytics and qualitative analysis, we analyzed COVID-19?related tweets posted by medical professionals and examined their content. We used qualitative analysis to explore the collected data to identify relevant tweets and uncover important concepts about the pandemic using qualitative coding. Unsupervised and supervised machine learning techniques and text analysis were used to identify topics and opinions. Results: Data were collected from 119 medical professionals on Twitter about the coronavirus pandemic. A total of 10,096 English tweets were collected from the identified medical professionals between December 1, 2019 and April 1, 2020. We identified eight topics, namely actions and recommendations, fighting misinformation, information and knowledge, the health care system, symptoms and illness, immunity, testing, and infection and transmission. The tweets mainly focused on needed actions and recommendations (2827/10,096, 28%) to control the pandemic. Many tweets warned about misleading information (2019/10,096, 20%) that could lead to infection of more people with the virus. Other tweets discussed general knowledge and information (911/10,096, 9%) about the virus as well as concerns about the health care systems and workers (909/10,096, 9%). The remaining tweets discussed information about symptoms associated with COVID-19 (810/10,096, 8%), immunity (707/10,096, 7%), testing (605/10,096, 6%), and virus infection and transmission (503/10,096, 5%). Conclusions: Our findings indicate that Twitter and social media platforms can help identify important and useful knowledge shared by medical professionals during a pandemic. UR - http://publichealth.jmir.org/2020/2/e19276/ UR - http://dx.doi.org/10.2196/19276 UR - http://www.ncbi.nlm.nih.gov/pubmed/32421686 ID - info:doi/10.2196/19276 ER - TY - JOUR AU - Huckins, F. Jeremy AU - daSilva, W. Alex AU - Wang, Weichen AU - Hedlund, Elin AU - Rogers, Courtney AU - Nepal, K. Subigya AU - Wu, Jialing AU - Obuchi, Mikio AU - Murphy, I. Eilis AU - Meyer, L. Meghan AU - Wagner, D. Dylan AU - Holtzheimer, E. Paul AU - Campbell, T. Andrew PY - 2020/6/17 TI - Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study JO - J Med Internet Res SP - e20185 VL - 22 IS - 6 KW - COVID-19 KW - depression KW - anxiety KW - mobile sensing KW - sedentary KW - phone usage KW - mental health KW - behavior KW - pandemic KW - app N2 - Background: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. Results: During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19?related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.03) were significantly associated with COVID-19?related news. Conclusions: Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods to reduce the impact of future catastrophic events on the mental health of the population. UR - http://www.jmir.org/2020/6/e20185/ UR - http://dx.doi.org/10.2196/20185 UR - http://www.ncbi.nlm.nih.gov/pubmed/32519963 ID - info:doi/10.2196/20185 ER - TY - JOUR AU - Parush, Avi AU - Wacht, Oren AU - Gomes, Ricardo AU - Frenkel, Amit PY - 2020/6/17 TI - Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study JO - J Med Internet Res SP - e19947 VL - 22 IS - 6 KW - COVID-19 KW - personal protective equipment KW - PPE KW - human factors KW - cognitive functioning KW - multinational survey KW - pandemic KW - protection KW - infectious disease KW - infection KW - survey N2 - Background: Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. Objective: This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19. Methods: The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research. Results: A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach ? was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78% in Israel; n=328/377, 87% in Portugal), hearing (n=236/370, 64% in Portugal; n=321/642, 50% in Israel), seeing (n=697/763, 89% in Israel; n=317/376, 84% in Portugal), and doffing (n=290/374, 77% in Portugal; n=315/713, 44% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech. Conclusions: In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols. UR - http://www.jmir.org/2020/6/e19947/ UR - http://dx.doi.org/10.2196/19947 UR - http://www.ncbi.nlm.nih.gov/pubmed/32511099 ID - info:doi/10.2196/19947 ER - TY - JOUR AU - Tosi, Davide AU - Verde, Alessandro AU - Verde, Manuela PY - 2020/6/17 TI - Clarification of Misleading Perceptions of COVID-19 Fatality and Testing Rates in Italy: Data Analysis JO - J Med Internet Res SP - e19825 VL - 22 IS - 6 KW - COVID-19 KW - SARS-CoV-2 KW - fatality rate KW - swab tests KW - Italy KW - Lombardy region N2 - 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. UR - http://www.jmir.org/2020/6/e19825/ UR - http://dx.doi.org/10.2196/19825 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490842 ID - info:doi/10.2196/19825 ER - TY - JOUR AU - Pizzoli, Francesca Silvia Maria AU - Marzorati, Chiara AU - Mazzoni, Davide AU - Pravettoni, Gabriella PY - 2020/6/17 TI - An Internet-Based Intervention to Alleviate Stress During Social Isolation With Guided Relaxation and Meditation: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e19236 VL - 9 IS - 6 KW - relaxation KW - guided meditation KW - internet-based intervention KW - social isolation KW - stress KW - COVID-19 KW - mental health KW - public health N2 - Background: Psychophysiological stress and decreased well-being are relevant issues during prolonged social isolation periods. Relaxation practices may represent helpful exercises to cope with anxiety and stressful sensations. Objective: The aim of this research protocol is to test whether remote relaxation practices such as natural sounds, deep respiration, and body scan meditation promote relaxation and improved emotional state and reduce psychomotor activation and the preoccupation related to the coronavirus disease (COVID-19) pandemic. Methods: The study population will consist of 3 experimental groups that will randomly receive one of 3 internet-based audio clips containing a single session of guided breathing exercise, guided body scan exercise, or natural sounds. The participants will listen to the fully automated audio clip for 7 minutes and complete pre-post self-assessment scales on their perceived relaxation, psychomotor activation, level of worry associated with COVID-19, and emotional state. At the end of the session, the participants will also be asked to provide qualitative reports on their subjective experiences. Results: Analyses will be performed to test the differences in the efficacy of the different audio clips in an internet-based intervention on 252 participants (84 per group), investigating whether natural sounds or remote guided practices such as deep respiration and body scan meditation positively enhance the participants? perceived psychological state. Conclusions: The study will provide information on if and to what extent guided practices can help in reducing psychological side effects related to social isolation during the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/19236 UR - http://www.researchprotocols.org/2020/6/e19236/ UR - http://dx.doi.org/10.2196/19236 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530814 ID - info:doi/10.2196/19236 ER - TY - JOUR AU - Fagherazzi, Guy AU - Goetzinger, Catherine AU - Rashid, Ally Mohammed AU - Aguayo, A. Gloria AU - Huiart, Laetitia PY - 2020/6/16 TI - Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers JO - J Med Internet Res SP - e19284 VL - 22 IS - 6 KW - coronavirus KW - COVID-19 KW - digital health KW - eHealth KW - digital technology KW - health care KW - surveillance KW - communication KW - review KW - epidemiology KW - infodemiology KW - public health UR - http://www.jmir.org/2020/6/e19284/ UR - http://dx.doi.org/10.2196/19284 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501804 ID - info:doi/10.2196/19284 ER - TY - JOUR AU - Li, Siyue AU - Feng, Bo AU - Liao, Wang AU - Pan, Wenjing PY - 2020/6/16 TI - 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 JO - J Med Internet Res SP - e19782 VL - 22 IS - 6 KW - COVID-19 KW - coronavirus KW - preventive behaviors KW - testing KW - online health information KW - risk awareness N2 - 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. UR - http://www.jmir.org/2020/6/e19782/ UR - http://dx.doi.org/10.2196/19782 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501801 ID - info:doi/10.2196/19782 ER - TY - JOUR AU - Tao, Zhuo-Ying AU - Chu, Guang AU - McGrath, Colman AU - Hua, Fang AU - Leung, Yan Yiu AU - Yang, Wei-Fa AU - Su, Yu-Xiong PY - 2020/6/15 TI - Nature and Diffusion of COVID-19?related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo JO - J Med Internet Res SP - e19981 VL - 22 IS - 6 KW - COVID-19 KW - dentistry KW - oral health KW - online health KW - social media KW - tweet KW - Weibo KW - China KW - health information N2 - 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. UR - http://www.jmir.org/2020/6/e19981/ UR - http://dx.doi.org/10.2196/19981 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501808 ID - info:doi/10.2196/19981 ER - TY - JOUR AU - Chen, Hsi Cathy AU - Mullen, Joseph Alexander PY - 2020/6/12 TI - COVID-19 Can Catalyze the Modernization of Medical Education JO - JMIR Med Educ SP - e19725 VL - 6 IS - 1 KW - medical education KW - health professions education KW - medical school KW - curriculum design KW - flipped classroom KW - preclinical education KW - COVID-19 KW - coronavirus KW - medical student UR - http://mededu.jmir.org/2020/1/e19725/ UR - http://dx.doi.org/10.2196/19725 UR - http://www.ncbi.nlm.nih.gov/pubmed/32501809 ID - info:doi/10.2196/19725 ER - TY - JOUR AU - Hamidian Jahromi, Alireza AU - Hamidianjahromi, Anahid PY - 2020/6/12 TI - Why African Americans Are a Potential Target for COVID-19 Infection in the United States JO - J Med Internet Res SP - e19934 VL - 22 IS - 6 KW - coronavirus KW - COVID-19 KW - African American KW - mortality KW - race KW - virus KW - minority KW - infectious disease UR - http://www.jmir.org/2020/6/e19934/ UR - http://dx.doi.org/10.2196/19934 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496205 ID - info:doi/10.2196/19934 ER - TY - JOUR AU - Bae, Seul Ye AU - Kim, Hwan Kyung AU - Choi, Won Sae AU - Ko, Taehoon AU - Jeong, Wook Chang AU - Cho, BeLong AU - Kim, Sun Min AU - Kang, EunKyo PY - 2020/6/12 TI - Information Technology?Based Management of Clinically Healthy COVID-19 Patients: Lessons From a Living and Treatment Support Center Operated by Seoul National University Hospital JO - J Med Internet Res SP - e19938 VL - 22 IS - 6 KW - COVID-19 KW - clinical informatics KW - mobile app KW - telemedicine KW - hospital information system KW - app KW - health information technology N2 - 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. UR - http://www.jmir.org/2020/6/e19938/ UR - http://dx.doi.org/10.2196/19938 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490843 ID - info:doi/10.2196/19938 ER - TY - JOUR AU - Suppan, Mélanie AU - Gartner, Birgit AU - Golay, Eric AU - Stuby, Loric AU - White, Marion AU - Cottet, Philippe AU - Abbas, Mohamed AU - Iten, Anne AU - Harbarth, Stephan AU - Suppan, Laurent PY - 2020/6/12 TI - Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module JO - JMIR Serious Games SP - e20173 VL - 8 IS - 2 KW - personal protective equipment KW - electronic learning KW - gamification KW - prehospital KW - COVID-19 N2 - 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. UR - http://games.jmir.org/2020/2/e20173/ UR - http://dx.doi.org/10.2196/20173 UR - http://www.ncbi.nlm.nih.gov/pubmed/32516115 ID - info:doi/10.2196/20173 ER - TY - JOUR AU - Denis, Fabrice AU - Galmiche, Simon AU - Dinh, Aurélien AU - Fontanet, Arnaud AU - Scherpereel, Arnaud AU - Benezit, Francois AU - Lescure, François-Xavier PY - 2020/6/11 TI - Epidemiological Observations on the Association Between Anosmia and COVID-19 Infection: Analysis of Data From a Self-Assessment Web Application JO - J Med Internet Res SP - e19855 VL - 22 IS - 6 KW - COVID-19 KW - anosmia KW - epidemiological surveillance KW - self-assessment KW - web application KW - outbreak KW - symptoms KW - surveillance KW - epidemiology N2 - 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 UR - http://www.jmir.org/2020/6/e19855/ UR - http://dx.doi.org/10.2196/19855 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496206 ID - info:doi/10.2196/19855 ER - TY - JOUR AU - Perski, Olga AU - Herbe?, Aleksandra AU - Shahab, Lion AU - Brown, Jamie PY - 2020/6/11 TI - Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis JO - JMIR Mhealth Uhealth SP - e19494 VL - 8 IS - 6 KW - SARS-CoV-2 KW - COVID-19 KW - smoking cessation KW - mobile health KW - smartphone app KW - time series analysis KW - smoking KW - public health KW - app N2 - Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. Objective: We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. Methods: Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. Results: Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). Conclusions: In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive. UR - http://mhealth.jmir.org/2020/6/e19494/ UR - http://dx.doi.org/10.2196/19494 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463375 ID - info:doi/10.2196/19494 ER - TY - JOUR AU - van Agteren, Joep AU - Bartholomaeus, Jonathan AU - Fassnacht, B. Daniel AU - Iasiello, Matthew AU - Ali, Kathina AU - Lo, Laura AU - Kyrios, Michael PY - 2020/6/11 TI - Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study JO - JMIR Ment Health SP - e20696 VL - 7 IS - 6 KW - psychological measurement KW - positive mental health KW - resilience KW - mental health KW - psychological distress KW - internet KW - COVID-19 KW - pandemic N2 - Background: The coronavirus disease (COVID-19) is expected to have widespread and pervasive implications for mental health in terms of deteriorating outcomes and increased health service use, leading to calls for empirical research on mental health during the pandemic. Internet-based psychological measurement can play an important role in collecting imperative data, assisting to guide evidence-based decision making in practice and policy, and subsequently facilitating immediate reporting of measurement results to participants. Objective: The aim of this study is to use an internet-based mental health measurement platform to compare the mental health profile of community members during COVID-19 with community members assessed before the pandemic. Methods: This study uses an internet-based self-assessment tool to collect data on psychological distress, mental well-being, and resilience in community cohorts during (n=673) and prior to the pandemic (two cohorts, n=1264 and n=340). Results: Our findings demonstrate significantly worse outcomes on all mental health measures for participants measured during COVID-19 compared to those measured before (P<.001 for all outcomes, effect sizes ranging between Cohen d=0.32 to Cohen d=0.81. Participants who demonstrated problematic scores for at least one of the mental health outcomes increased from 58% (n=197/340) before COVID-19 to 79% (n=532/673) during COVID-19, leading to only 21% (n=141) of measured participants displaying good mental health during the pandemic. Conclusions: The results clearly demonstrate deterioration in mental health outcomes during COVID-19. Although further research is needed, our findings support the serious mental health implications of the pandemic and highlight the utility of internet-based data collection tools in providing evidence to innovate and strengthen practice and policy during and after the pandemic. UR - http://mental.jmir.org/2020/6/e20696/ UR - http://dx.doi.org/10.2196/20696 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490845 ID - info:doi/10.2196/20696 ER - TY - JOUR AU - Li, Mengyang AU - Leslie, Heather AU - Qi, Bin AU - Nan, Shan AU - Feng, Hongshuo AU - Cai, Hailing AU - Lu, Xudong AU - Duan, Huilong PY - 2020/6/10 TI - Development of an openEHR Template for COVID-19 Based on Clinical Guidelines JO - J Med Internet Res SP - e20239 VL - 22 IS - 6 KW - coronavirus disease KW - COVID-19 KW - openEHR KW - archetype KW - template KW - knowledge modeling KW - clinical guidelines N2 - Background: The coronavirus disease (COVID-19) was discovered in China in December 2019. It has developed into a threatening international public health emergency. With the exception of China, the number of cases continues to increase worldwide. A number of studies about disease diagnosis and treatment have been carried out, and many clinically proven effective results have been achieved. Although information technology can improve the transferring of such knowledge to clinical practice rapidly, data interoperability is still a challenge due to the heterogeneous nature of hospital information systems. This issue becomes even more serious if the knowledge for diagnosis and treatment is updated rapidly as is the case for COVID-19. An open, semantic-sharing, and collaborative-information modeling framework is needed to rapidly develop a shared data model for exchanging data among systems. openEHR is such a framework and is supported by many open software packages that help to promote information sharing and interoperability. Objective: This study aims to develop a shared data model based on the openEHR modeling approach to improve the interoperability among systems for the diagnosis and treatment of COVID-19. Methods: The latest Guideline of COVID-19 Diagnosis and Treatment in China was selected as the knowledge source for modeling. First, the guideline was analyzed and the data items used for diagnosis and treatment, and management were extracted. Second, the data items were classified and further organized into domain concepts with a mind map. Third, searching was executed in the international openEHR Clinical Knowledge Manager (CKM) to find the existing archetypes that could represent the concepts. New archetypes were developed for those concepts that could not be found. Fourth, these archetypes were further organized into a template using Ocean Template Editor. Fifth, a test case of data exchanging between the clinical data repository and clinical decision support system based on the template was conducted to verify the feasibility of the study. Results: A total of 203 data items were extracted from the guideline in China, and 16 domain concepts (16 leaf nodes in the mind map) were organized. There were 22 archetypes used to develop the template for all data items extracted from the guideline. All of them could be found in the CKM and reused directly. The archetypes and templates were reviewed and finally released in a public project within the CKM. The test case showed that the template can facilitate the data exchange and meet the requirements of decision support. Conclusions: This study has developed the openEHR template for COVID-19 based on the latest guideline from China using openEHR modeling methodology. It represented the capability of the methodology for rapidly modeling and sharing knowledge through reusing the existing archetypes, which is especially useful in a new and fast-changing area such as with COVID-19. UR - http://www.jmir.org/2020/6/e20239/ UR - http://dx.doi.org/10.2196/20239 UR - http://www.ncbi.nlm.nih.gov/pubmed/32496207 ID - info:doi/10.2196/20239 ER - TY - JOUR AU - Wang, Shaoxiong AU - Ding, Shuizi AU - Xiong, Li PY - 2020/6/10 TI - A New System for Surveillance and Digital Contact Tracing for COVID-19: Spatiotemporal Reporting Over Network and GPS JO - JMIR Mhealth Uhealth SP - e19457 VL - 8 IS - 6 KW - COVID-19 KW - China KW - mobile health KW - mobile phones KW - smartphones KW - contact tracing KW - social media KW - spatiotemporal data KW - GPS KW - disease tracking KW - public health KW - infectious disease KW - virus UR - http://mhealth.jmir.org/2020/6/e19457/ UR - http://dx.doi.org/10.2196/19457 UR - http://www.ncbi.nlm.nih.gov/pubmed/32499212 ID - info:doi/10.2196/19457 ER - TY - JOUR AU - Fisk, Malcolm AU - Livingstone, Anne AU - Pit, Winona Sabrina PY - 2020/6/9 TI - Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States JO - J Med Internet Res SP - e19264 VL - 22 IS - 6 KW - telehealth KW - COVID-19 KW - SARS-CoV-2 KW - public health KW - older people KW - resource allocation KW - aged care KW - innovation KW - pandemic KW - telemedicine N2 - Background: On March 12, 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. On that date, there were 134,576 reported cases and 4981 deaths worldwide. By March 26, 2020, just 2 weeks later, reported cases had increased four-fold to 531,865, and deaths increased five-fold to 24,073. Older people are both major users of telehealth services and are more likely to die as a result of COVID-19. Objective: This paper examines the extent that Australia, the United Kingdom, and the United States, during the 2 weeks following the pandemic announcement, sought to promote telehealth as a tool that could help identify COVID-19 among older people who may live alone, be frail, or be self-isolating, and give support to or facilitate the treatment of people who are or may be infected. Methods: This paper reports, for the 2-week period previously mentioned and immediately prior, on activities and initiatives in the three countries taken by governments or their agencies (at national or state levels) together with publications or guidance issued by professional, trade, and charitable bodies. Different sources of information are drawn upon that point to the perceived likely benefits of telehealth in fighting the pandemic. It is not the purpose of this paper to draw together or analyze information that reflects growing knowledge about COVID-19, except where telehealth is seen as a component. Results: The picture that emerges for the three countries, based on the sources identified, shows a number of differences. These differences center on the nature of their health services, the extent of attention given to older people (and the circumstances that can relate to them), the different geographies (notably concerned with rurality), and the changes to funding frameworks that could impact these. Common to all three countries is the value attributed to maintaining quality safeguards in the wider context of their health services but where such services are noted as sometimes having precluded significant telehealth use. Conclusions: The COVID-19 pandemic is forcing changes and may help to establish telehealth more firmly in its aftermath. Some of the changes may not be long-lasting. However, the momentum is such that telehealth will almost certainly find a stronger place within health service frameworks for each of the three countries and is likely to have increased acceptance among both patients and health care providers. UR - http://www.jmir.org/2020/6/e19264/ UR - http://dx.doi.org/10.2196/19264 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463377 ID - info:doi/10.2196/19264 ER - TY - JOUR AU - Ye, Qing AU - Zhou, Jin AU - Wu, Hong PY - 2020/6/8 TI - Using Information Technology to Manage the COVID-19 Pandemic: Development of a Technical Framework Based on Practical Experience in China JO - JMIR Med Inform SP - e19515 VL - 8 IS - 6 KW - COVID-19 KW - pandemic KW - health informatics KW - health information technology KW - technical framework KW - privacy protection N2 - Background: The coronavirus disease (COVID-19) epidemic poses an enormous challenge to the global health system, and governments have taken active preventive and control measures. The health informatics community in China has actively taken action to leverage health information technologies for epidemic monitoring, detection, early warning, prevention and control, and other tasks. Objective: The aim of this study was to develop a technical framework to respond to the COVID-19 epidemic from a health informatics perspective. Methods: In this study, we collected health information technology?related information to understand the actions taken by the health informatics community in China during the COVID-19 outbreak and developed a health information technology framework for epidemic response based on health information technology?related measures and methods. Results: Based on the framework, we review specific health information technology practices for managing the outbreak in China, describe the highlights of their application in detail, and discuss critical issues to consider when using health information technology. Technologies employed include mobile and web-based services such as Internet hospitals and Wechat, big data analyses (including digital contact tracing through QR codes or epidemic prediction), cloud computing, Internet of things, Artificial Intelligence (including the use of drones, robots, and intelligent diagnoses), 5G telemedicine, and clinical information systems to facilitate clinical management for COVID-19. Conclusions: Practical experience in China shows that health information technologies play a pivotal role in responding to the COVID-19 epidemic. UR - http://medinform.jmir.org/2020/6/e19515/ UR - http://dx.doi.org/10.2196/19515 UR - http://www.ncbi.nlm.nih.gov/pubmed/32479411 ID - info:doi/10.2196/19515 ER - TY - JOUR AU - Mackey, Tim AU - Purushothaman, Vidya AU - Li, Jiawei AU - Shah, Neal AU - Nali, Matthew AU - Bardier, Cortni AU - Liang, Bryan AU - Cai, Mingxiang AU - Cuomo, Raphael PY - 2020/6/8 TI - Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study JO - JMIR Public Health Surveill SP - e19509 VL - 6 IS - 2 KW - infoveillance KW - COVID-19 KW - Twitter KW - machine learning KW - surveillance N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19509/ UR - http://dx.doi.org/10.2196/19509 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490846 ID - info:doi/10.2196/19509 ER - TY - JOUR AU - Wang, Peng-Wei AU - Lu, Wei-Hsin AU - Ko, Nai-Ying AU - Chen, Yi-Lung AU - Li, Dian-Jeng AU - Chang, Yu-Ping AU - Yen, Cheng-Fang PY - 2020/6/5 TI - COVID-19-Related Information Sources and the Relationship With Confidence in People Coping with COVID-19: Facebook Survey Study in Taiwan JO - J Med Internet Res SP - e20021 VL - 22 IS - 6 KW - COVID-19 KW - information KW - internet KW - coping KW - confidence KW - mental health KW - social media KW - Facebook KW - survey KW - online health information N2 - Background: People obtain information on the coronavirus disease (COVID-19) from the internet and other sources. Understanding the factors related to such information sources aids health professionals in educating individuals. Objective: This study used data collected from the online survey study on COVID-19 in Taiwan to examine what major COVID-19 information sources are available and which sources are significantly related to the self-confidence of people in coping with COVID-19 in Taiwan. Methods: A total of 1904 participants (1270 non?health-care workers and 634 health care workers) were recruited from the Facebook advertisement. Their major sources of information about COVID-19, the relationships between the sources and demographic factors, and the relationships between the sources and the self-confidence in coping with COVID-19 were surveyed. Results: Most Taiwanese people relied on the internet for COVID-19 information. Many respondents also used a variety of sources of information on COVID-19; such variety was associated with sex, age, and the level of worry toward COVID-19, as well as if one was a health care worker. For health care workers, the use of formal lessons as an information source was significantly associated with better self-confidence in coping with COVID-19. The significant association between receiving information from more sources and greater self-confidence was found only in health care workers but not in non?health-care workers. Conclusions: Medical professionals should consider subgroups of the population when establishing various means to deliver information on COVID-19. UR - http://www.jmir.org/2020/6/e20021/ UR - http://dx.doi.org/10.2196/20021 UR - http://www.ncbi.nlm.nih.gov/pubmed/32490839 ID - info:doi/10.2196/20021 ER - TY - JOUR AU - Sakib, Nazmus Mohammad AU - Butt, A. Zahid AU - Morita, Pelegrini Plinio AU - Oremus, Mark AU - Fong, T. Geoffrey AU - Hall, A. Peter PY - 2020/6/5 TI - Considerations for an Individual-Level Population Notification System for Pandemic Response: A Review and Prototype JO - J Med Internet Res SP - e19930 VL - 22 IS - 6 KW - pandemic KW - epidemic KW - notification system KW - hygiene KW - physical distancing KW - lockdown KW - mobile technology KW - COVID-19 KW - coronavirus UR - http://www.jmir.org/2020/6/e19930/ UR - http://dx.doi.org/10.2196/19930 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484443 ID - info:doi/10.2196/19930 ER - TY - JOUR AU - Jo, Wonkwang AU - Lee, Jaeho AU - Park, Junli AU - Kim, Yeol PY - 2020/6/2 TI - 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 JO - J Med Internet Res SP - e19455 VL - 22 IS - 6 KW - coronavirus KW - anxiety KW - pandemic KW - online KW - health information exchange KW - topic modeling N2 - 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. UR - https://www.jmir.org/2020/6/e19455 UR - http://dx.doi.org/10.2196/19455 UR - http://www.ncbi.nlm.nih.gov/pubmed/32463367 ID - info:doi/10.2196/19455 ER - TY - JOUR AU - Crawford, Allison AU - Serhal, Eva PY - 2020/6/2 TI - Digital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health JO - J Med Internet Res SP - e19361 VL - 22 IS - 6 KW - virtual health KW - digital determinants of health KW - digital health equity KW - digital health KW - equity KW - COVID-19 KW - public health KW - eHealth KW - social UR - https://www.jmir.org/2020/6/e19361 UR - http://dx.doi.org/10.2196/19361 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452816 ID - info:doi/10.2196/19361 ER - TY - JOUR AU - Garg, Suneela AU - Basu, Saurav AU - Rustagi, Ruchir AU - Borle, Amod PY - 2020/6/1 TI - Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e19927 VL - 6 IS - 2 KW - primary health care KW - COVID-19 KW - pandemic KW - health systems KW - India N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19927/ UR - http://dx.doi.org/10.2196/19927 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452819 ID - info:doi/10.2196/19927 ER - TY - JOUR AU - Mavian, Carla AU - Marini, Simone AU - Prosperi, Mattia AU - Salemi, Marco PY - 2020/6/1 TI - A Snapshot of SARS-CoV-2 Genome Availability up to April 2020 and its Implications: Data Analysis JO - JMIR Public Health Surveill SP - e19170 VL - 6 IS - 2 KW - covid-19 KW - sars-cov-2 KW - phylogenetics KW - genome KW - evolution KW - genetics KW - pandemic KW - infectious disease KW - virus KW - sequence KW - transmission KW - tracing KW - tracking N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19170/ UR - http://dx.doi.org/10.2196/19170 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412415 ID - info:doi/10.2196/19170 ER - TY - JOUR AU - Schinköthe, Timo AU - Gabri, Rolando Mariano AU - Mitterer, Manfred AU - Gouveia, Pedro AU - Heinemann, Volker AU - Harbeck, Nadia AU - Subklewe, Marion PY - 2020/6/1 TI - A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development JO - JMIR Public Health Surveill SP - e19033 VL - 6 IS - 2 KW - COVID-19 KW - eHealth KW - connected care KW - telecare KW - cloud solution KW - telehealth KW - public health KW - infectious disease KW - pandemic KW - outbreak N2 - Background: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. Objective: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. Methods: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. Results: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. Conclusions: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19. UR - http://publichealth.jmir.org/2020/2/e19033/ UR - http://dx.doi.org/10.2196/19033 UR - http://www.ncbi.nlm.nih.gov/pubmed/32406855 ID - info:doi/10.2196/19033 ER - TY - JOUR AU - Jacobson, C. Nicholas AU - Lekkas, Damien AU - Price, George AU - Heinz, V. Michael AU - Song, Minkeun AU - O?Malley, James A. AU - Barr, J. Paul PY - 2020/6/1 TI - Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States JO - JMIR Ment Health SP - e19347 VL - 7 IS - 6 KW - COVID-19 KW - coronavirus KW - stay-at-home orders KW - mental health KW - suicide KW - anxiety KW - infodemiology KW - infoveillance KW - search trends KW - health information needs N2 - Background: The coronavirus disease (COVID-19) has led to dramatic changes worldwide in people?s everyday lives. To combat the pandemic, many governments have implemented social distancing, quarantine, and stay-at-home orders. There is limited research on the impact of such extreme measures on mental health. Objective: The goal of this study was to examine whether stay-at-home orders produced differential changes in mental health symptoms using internet search queries on a national scale. Methods: In the United States, individual states vary in their adoption of measures to reduce the spread of COVID-19; as of March 23, 2020, 11 of the 50 states had issued stay-at-home orders. The staggered rollout of stay-at-home measures across the United States allows us to investigate whether these measures impact mental health by exploring variations in mental health search queries across the states. This paper examines the changes in mental health search queries on Google between March 16-23, 2020, across each state and Washington, DC. Specifically, this paper examines differential changes in mental health searches based on patterns of search activity following issuance of stay-at-home orders in these states compared to all other states. The participants were all the people who searched mental health terms in Google between March 16-23. Between March 16-23, 11 states underwent stay-at-home orders to prevent the transmission of COVID-19. Outcomes included search terms measuring anxiety, depression, obsessive-compulsive, negative thoughts, irritability, fatigue, anhedonia, concentration, insomnia, and suicidal ideation. Results: Analyzing over 10 million search queries using generalized additive mixed models, the results suggested that the implementation of stay-at-home orders are associated with a significant flattening of the curve for searches for suicidal ideation, anxiety, negative thoughts, and sleep disturbances, with the most prominent flattening associated with suicidal ideation and anxiety. Conclusions: These results suggest that, despite decreased social contact, mental health search queries increased rapidly prior to the issuance of stay-at-home orders, and these changes dissipated following the announcement and enactment of these orders. Although more research is needed to examine sustained effects, these results suggest mental health symptoms were associated with an immediate leveling off following the issuance of stay-at-home orders. UR - https://mental.jmir.org/2020/6/e19347 UR - http://dx.doi.org/10.2196/19347 UR - http://www.ncbi.nlm.nih.gov/pubmed/32459186 ID - info:doi/10.2196/19347 ER - TY - JOUR AU - Chen, Emily AU - Lerman, Kristina AU - Ferrara, Emilio PY - 2020/5/29 TI - Tracking Social Media Discourse About the COVID-19 Pandemic: Development of a Public Coronavirus Twitter Data Set JO - JMIR Public Health Surveill SP - e19273 VL - 6 IS - 2 KW - COVID-19 KW - SARS-CoV-2 KW - social media KW - network analysis KW - computational social sciences N2 - Background: At the time of this writing, the coronavirus disease (COVID-19) pandemic outbreak has already put tremendous strain on many countries' citizens, resources, and economies around the world. Social distancing measures, travel bans, self-quarantines, and business closures are changing the very fabric of societies worldwide. With people forced out of public spaces, much of the conversation about these phenomena now occurs online on social media platforms like Twitter. Objective: In this paper, we describe a multilingual COVID-19 Twitter data set that we are making available to the research community via our COVID-19-TweetIDs GitHub repository. Methods: We started this ongoing data collection on January 28, 2020, leveraging Twitter?s streaming application programming interface (API) and Tweepy to follow certain keywords and accounts that were trending at the time data collection began. We used Twitter?s search API to query for past tweets, resulting in the earliest tweets in our collection dating back to January 21, 2020. Results: Since the inception of our collection, we have actively maintained and updated our GitHub repository on a weekly basis. We have published over 123 million tweets, with over 60% of the tweets in English. This paper also presents basic statistics that show that Twitter activity responds and reacts to COVID-19-related events. Conclusions: It is our hope that our contribution will enable the study of online conversation dynamics in the context of a planetary-scale epidemic outbreak of unprecedented proportions and implications. This data set could also help track COVID-19-related misinformation and unverified rumors or enable the understanding of fear and panic?and undoubtedly more. UR - http://publichealth.jmir.org/2020/2/e19273/ UR - http://dx.doi.org/10.2196/19273 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427106 ID - info:doi/10.2196/19273 ER - TY - JOUR AU - McLennan, Stuart AU - Celi, Anthony Leo AU - Buyx, Alena PY - 2020/5/29 TI - COVID-19: Putting the General Data Protection Regulation to the Test JO - JMIR Public Health Surveill SP - e19279 VL - 6 IS - 2 KW - COVID-19 KW - data sharing KW - GDPR KW - research exemption KW - global health KW - public health KW - research KW - digital health KW - electronic health records KW - EHR UR - http://publichealth.jmir.org/2020/2/e19279/ UR - http://dx.doi.org/10.2196/19279 UR - http://www.ncbi.nlm.nih.gov/pubmed/32449686 ID - info:doi/10.2196/19279 ER - TY - JOUR AU - Delen, Dursun AU - Eryarsoy, Enes AU - Davazdahemami, Behrooz PY - 2020/5/28 TI - No Place Like Home: Cross-National Data Analysis of the Efficacy of Social Distancing During the COVID-19 Pandemic JO - JMIR Public Health Surveill SP - e19862 VL - 6 IS - 2 KW - COVID-19 KW - public health KW - social distancing KW - machine learning KW - pandemic N2 - Background: In the absence of a cure in the time of a pandemic, social distancing measures seem to be the most effective intervention to slow the spread of disease. Various simulation-based studies have been conducted to investigate the effectiveness of these measures. While those studies unanimously confirm the mitigating effect of social distancing on disease spread, the reported effectiveness varies from 10% to more than 90% reduction in the number of infections. This level of uncertainty is mostly due to the complex dynamics of epidemics and their time-variant parameters. However, real transactional data can reduce uncertainty and provide a less noisy picture of the effectiveness of social distancing. Objective: The aim of this paper was to integrate multiple transactional data sets (GPS mobility data from Google and Apple as well as disease statistics from the European Centre for Disease Prevention and Control) to study the role of social distancing policies in 26 countries and analyze the transmission rate of the coronavirus disease (COVID-19) pandemic over the course of 5 weeks. Methods: Relying on the susceptible-infected-recovered (SIR) model and official COVID-19 reports, we first calculated the weekly transmission rate (?) of COVID-19 in 26 countries for 5 consecutive weeks. Then, we integrated these data with the Google and Apple mobility data sets for the same time frame and used a machine learning approach to investigate the relationship between the mobility factors and ? values. Results: Gradient boosted trees regression analysis showed that changes in mobility patterns resulting from social distancing policies explain approximately 47% of the variation in the disease transmission rates. Conclusions: Consistent with simulation-based studies, real cross-national transactional data confirms the effectiveness of social distancing interventions in slowing the spread of COVID-19. In addition to providing less noisy and more generalizable support for the idea of social distancing, we provide specific insights for public health policy makers regarding locations that should be given higher priority for enforcing social distancing measures. UR - http://publichealth.jmir.org/2020/2/e19862/ UR - http://dx.doi.org/10.2196/19862 UR - http://www.ncbi.nlm.nih.gov/pubmed/32434145 ID - info:doi/10.2196/19862 ER - TY - JOUR AU - Yin, Guosheng AU - Jin, Huaqing PY - 2020/5/28 TI - Comparison of Transmissibility of Coronavirus Between Symptomatic and Asymptomatic Patients: Reanalysis of the Ningbo COVID-19 Data JO - JMIR Public Health Surveill SP - e19464 VL - 6 IS - 2 KW - asymptomatic case KW - close contact KW - coronavirus KW - COVID-19 KW - Fisher exact test KW - transmission rate KW - transmission KW - virus KW - immunology KW - analysis N2 - Background: Since the outbreak of the novel coronavirus disease (COVID-19) in December 2019, the coronavirus has spread all over the world at an unprecedented rate. The transmissibility of the coronavirus from asymptomatic patients to healthy individuals has received enormous attention. An important study using COVID-19 data from the city of Ningbo, China, was carried out to estimate and compare the transmission rates of the coronavirus by the symptomatic and asymptomatic patients. However, in the original analysis, the usual chi-square tests were unduly used for some contingency tables with small cell counts including zero, which may violate the assumptions for the chi-square test. Objective: We reanalyze the data from the city of Ningbo with more appropriate statistical methods to draw more reliable and sound conclusions on the transmission rates of the coronavirus by the symptomatic and asymptomatic patients. Methods: We excluded the cases associated with the super-spreader and adopted a more appropriate statistical method, including the permutation test and the Fisher exact test, to reanalyze the COVID-19 data from the city of Ningbo. Results: After excluding the cases related to the super-spreader, the Fisher exact test yields a P value of .84, which indicates stronger evidence of no difference in the transmission rates compared with the original analysis. The odds ratio of the coronavirus transmission rates between the symptomatic and asymptomatic patients is 1.2 with a 95% confidence interval 0.5-2.8. Conclusions: Through a more in-depth and comprehensive statistical analysis of the Ningbo data, we concluded that there is no difference in the transmission rates of coronavirus between symptomatic and asymptomatic patients. UR - http://publichealth.jmir.org/2020/2/e19464/ UR - http://dx.doi.org/10.2196/19464 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442131 ID - info:doi/10.2196/19464 ER - TY - JOUR AU - Shen, Cuihua AU - Chen, Anfan AU - Luo, Chen AU - Zhang, Jingwen AU - Feng, Bo AU - Liao, Wang PY - 2020/5/28 TI - Using Reports of Symptoms and Diagnoses on Social Media to Predict COVID-19 Case Counts in Mainland China: Observational Infoveillance Study JO - J Med Internet Res SP - e19421 VL - 22 IS - 5 KW - COVID-19 KW - SARS-CoV-2 KW - novel coronavirus KW - infectious disease KW - social media KW - Weibo KW - China KW - disease surveillance KW - surveillance KW - infoveillance KW - infodemiology N2 - Background: Coronavirus disease (COVID-19) has affected more than 200 countries and territories worldwide. This disease poses an extraordinary challenge for public health systems because screening and surveillance capacity is often severely limited, especially during the beginning of the outbreak; this can fuel the outbreak, as many patients can unknowingly infect other people. Objective: The aim of this study was to collect and analyze posts related to COVID-19 on Weibo, a popular Twitter-like social media site in China. To our knowledge, this infoveillance study employs the largest, most comprehensive, and most fine-grained social media data to date to predict COVID-19 case counts in mainland China. Methods: We built a Weibo user pool of 250 million people, approximately half the entire monthly active Weibo user population. Using a comprehensive list of 167 keywords, we retrieved and analyzed around 15 million COVID-19?related posts from our user pool from November 1, 2019 to March 31, 2020. We developed a machine learning classifier to identify ?sick posts,? in which users report their own or other people?s symptoms and diagnoses related to COVID-19. Using officially reported case counts as the outcome, we then estimated the Granger causality of sick posts and other COVID-19 posts on daily case counts. For a subset of geotagged posts (3.10% of all retrieved posts), we also ran separate predictive models for Hubei province, the epicenter of the initial outbreak, and the rest of mainland China. Results: We found that reports of symptoms and diagnosis of COVID-19 significantly predicted daily case counts up to 14 days ahead of official statistics, whereas other COVID-19 posts did not have similar predictive power. For the subset of geotagged posts, we found that the predictive pattern held true for both Hubei province and the rest of mainland China regardless of the unequal distribution of health care resources and the outbreak timeline. Conclusions: Public social media data can be usefully harnessed to predict infection cases and inform timely responses. Researchers and disease control agencies should pay close attention to the social media infosphere regarding COVID-19. In addition to monitoring overall search and posting activities, leveraging machine learning approaches and theoretical understanding of information sharing behaviors is a promising approach to identify true disease signals and improve the effectiveness of infoveillance. UR - http://www.jmir.org/2020/5/e19421/ UR - http://dx.doi.org/10.2196/19421 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452804 ID - info:doi/10.2196/19421 ER - TY - JOUR AU - Schulz, L. Wade AU - Durant, S. Thomas J. AU - Torre Jr, J. Charles AU - Hsiao, L. Allen AU - Krumholz, M. Harlan PY - 2020/5/28 TI - Agile Health Care Analytics: Enabling Real-Time Disease Surveillance With a Computational Health Platform JO - J Med Internet Res SP - e18707 VL - 22 IS - 5 KW - real-time analytics KW - real-world data KW - disease surveillance KW - computational health KW - surveillance KW - public health KW - COVID-19 KW - outbreak KW - health information technology KW - HIT KW - interface KW - monitoring KW - pandemic UR - http://www.jmir.org/2020/5/e18707/ UR - http://dx.doi.org/10.2196/18707 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442130 ID - info:doi/10.2196/18707 ER - TY - JOUR AU - Komenda, Martin AU - Bulhart, Vojt?ch AU - Karolyi, Mat?j AU - Jarkovský, Ji?í AU - Mu?ík, Jan AU - Májek, Ond?ej AU - ?najdrová, Lenka AU - R??i?ková, Petra AU - Rá?ová, Jarmila AU - Prymula, Roman AU - Macková, Barbora AU - B?ezovský, Pavel AU - Marounek, Jan AU - ?erný, Vladimír AU - Du?ek, Ladislav PY - 2020/5/27 TI - Complex Reporting of the COVID-19 Epidemic in the Czech Republic: Use of an Interactive Web-Based App in Practice JO - J Med Internet Res SP - e19367 VL - 22 IS - 5 KW - coronavirus disease KW - COVID-19 KW - Czech Republic KW - web app KW - interactive reporting KW - epidemiological overview KW - CRISP-DM KW - public health KW - app KW - epidemiology KW - virus KW - health data KW - data mining KW - modeling N2 - Background: The beginning of the coronavirus disease (COVID-19) epidemic dates back to December 31, 2019, when the first cases were reported in the People?s Republic of China. In the Czech Republic, the first three cases of infection with the novel coronavirus were confirmed on March 1, 2020. The joint effort of state authorities and researchers gave rise to a unique team, which combines methodical knowledge of real-world processes with the know-how needed for effective processing, analysis, and online visualization of data. Objective: Due to an urgent need for a tool that presents important reports based on valid data sources, a team of government experts and researchers focused on the design and development of a web app intended to provide a regularly updated overview of COVID-19 epidemiology in the Czech Republic to the general population. Methods: The cross-industry standard process for data mining model was chosen for the complex solution of analytical processing and visualization of data that provides validated information on the COVID-19 epidemic across the Czech Republic. Great emphasis was put on the understanding and a correct implementation of all six steps (business understanding, data understanding, data preparation, modelling, evaluation, and deployment) needed in the process, including the infrastructure of a nationwide information system; the methodological setting of communication channels between all involved stakeholders; and data collection, processing, analysis, validation, and visualization. Results: The web-based overview of the current spread of COVID-19 in the Czech Republic has been developed as an online platform providing a set of outputs in the form of tables, graphs, and maps intended for the general public. On March 12, 2020, the first version of the web portal, containing fourteen overviews divided into five topical sections, was released. The web portal?s primary objective is to publish a well-arranged visualization and clear explanation of basic information consisting of the overall numbers of performed tests, confirmed cases of COVID-19, COVID-19-related deaths, the daily and cumulative overviews of people with a positive COVID-19 case, performed tests, location and country of infection of people with a positive COVID-19 case, hospitalizations of patients with COVID-19, and distribution of personal protective equipment. Conclusions: The online interactive overview of the current spread of COVID-19 in the Czech Republic was launched on March 11, 2020, and has immediately become the primary communication channel employed by the health care sector to present the current situation regarding the COVID-19 epidemic. This complex reporting of the COVID-19 epidemic in the Czech Republic also shows an effective way to interconnect knowledge held by various specialists, such as regional and national methodology experts (who report positive cases of the disease on a daily basis), with knowledge held by developers of central registries, analysts, developers of web apps, and leaders in the health care sector. UR - http://www.jmir.org/2020/5/e19367/ UR - http://dx.doi.org/10.2196/19367 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412422 ID - info:doi/10.2196/19367 ER - TY - JOUR AU - Liao, Qiuyan AU - Yuan, Jiehu AU - Dong, Meihong AU - Yang, Lin AU - Fielding, Richard AU - Lam, Tak Wendy Wing PY - 2020/5/26 TI - Public Engagement and Government Responsiveness in the Communications About COVID-19 During the Early Epidemic Stage in China: Infodemiology Study on Social Media Data JO - J Med Internet Res SP - e18796 VL - 22 IS - 5 KW - risk communication KW - social media KW - epidemic KW - COVID-19 KW - pandemic KW - outbreak KW - infectious disease KW - content analysis N2 - 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 (?21=13.3, P<.001), attribute blame to other individuals or government (?21=28.9, P<.001), and express worry about the epidemic (?21=32.1, P<.001), while government posts were more likely to share instrumental support (?21=32.5, P<.001) and praise people or organizations (?21=8.7, P=.003). As the epidemic evolved, sharing situation updates (for trend, ?21=19.7, P<.001) and policies, guidelines, and official actions (for trend, ?21=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, ?21=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, ?21=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. UR - http://www.jmir.org/2020/5/e18796/ UR - http://dx.doi.org/10.2196/18796 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412414 ID - info:doi/10.2196/18796 ER - TY - JOUR AU - Laestadius, Linnea AU - Wang, Yang AU - Ben Taleb, Ziyad AU - Kalan, Ebrahimi Mohammad AU - Cho, Young AU - Manganello, Jennifer PY - 2020/5/26 TI - Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis JO - JMIR Public Health Surveill SP - e19501 VL - 6 IS - 2 KW - public health policy KW - infectious disease KW - personal protective equipment KW - public health KW - COVID-19 KW - pandemic KW - online health information KW - content analysis N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19501/ UR - http://dx.doi.org/10.2196/19501 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427103 ID - info:doi/10.2196/19501 ER - TY - JOUR AU - Katapally, R. Tarun PY - 2020/5/26 TI - A Global Digital Citizen Science Policy to Tackle Pandemics Like COVID-19 JO - J Med Internet Res SP - e19357 VL - 22 IS - 5 KW - COVID-19 KW - pandemic KW - citizen science KW - smartphones KW - population health KW - mHealth KW - eHealth KW - big data KW - virus KW - infectious diseases KW - public health KW - digital epidemiology UR - http://www.jmir.org/2020/5/e19357/ UR - http://dx.doi.org/10.2196/19357 UR - http://www.ncbi.nlm.nih.gov/pubmed/32408267 ID - info:doi/10.2196/19357 ER - TY - JOUR AU - Ho, J. Hanley AU - Zhang, Xiaozhu Zoe AU - Huang, Zhilian AU - Aung, Hein Aung AU - Lim, Wei-Yen AU - Chow, Angela PY - 2020/5/26 TI - Use of a Real-Time Locating System for Contact Tracing of Health Care Workers During the COVID-19 Pandemic at an Infectious Disease Center in Singapore: Validation Study JO - J Med Internet Res SP - e19437 VL - 22 IS - 5 KW - infectious disease KW - real-time locating systems KW - electronic medical records KW - COVID-19 KW - contact tracing KW - health care workers KW - RFID N2 - Background: In early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting. Objective: This study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore. Methods: Over a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers. Results: Of 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%). Conclusions: RTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary. UR - http://www.jmir.org/2020/5/e19437/ UR - http://dx.doi.org/10.2196/19437 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412416 ID - info:doi/10.2196/19437 ER - TY - JOUR AU - Huang, Qiangsheng AU - Kang, Sunny Yu PY - 2020/5/25 TI - Mathematical Modeling of COVID-19 Control and Prevention Based on Immigration Population Data in China: Model Development and Validation JO - JMIR Public Health Surveill SP - e18638 VL - 6 IS - 2 KW - COVID-19 KW - 2019-ncov KW - epidemic control and prevention KW - epidemic risk time series model KW - incoming immigration population KW - new diagnoses per day N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18638/ UR - http://dx.doi.org/10.2196/18638 UR - http://www.ncbi.nlm.nih.gov/pubmed/32396132 ID - info:doi/10.2196/18638 ER - TY - JOUR AU - Lwin, Oo May AU - Lu, Jiahui AU - Sheldenkar, Anita AU - Schulz, Johannes Peter AU - Shin, Wonsun AU - Gupta, Raj AU - Yang, Yinping PY - 2020/5/22 TI - Global Sentiments Surrounding the COVID-19 Pandemic on Twitter: Analysis of Twitter Trends JO - JMIR Public Health Surveill SP - e19447 VL - 6 IS - 2 KW - COVID-19 KW - Twitter KW - pandemic KW - social sentiments KW - emotions KW - infodemic N2 - Background: With the World Health Organization?s pandemic declaration and government-initiated actions against coronavirus disease (COVID-19), sentiments surrounding COVID-19 have evolved rapidly. Objective: This study aimed to examine worldwide trends of four emotions?fear, anger, sadness, and joy?and the narratives underlying those emotions during the COVID-19 pandemic. Methods: Over 20 million social media twitter posts made during the early phases of the COVID-19 outbreak from January 28 to April 9, 2020, were collected using ?wuhan,? ?corona,? ?nCov,? and ?covid? as search keywords. Results: Public emotions shifted strongly from fear to anger over the course of the pandemic, while sadness and joy also surfaced. Findings from word clouds suggest that fears around shortages of COVID-19 tests and medical supplies became increasingly widespread discussion points. Anger shifted from xenophobia at the beginning of the pandemic to discourse around the stay-at-home notices. Sadness was highlighted by the topics of losing friends and family members, while topics related to joy included words of gratitude and good health. Conclusions: Overall, global COVID-19 sentiments have shown rapid evolutions within just the span of a few weeks. Findings suggest that emotion-driven collective issues around shared public distress experiences of the COVID-19 pandemic are developing and include large-scale social isolation and the loss of human lives. The steady rise of societal concerns indicated by negative emotions needs to be monitored and controlled by complementing regular crisis communication with strategic public health communication that aims to balance public psychological wellbeing. UR - http://publichealth.jmir.org/2020/2/e19447/ UR - http://dx.doi.org/10.2196/19447 UR - http://www.ncbi.nlm.nih.gov/pubmed/32412418 ID - info:doi/10.2196/19447 ER - TY - JOUR AU - Goodman-Casanova, Marian Jessica AU - Dura-Perez, Elena AU - Guzman-Parra, Jose AU - Cuesta-Vargas, Antonio AU - Mayoral-Cleries, Fermin PY - 2020/5/22 TI - Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study JO - J Med Internet Res SP - e19434 VL - 22 IS - 5 KW - telehealth KW - confinement KW - coronavirus KW - COVID-19 KW - well-being KW - emergency response KW - public health KW - mental health KW - physical health KW - elderly KW - older adults KW - cognitive impairment KW - dementia N2 - 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 UR - http://www.jmir.org/2020/5/e19434/ UR - http://dx.doi.org/10.2196/19434 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401215 ID - info:doi/10.2196/19434 ER - TY - JOUR AU - Higgins, S. Thomas AU - Wu, W. Arthur AU - Sharma, Dhruv AU - Illing, A. Elisa AU - Rubel, Kolin AU - Ting, Y. Jonathan AU - PY - 2020/5/21 TI - Correlations of Online Search Engine Trends With Coronavirus Disease (COVID-19) Incidence: Infodemiology Study JO - JMIR Public Health Surveill SP - e19702 VL - 6 IS - 2 KW - COVID-19 KW - coronavirus KW - big data KW - infodemiology KW - infoveillance KW - Baidu KW - SARS-CoV-2 KW - Google Trends KW - digital health KW - epidemiology KW - China KW - Italy KW - Spain KW - New York KW - Washington N2 - Background: The coronavirus disease (COVID-19) is the latest pandemic of the digital age. With the internet harvesting large amounts of data from the general population in real time, public databases such as Google Trends (GT) and the Baidu Index (BI) can be an expedient tool to assist public health efforts. Objective: The aim of this study is to apply digital epidemiology to the current COVID-19 pandemic to determine the utility of providing adjunctive epidemiologic information on outbreaks of this disease and evaluate this methodology in the case of future pandemics. Methods: An epidemiologic time series analysis of online search trends relating to the COVID-19 pandemic was performed from January 9, 2020, to April 6, 2020. BI was used to obtain online search data for China, while GT was used for worldwide data, the countries of Italy and Spain, and the US states of New York and Washington. These data were compared to real-world confirmed cases and deaths of COVID-19. Chronologic patterns were assessed in relation to disease patterns, significant events, and media reports. Results: Worldwide search terms for shortness of breath, anosmia, dysgeusia and ageusia, headache, chest pain, and sneezing had strong correlations (r>0.60, P<.001) to both new daily confirmed cases and deaths from COVID-19. GT COVID-19 (search term) and GT coronavirus (virus) searches predated real-world confirmed cases by 12 days (r=0.85, SD 0.10 and r=0.76, SD 0.09, respectively, P<.001). Searches for symptoms of diarrhea, fever, shortness of breath, cough, nasal obstruction, and rhinorrhea all had a negative lag greater than 1 week compared to new daily cases, while searches for anosmia and dysgeusia peaked worldwide and in China with positive lags of 5 days and 6 weeks, respectively, corresponding with widespread media coverage of these symptoms in COVID-19. Conclusions: This study demonstrates the utility of digital epidemiology in providing helpful surveillance data of disease outbreaks like COVID-19. Although certain online search trends for this disease were influenced by media coverage, many search terms reflected clinical manifestations of the disease and showed strong correlations with real-world cases and deaths. UR - https://publichealth.jmir.org/2020/2/e19702 UR - http://dx.doi.org/10.2196/19702 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401211 ID - info:doi/10.2196/19702 ER - TY - JOUR AU - Sesagiri Raamkumar, Aravind AU - Tan, Guan Soon AU - Wee, Lin Hwee PY - 2020/5/19 TI - Measuring the Outreach Efforts of Public Health Authorities and the Public Response on Facebook During the COVID-19 Pandemic in Early 2020: Cross-Country Comparison JO - J Med Internet Res SP - e19334 VL - 22 IS - 5 KW - COVID-19 KW - sentiment analysis KW - emotion analysis KW - public health authorities KW - infectious disease KW - outbreak KW - public engagement KW - social media KW - public health KW - virus N2 - Background: The coronavirus disease (COVID-19) pandemic presents one of the most challenging global crises at the dawn of a new decade. Public health authorities (PHAs) are increasingly adopting the use of social media such as Facebook to rapidly communicate and disseminate pandemic response measures to the public. Understanding of communication strategies across different PHAs and examining the public response on the social media landscapes can help improve practices for disseminating information to the public. Objective: This study aims to examine COVID-19-related outreach efforts of PHAs in Singapore, the United States, and England, and the corresponding public response to these outreach efforts on Facebook. Methods: Posts and comments from the Facebook pages of the Ministry of Health (MOH) in Singapore, the Centers for Disease Control and Prevention (CDC) in the United States, and Public Health England (PHE) in England were extracted from January 1, 2019, to March 18, 2020. Posts published before January 1, 2020, were categorized as pre-COVID-19, while the remaining posts were categorized as peri-COVID-19 posts. COVID-19-related posts were identified and classified into themes. Metrics used for measuring outreach and engagement were frequency, mean posts per day (PPD), mean reactions per post, mean shares per post, and mean comments per post. Responses to the COVID-19 posts were measured using frequency, mean sentiment polarity, positive to negative sentiments ratio (PNSR), and positive to negative emotions ratio (PNER). Toxicity in comments were identified and analyzed using frequency, mean likes per toxic comment, and mean replies per toxic comment. Trend analysis was performed to examine how the metrics varied with key events such as when COVID-19 was declared a pandemic. Results: The MOH published more COVID-19 posts (n=271; mean PPD 5.0) compared to the CDC (n=94; mean PPD 2.2) and PHE (n=45; mean PPD 1.4). The mean number of comments per COVID-19 post was highest for the CDC (mean CPP 255.3) compared to the MOH (mean CPP 15.6) and PHE (mean CPP 12.5). Six major themes were identified, with posts about prevention and safety measures and situation updates being prevalent across the three PHAs. The themes of the MOH?s posts were diverse, while the CDC and PHE posts focused on a few themes. Overall, response sentiments for the MOH posts (PNSR 0.94) were more favorable compared to response sentiments for the CDC (PNSR 0.57) and PHE (PNSR 0.55) posts. Toxic comments were rare (0.01%) across all PHAs. Conclusions: PHAs? extent of Facebook use for outreach purposes during the COVID-19 pandemic varied among the three PHAs, highlighting the strategies and approaches that other PHAs can potentially adopt. Our study showed that social media analysis was capable of providing insights about the communication strategies of PHAs during disease outbreaks. UR - http://www.jmir.org/2020/5/e19334/ UR - http://dx.doi.org/10.2196/19334 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401219 ID - info:doi/10.2196/19334 ER - TY - JOUR AU - Ahmad, Ramazan Araz AU - Murad, Rasool Hersh PY - 2020/5/19 TI - The Impact of Social Media on Panic During the COVID-19 Pandemic in Iraqi Kurdistan: Online Questionnaire Study JO - J Med Internet Res SP - e19556 VL - 22 IS - 5 KW - social media KW - COVID-19 KW - infodemic KW - panic KW - mental health KW - fake news KW - misinformation KW - impact KW - Kurdistan region KW - Iraq N2 - Background: In the first few months of 2020, information and news reports about the coronavirus disease (COVID-19) were rapidly published and shared on social media and social networking sites. While the field of infodemiology has studied information patterns on the Web and in social media for at least 18 years, the COVID-19 pandemic has been referred to as the first social media infodemic. However, there is limited evidence about whether and how the social media infodemic has spread panic and affected the mental health of social media users. Objective: The aim of this study is to determine how social media affects self-reported mental health and the spread of panic about COVID-19 in the Kurdistan Region of Iraq. Methods: To carry out this study, an online questionnaire was prepared and conducted in Iraqi Kurdistan, and a total of 516 social media users were sampled. This study deployed a content analysis method for data analysis. Correspondingly, data were analyzed using SPSS software. Results: Participants reported that social media has a significant impact on spreading fear and panic related to the COVID-19 outbreak in Iraqi Kurdistan, with a potential negative influence on people?s mental health and psychological well-being. Facebook was the most used social media network for spreading panic about the COVID-19 outbreak in Iraq. We found a significant positive statistical correlation between self-reported social media use and the spread of panic related to COVID-19 (R=.8701). Our results showed that the majority of youths aged 18-35 years are facing psychological anxiety. Conclusions: During lockdown, people are using social media platforms to gain information about COVID-19. The nature of the impact of social media panic among people varies depending on an individual's gender, age, and level of education. Social media has played a key role in spreading anxiety about the COVID-19 outbreak in Iraqi Kurdistan. UR - http://www.jmir.org/2020/5/e19556/ UR - http://dx.doi.org/10.2196/19556 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369026 ID - info:doi/10.2196/19556 ER - TY - JOUR AU - Huang, Chunmei AU - Xu, Xinjie AU - Cai, Yuyang AU - Ge, Qinmin AU - Zeng, Guangwang AU - Li, Xiaopan AU - Zhang, Weide AU - Ji, Chen AU - Yang, Ling PY - 2020/5/17 TI - Mining the Characteristics of COVID-19 Patients in China: Analysis of Social Media Posts JO - J Med Internet Res SP - e19087 VL - 22 IS - 5 KW - SARS-CoV-2 KW - COVID-19 KW - coronavirus disease KW - social media KW - Sina Weibo KW - help N2 - 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. UR - http://www.jmir.org/2020/5/e19087/ UR - http://dx.doi.org/10.2196/19087 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401210 ID - info:doi/10.2196/19087 ER - TY - JOUR AU - Gamble, Anissa AU - Pham, Quynh AU - Goyal, Shivani AU - Cafazzo, A. Joseph PY - 2020/5/15 TI - The Challenges of COVID-19 for People Living With Diabetes: Considerations for Digital Health JO - JMIR Diabetes SP - e19581 VL - 5 IS - 2 KW - diabetes KW - digital health KW - COVID-19 KW - pandemic UR - http://diabetes.jmir.org/2020/2/e19581/ UR - http://dx.doi.org/10.2196/19581 UR - http://www.ncbi.nlm.nih.gov/pubmed/32392473 ID - info:doi/10.2196/19581 ER - TY - JOUR AU - Krausz, Michael AU - Westenberg, Nicolas Jean AU - Vigo, Daniel AU - Spence, Trafford Richard AU - Ramsey, Damon PY - 2020/5/15 TI - Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management JO - JMIR Public Health Surveill SP - e18995 VL - 6 IS - 2 KW - eHealth KW - digital health KW - web-based intervention KW - crisis management KW - COVID-19 KW - public health KW - health care system N2 - Background: Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. Objective: The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. Methods: An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system?s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. Results: The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. Conclusions: Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies. UR - http://publichealth.jmir.org/2020/2/e18995/ UR - http://dx.doi.org/10.2196/18995 UR - http://www.ncbi.nlm.nih.gov/pubmed/32401218 ID - info:doi/10.2196/18995 ER - TY - JOUR AU - Gesser-Edelsburg, Anat AU - Cohen, Ricky AU - Hijazi, Rana AU - Abed Elhadi Shahbari, Nour PY - 2020/5/15 TI - Analysis of Public Perception of the Israeli Government?s Early Emergency Instructions Regarding COVID-19: Online Survey Study JO - J Med Internet Res SP - e19370 VL - 22 IS - 5 KW - covid-19 KW - risk KW - perception KW - crisis management KW - economical threat KW - compliance to guidelines KW - spokesperson credibility KW - source of information credibility KW - online survey KW - public health KW - pandemic N2 - Background: On March 11, 2020, the World Health Organization (WHO) officially declared coronavirus disease (COVID-19) to be a pandemic. This posed challenges to many countries, prominent among which is communication with the public to gain their cooperation. Israel faces different challenges from other countries in its management of the COVID-19 crisis because it is in the midst of a deep constitutional crisis. Objective: The objective of this paper was to examine the response of the Israeli public to the government?s emergency instructions regarding the pandemic in terms of correlations between overall risk perception and crisis management; overall risk perception and economic threat perception; crisis management and compliance with behavioral guidelines; and crisis management and economic threat perception. We also made comparisons between crisis management and spokesperson credibility and between crisis management and the credibility of information sources. Methods: The sample was established using an online survey that enabled rapid and effective distribution of an online questionnaire during the COVID-19 crisis. The self-selection online survey method of nonprobability sampling was used to recruit participants (N=1056) through social network posts asking the general public (aged ?18 years) to answer the survey. Results: Participants aged ?65 years perceived higher personal risk compared to those aged 18-30 years (mean difference 0.33, 95% CI 0.04-0.61) and those aged 46-64 years (mean difference 0.38, 95% CI 0.12-0.64). Significant correlations were found between overall risk perception and attitudes toward crisis management (r=0.19, P<.001), overall risk perception and economic threat perception (r=0.22, P<.001), attitudes toward crisis management and compliance with behavioral guidelines (r=0.15, P<.001), and attitudes toward crisis management and economic threat perception (r=?0.15, P<.001). Participants who perceived that the prime minister was the most credible spokesperson evaluated the crisis management significantly higher than all other groups. The crisis management was evaluated significantly lower by participants who stated that infectious disease specialists were the most credible spokespersons. Participants for whom the Ministry of Health website was the most credible source of information evaluated the crisis management higher than all other groups. Participants for whom scientific articles were the most credible source of information evaluated the crisis management lower than those who perceived that the WHO/Centers for Disease Control and Prevention websites or Ministry of Health/hospital websites and health care workers were the most credible. Conclusions: The higher the public trust and evaluation of crisis management, the greater the compliance of the public with guidelines. It was also found that crisis management and information cannot be approached in the same way for the overall public. Furthermore, unlike other epidemics, the COVID-19 crisis has widespread economic and social consequences; therefore, it is impossible to focus only on health risks without communicating economic and social risks as well. UR - http://www.jmir.org/2020/5/e19370/ UR - http://dx.doi.org/10.2196/19370 UR - http://www.ncbi.nlm.nih.gov/pubmed/32392172 ID - info:doi/10.2196/19370 ER - TY - JOUR AU - Victor Okhuese, Alexander PY - 2020/5/13 TI - Estimation of the Probability of Reinfection With COVID-19 by the Susceptible-Exposed-Infectious-Removed-Undetectable-Susceptible Model JO - JMIR Public Health Surveill SP - e19097 VL - 6 IS - 2 KW - infectious KW - disease KW - reinfection KW - model KW - math KW - COVID-19 KW - coronavirus KW - pandemic KW - outbreak KW - SEIRUS N2 - Background: With the sensitivity of the polymerase chain reaction test used to detect the presence of the virus in the human host, the worldwide health community has been able to record a large number of the recovered population. Objective: The aim of this study was to evaluate the probability of reinfection in the recovered class and the model equations, which exhibits the disease-free equilibrium state for the coronavirus disease. Methods: The model differential equation was evaluated for the disease-free equilibrium for the case of reinfection as well as the existence and stability criteria for the disease, using the model proportions. This evaluation shows that the criteria for a local or worldwide asymptotic stability with a basic reproductive number (R0=0) were satisfied. Hence, there is a chance of no secondary reinfections from the recovered population, as the rate of incidence of the recovered population vanishes (ie, B=0). Results: With a total of about 900,000 infected cases worldwide, numerical simulations for this study were carried out to complement the analytical results and investigate the effect that the implementation of quarantine and observation procedures has on the projection of further virus spread. Conclusions: As shown by the results, the proportion of the infected population, in the absence of a curative vaccination, will continue to grow worldwide; meanwhile, the recovery rate will continue slowly, which means that the ratio of infection rate to recovery rate will determine the death rate that is recorded. Most significant for this study is the rate of reinfection by the recovered population, which will decline to zero over time as the virus is cleared clinically from the system of the recovered class. UR - http://publichealth.jmir.org/2020/2/e19097/ UR - http://dx.doi.org/10.2196/19097 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369029 ID - info:doi/10.2196/19097 ER - TY - JOUR AU - Rogosnitzky, Moshe AU - Berkowitz, Esther AU - Jadad, R. Alejandro PY - 2020/5/13 TI - Delivering Benefits at Speed Through Real-World Repurposing of Off-Patent Drugs: The COVID-19 Pandemic as a Case in Point JO - JMIR Public Health Surveill SP - e19199 VL - 6 IS - 2 KW - COVID-19 KW - drug costs KW - drug repositioning KW - drugs, generic KW - off-label use KW - public health KW - severe acute respiratory syndrome coronavirus 2 KW - pandemic KW - crisis UR - http://publichealth.jmir.org/2020/2/e19199/ UR - http://dx.doi.org/10.2196/19199 UR - http://www.ncbi.nlm.nih.gov/pubmed/32374264 ID - info:doi/10.2196/19199 ER - TY - JOUR AU - Huang, Yu AU - Wu, Qingqing AU - Wang, Ping AU - Xu, Yan AU - Wang, Lei AU - Zhao, Yusui AU - Yao, Dingming AU - Xu, Yue AU - Lv, Qiaohong AU - Xu, Shuiyang PY - 2020/5/12 TI - Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study JO - J Med Internet Res SP - e18718 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus disease KW - response KW - strategy KW - preventive measures KW - internet-based research KW - health QR code KW - outbreak KW - infectious disease KW - health education N2 - Background: In early 2020, over 80,000 cases of coronavirus disease (COVID-19) were confirmed in China. Public prevention and control measures, along with efforts from all sectors of society, were undertaken to control and eliminate disease transmission. Objective: This paper describes Chinese citizens? response to the epidemic, the preventive measures they implemented to avoid being infected, and the public strategies that were carried out by the government, health workers, etc. We also discuss the efficacy of these measures in controlling the epidemic in China. Methods: Information on the responses and behaviors of Chinese citizens were collected through a cross-sectional, internet-based survey using Dingxiang Doctor?s public account on WeChat. Information on public strategies implemented by all sectors of society to control the epidemic and data on new COVID-19 cases were collected from the internet, mainly from government websites. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data. Results: A total of 10,304 participants responded to the survey, with 10,198 valid responses; 74.1% (n=7557) were female and 25.9% (n=2641) were male. Overall, 98.2% (n=10,013) of participants paid high or very high attention to the epidemic, with WeChat being their main information source (n=9400, 92.2%). Over half the participants (n=5878, 57.7%) were confident that the epidemic could be curbed in China; 92.4% (n=9427) opened windows for ventilation more frequently than usual; 97.9% (n=9986) used masks in public; 95.7% (n=9759) avoided large crowds and stayed at home as much as possible; and 97.9% (n=9988) washed their hands more often than usual. Women were more likely to practice these behaviors than men (P<.001). With a series of strict public control measures, like nationwide health education campaigns, holiday extensions, the Examine and Approve Policy on the resumption of work, close management of working and living quarters, a health QR (Quick Response) code system, community screening, and social distancing policies, the number of new cases have decreased dramatically since February 12, 2020. Conclusions: The methods employed by Chinese citizens and authorities have effectively curtailed the spread of COVID-19, demonstrating that this pandemic can be brought under control as long as the right measures are taken. UR - http://www.jmir.org/2020/5/e18718/ UR - http://dx.doi.org/10.2196/18718 UR - http://www.ncbi.nlm.nih.gov/pubmed/32396516 ID - info:doi/10.2196/18718 ER - TY - JOUR AU - Ni, Y. Michael AU - Yang, Lin AU - Leung, C. Candi M. AU - Li, Na AU - Yao, I. Xiaoxin AU - Wang, Yishan AU - Leung, M. Gabriel AU - Cowling, J. Benjamin AU - Liao, Qiuyan PY - 2020/5/12 TI - Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey JO - JMIR Ment Health SP - e19009 VL - 7 IS - 5 KW - COVID-19 KW - nonpharmaceutical interventions KW - population mental health KW - depression KW - anxiety KW - community KW - health professionals KW - social media KW - WeChat KW - pandemic KW - outbreak KW - public health KW - mental health KW - intervention N2 - Background: The mental health consequences of the coronavirus disease (COVID-19) pandemic, community-wide interventions, and social media use during a pandemic are unclear. The first and most draconian interventions have been implemented in Wuhan, China, and these countermeasures have been increasingly deployed by countries around the world. Objective: The aim of this study was to examine risk factors, including the use of social media, for probable anxiety and depression in the community and among health professionals in the epicenter, Wuhan, China. Methods: We conducted an online survey via WeChat, the most widely used social media platform in China, which was administered to 1577 community-based adults and 214 health professionals in Wuhan. Probable anxiety and probable depression were assessed by the validated Generalized Anxiety Disorder-2 (cutoff ?3) and Patient Health Questionnaire-2 (cutoff ?3), respectively. A multivariable logistic regression analysis was used to examine factors associated with probable anxiety and probable depression. Results: Of the 1577 community-based adults, about one-fifth of respondents reported probable anxiety (n=376, 23.84%, 95% CI 21.8-26.0) and probable depression (n=303, 19.21%, 95% CI 17.3-21.2). Similarly, of the 214 health professionals, about one-fifth of surveyed health professionals reported probable anxiety (n=47, 22.0%, 95% CI 16.6-28.1) or probable depression (n=41, 19.2%, 95% CI 14.1-25.1). Around one-third of community-based adults and health professionals spent ?2 hours daily on COVID-19 news via social media. Close contact with individuals with COVID-19 and spending ?2 hours daily on COVID-19 news via social media were associated with probable anxiety and depression in community-based adults. Social support was associated with less probable anxiety and depression in both health professionals and community-based adults. Conclusions: The internet could be harnessed for telemedicine and restoring daily routines, yet caution is warranted toward spending excessive time searching for COVID-19 news on social media given the infodemic and emotional contagion through online social networks. Online platforms may be used to monitor the toll of the pandemic on mental health. UR - https://mental.jmir.org/2020/5/e19009 UR - http://dx.doi.org/10.2196/19009 UR - http://www.ncbi.nlm.nih.gov/pubmed/32365044 ID - info:doi/10.2196/19009 ER - TY - JOUR AU - Yamahata, Yoshihiro AU - Shibata, Ayako PY - 2020/5/11 TI - Preparation for Quarantine on the Cruise Ship Diamond Princess in Japan due to COVID-19 JO - JMIR Public Health Surveill SP - e18821 VL - 6 IS - 2 KW - SARS-CoV-2 KW - COVID-19 KW - infectious control KW - cruise ship quarantine KW - pandemic KW - outbreak KW - surveillance KW - preparation KW - infectious disease KW - public health KW - quarantine N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18821/ UR - http://dx.doi.org/10.2196/18821 UR - http://www.ncbi.nlm.nih.gov/pubmed/32365046 ID - info:doi/10.2196/18821 ER - TY - JOUR AU - Clements, M. John PY - 2020/5/8 TI - Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire JO - JMIR Public Health Surveill SP - e19161 VL - 6 IS - 2 KW - public health KW - surveillance KW - COVID-19 KW - knowledge KW - behavior KW - outbreak KW - infectious disease KW - health information N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19161/ UR - http://dx.doi.org/10.2196/19161 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369759 ID - info:doi/10.2196/19161 ER - TY - JOUR AU - Sheehy, Mary Lisa PY - 2020/5/8 TI - Considerations for Postacute Rehabilitation for Survivors of COVID-19 JO - JMIR Public Health Surveill SP - e19462 VL - 6 IS - 2 KW - covid-19 KW - rehabilitation KW - subacute care KW - inpatient rehabilitation KW - public health KW - infectious disease KW - virus KW - patient outcome KW - geriatric KW - treatment KW - recovery UR - http://publichealth.jmir.org/2020/2/e19462/ UR - http://dx.doi.org/10.2196/19462 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369030 ID - info:doi/10.2196/19462 ER - TY - JOUR AU - Hong, Zhen AU - Li, Nian AU - Li, Dajiang AU - Li, Junhua AU - Li, Bing AU - Xiong, Weixi AU - Lu, Lu AU - Li, Weimin AU - Zhou, Dong PY - 2020/5/8 TI - Telemedicine During the COVID-19 Pandemic: Experiences From Western China JO - J Med Internet Res SP - e19577 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus disease KW - medical education KW - pandemics KW - teleteaching KW - tele-education KW - telemedicine UR - http://www.jmir.org/2020/5/e19577/ UR - http://dx.doi.org/10.2196/19577 UR - http://www.ncbi.nlm.nih.gov/pubmed/32349962 ID - info:doi/10.2196/19577 ER - TY - JOUR AU - Ambikapathy, Bakiya AU - Krishnamurthy, Kamalanand PY - 2020/5/7 TI - Mathematical Modelling to Assess the Impact of Lockdown on COVID-19 Transmission in India: Model Development and Validation JO - JMIR Public Health Surveill SP - e19368 VL - 6 IS - 2 KW - covid-19 KW - coronavirus KW - epidemic KW - mathematical modelling KW - pandemic KW - sars N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19368/ UR - http://dx.doi.org/10.2196/19368 UR - http://www.ncbi.nlm.nih.gov/pubmed/32365045 ID - info:doi/10.2196/19368 ER - TY - JOUR AU - Goethals, Luc AU - Barth, Nathalie AU - Guyot, Jessica AU - Hupin, David AU - Celarier, Thomas AU - Bongue, Bienvenu PY - 2020/5/7 TI - Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study JO - JMIR Aging SP - e19007 VL - 3 IS - 1 KW - older adults KW - physical activity KW - COVID-19 KW - social marketing N2 - Background: Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults. Objective: Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle. Methods: We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews. Results: This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context. Conclusions: Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home. UR - http://aging.jmir.org/2020/1/e19007/ UR - http://dx.doi.org/10.2196/19007 UR - http://www.ncbi.nlm.nih.gov/pubmed/32356777 ID - info:doi/10.2196/19007 ER - TY - JOUR AU - Ahmed, Wasim AU - Vidal-Alaball, Josep AU - Downing, Joseph AU - López Seguí, Francesc PY - 2020/5/6 TI - COVID-19 and the 5G Conspiracy Theory: Social Network Analysis of Twitter Data JO - J Med Internet Res SP - e19458 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus KW - twitter KW - misinformation KW - fake news KW - 5G KW - social network analysis KW - social media KW - public health KW - pandemic N2 - Background: Since the beginning of December 2019, the coronavirus disease (COVID-19) has spread rapidly around the world, which has led to increased discussions across online platforms. These conversations have also included various conspiracies shared by social media users. Amongst them, a popular theory has linked 5G to the spread of COVID-19, leading to misinformation and the burning of 5G towers in the United Kingdom. The understanding of the drivers of fake news and quick policies oriented to isolate and rebate misinformation are keys to combating it. Objective: The aim of this study is to develop an understanding of the drivers of the 5G COVID-19 conspiracy theory and strategies to deal with such misinformation. Methods: This paper performs a social network analysis and content analysis of Twitter data from a 7-day period (Friday, March 27, 2020, to Saturday, April 4, 2020) in which the #5GCoronavirus hashtag was trending on Twitter in the United Kingdom. Influential users were analyzed through social network graph clusters. The size of the nodes were ranked by their betweenness centrality score, and the graph?s vertices were grouped by cluster using the Clauset-Newman-Moore algorithm. The topics and web sources used were also examined. Results: Social network analysis identified that the two largest network structures consisted of an isolates group and a broadcast group. The analysis also revealed that there was a lack of an authority figure who was actively combating such misinformation. Content analysis revealed that, of 233 sample tweets, 34.8% (n=81) contained views that 5G and COVID-19 were linked, 32.2% (n=75) denounced the conspiracy theory, and 33.0% (n=77) were general tweets not expressing any personal views or opinions. Thus, 65.2% (n=152) of tweets derived from nonconspiracy theory supporters, which suggests that, although the topic attracted high volume, only a handful of users genuinely believed the conspiracy. This paper also shows that fake news websites were the most popular web source shared by users; although, YouTube videos were also shared. The study also identified an account whose sole aim was to spread the conspiracy theory on Twitter. Conclusions: The combination of quick and targeted interventions oriented to delegitimize the sources of fake information is key to reducing their impact. Those users voicing their views against the conspiracy theory, link baiting, or sharing humorous tweets inadvertently raised the profile of the topic, suggesting that policymakers should insist in the efforts of isolating opinions that are based on fake news. Many social media platforms provide users with the ability to report inappropriate content, which should be used. This study is the first to analyze the 5G conspiracy theory in the context of COVID-19 on Twitter offering practical guidance to health authorities in how, in the context of a pandemic, rumors may be combated in the future. UR - http://www.jmir.org/2020/5/e19458/ UR - http://dx.doi.org/10.2196/19458 UR - http://www.ncbi.nlm.nih.gov/pubmed/32352383 ID - info:doi/10.2196/19458 ER - TY - JOUR AU - Meinert, Edward AU - Milne-Ives, Madison AU - Surodina, Svitlana AU - Lam, Ching PY - 2020/5/6 TI - Agile Requirements Engineering and Software Planning for a Digital Health Platform to Engage the Effects of Isolation Caused by Social Distancing: Case Study JO - JMIR Public Health Surveill SP - e19297 VL - 6 IS - 2 KW - telemedicine KW - information science KW - data science KW - COVID-19 KW - coronavirus KW - public reporting of healthcare data KW - health care quality, access and evaluation KW - aged KW - mental health KW - exercise KW - cellphone KW - artificial intelligence KW - agile KW - requirements engineering KW - social distancing KW - digital health KW - app N2 - Background: Social distancing and shielding measures have been put in place to reduce social interaction and slow the transmission of the coronavirus disease (COVID-19). For older people, self-isolation presents particular challenges for mental health and social relationships. As time progresses, continued social distancing could have a compounding impact on these concerns. Objective: This project aims to provide a tool for older people and their families and peers to improve their well-being and health during and after regulated social distancing. First, we will evaluate the tool?s feasibility, acceptability, and usability to encourage positive nutrition, enhance physical activity, and enable virtual interaction while social distancing. Second, we will be implementing the app to provide an online community to assist families and peer groups in maintaining contact with older people using goal setting. Anonymized data from the app will be aggregated with other real-world data sources to develop a machine learning algorithm to improve the identification of patients with COVID-19 and track for real time use by health systems. Methods: Development of this project is occurring at the time of publication, and therefore, a case study design was selected to provide a systematic means of capturing software engineering in progress. The app development framework for software design was based on agile methods. The evaluation of the app?s feasibility, acceptability and usability shall be conducted using Public Health England's guidance on evaluating digital health products, Bandura?s model of health promotion, the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework and the Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Suitability (NASSS) framework. Results: Making use of a pre-existing software framework for health behavior change, a proof of concept was developed, and a multistage app development and deployment for the solution was created. Grant submissions to fund the project and study execution have been sought at the time of publication, and prediscovery iteration of the solution has begun. Ethical approval for a feasibility study design is being sought. Conclusions: This case study lays the foundations for future app development to combat mental and societal issues arising from social distancing measures. The app will be tested and evaluated in future studies to allow continuous improvement of the app. This novel contribution will provide an evidence-based exemplar for future app development in the space of social isolation and loneliness. UR - http://publichealth.jmir.org/2020/2/e19297/ UR - http://dx.doi.org/10.2196/19297 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348293 ID - info:doi/10.2196/19297 ER - TY - JOUR AU - Farooq, Ali AU - Laato, Samuli AU - Islam, Najmul A. K. M. PY - 2020/5/6 TI - Impact of Online Information on Self-Isolation Intention During the COVID-19 Pandemic: Cross-Sectional Study JO - J Med Internet Res SP - e19128 VL - 22 IS - 5 KW - COVID-19 KW - pandemic KW - self-isolation KW - behavior KW - protection motivation theory KW - cyberchondria KW - information overload N2 - Background: During the coronavirus disease (COVID-19) pandemic, governments issued movement restrictions and placed areas into quarantine to combat the spread of the disease. In addition, individuals were encouraged to adopt personal health measures such as social isolation. Information regarding the disease and recommended avoidance measures were distributed through a variety of channels including social media, news websites, and emails. Previous research suggests that the vast amount of available information can be confusing, potentially resulting in overconcern and information overload. Objective: This study investigates the impact of online information on the individual-level intention to voluntarily self-isolate during the pandemic. Using the protection-motivation theory as a framework, we propose a model outlining the effects of cyberchondria and information overload on individuals? perceptions and motivations. Methods: To test the proposed model, we collected data with an online survey (N=225) and analyzed it using partial least square-structural equation modeling. The effects of social media and living situation were tested through multigroup analysis. Results: Cyberchondria and information overload had a significant impact on individuals? threat and coping perceptions, and through them on self-isolation intention. Among the appraisal constructs, perceived severity (P=.002) and self-efficacy (P=.003) positively impacted self-isolation intention, while response cost (P<.001) affected the intention negatively. Cyberchondria (P=.003) and information overload (P=.003) indirectly affected self-isolation intention through the aforementioned perceptions. Using social media as an information source increased both cyberchondria and information overload. No differences in perceptions were found between people living alone and those living with their families. Conclusions: During COVID-19, frequent use of social media contributed to information overload and overconcern among individuals. To boost individuals? motivation to adopt preventive measures such as self-isolation, actions should focus on lowering individuals? perceived response costs in addition to informing them about the severity of the situation. UR - http://www.jmir.org/2020/5/e19128/ UR - http://dx.doi.org/10.2196/19128 UR - http://www.ncbi.nlm.nih.gov/pubmed/32330115 ID - info:doi/10.2196/19128 ER - TY - JOUR AU - Budhwani, Henna AU - Sun, Ruoyan PY - 2020/5/6 TI - Creating COVID-19 Stigma by Referencing the Novel Coronavirus as the ?Chinese virus? on Twitter: Quantitative Analysis of Social Media Data JO - J Med Internet Res SP - e19301 VL - 22 IS - 5 KW - COVID-19 KW - coronavirus KW - Twitter KW - stigma KW - social media KW - public health N2 - Background: Stigma is the deleterious, structural force that devalues members of groups that hold undesirable characteristics. Since stigma is created and reinforced by society?through in-person and online social interactions?referencing the novel coronavirus as the ?Chinese virus? or ?China virus? has the potential to create and perpetuate stigma. Objective: The aim of this study was to assess if there was an increase in the prevalence and frequency of the phrases ?Chinese virus? and ?China virus? on Twitter after the March 16, 2020, US presidential reference of this term. Methods: Using the Sysomos software (Sysomos, Inc), we extracted tweets from the United States using a list of keywords that were derivatives of ?Chinese virus.? We compared tweets at the national and state levels posted between March 9 and March 15 (preperiod) with those posted between March 19 and March 25 (postperiod). We used Stata 16 (StataCorp) for quantitative analysis, and Python (Python Software Foundation) to plot a state-level heat map. Results: A total of 16,535 ?Chinese virus? or ?China virus? tweets were identified in the preperiod, and 177,327 tweets were identified in the postperiod, illustrating a nearly ten-fold increase at the national level. All 50 states witnessed an increase in the number of tweets exclusively mentioning ?Chinese virus? or ?China virus? instead of coronavirus disease (COVID-19) or coronavirus. On average, 0.38 tweets referencing ?Chinese virus? or ?China virus? were posted per 10,000 people at the state level in the preperiod, and 4.08 of these stigmatizing tweets were posted in the postperiod, also indicating a ten-fold increase. The 5 states with the highest number of postperiod ?Chinese virus? tweets were Pennsylvania (n=5249), New York (n=11,754), Florida (n=13,070), Texas (n=14,861), and California (n=19,442). Adjusting for population size, the 5 states with the highest prevalence of postperiod ?Chinese virus? tweets were Arizona (5.85), New York (6.04), Florida (6.09), Nevada (7.72), and Wyoming (8.76). The 5 states with the largest increase in pre- to postperiod ?Chinese virus? tweets were Kansas (n=697/58, 1202%), South Dakota (n=185/15, 1233%), Mississippi (n=749/54, 1387%), New Hampshire (n=582/41, 1420%), and Idaho (n=670/46, 1457%). Conclusions: The rise in tweets referencing ?Chinese virus? or ?China virus,? along with the content of these tweets, indicate that knowledge translation may be occurring online and COVID-19 stigma is likely being perpetuated on Twitter. UR - http://www.jmir.org/2020/5/e19301/ UR - http://dx.doi.org/10.2196/19301 UR - http://www.ncbi.nlm.nih.gov/pubmed/32343669 ID - info:doi/10.2196/19301 ER - TY - JOUR AU - Chen, Chi-Mai AU - Jyan, Hong-Wei AU - Chien, Shih-Chieh AU - Jen, Hsiao-Hsuan AU - Hsu, Chen-Yang AU - Lee, Po-Chang AU - Lee, Chun-Fu AU - Yang, Yi-Ting AU - Chen, Meng-Yu AU - Chen, Li-Sheng AU - Chen, Hsiu-Hsi AU - Chan, Chang-Chuan PY - 2020/5/5 TI - Containing COVID-19 Among 627,386 Persons in Contact With the Diamond Princess Cruise Ship Passengers Who Disembarked in Taiwan: Big Data Analytics JO - J Med Internet Res SP - e19540 VL - 22 IS - 5 KW - COVID-19 KW - mobile geopositioning KW - contact tracing KW - proximity tracing KW - digital contact tracking KW - big data KW - public health KW - precision public health KW - surveillance KW - virus N2 - 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. UR - http://www.jmir.org/2020/5/e19540/ UR - http://dx.doi.org/10.2196/19540 UR - http://www.ncbi.nlm.nih.gov/pubmed/32353827 ID - info:doi/10.2196/19540 ER - TY - JOUR AU - Rovetta, Alessandro AU - Bhagavathula, Srikanth Akshaya PY - 2020/5/5 TI - COVID-19-Related Web Search Behaviors and Infodemic Attitudes in Italy: Infodemiological Study JO - JMIR Public Health Surveill SP - e19374 VL - 6 IS - 2 KW - novel coronavirus, COVID-19, Google search KW - Google Trends KW - infodemiology, infodemic monikers, Italy KW - behavior KW - public health KW - communication KW - digital health KW - online search N2 - Background: Since the beginning of the novel coronavirus disease (COVID-19) outbreak, fake news and misleading information have circulated worldwide, which can profoundly affect public health communication. Objective: We investigated online search behavior related to the COVID-19 outbreak and the attitudes of ?infodemic monikers? (ie, erroneous information that gives rise to interpretative mistakes, fake news, episodes of racism, etc) circulating in Italy. Methods: By using Google Trends to explore the internet search activity related to COVID-19 from January to March 2020, article titles from the most read newspapers and government websites were mined to investigate the attitudes of infodemic monikers circulating across various regions and cities in Italy. Search volume values and average peak comparison (APC) values were used to analyze the results. Results: Keywords such as ?novel coronavirus,? ?China coronavirus,? ?COVID-19,? ?2019-nCOV,? and ?SARS-COV-2? were the top infodemic and scientific COVID-19 terms trending in Italy. The top five searches related to health were ?face masks,? ?amuchina? (disinfectant), ?symptoms of the novel coronavirus,? ?health bulletin,? and ?vaccines for coronavirus.? The regions of Umbria and Basilicata recorded a high number of infodemic monikers (APC weighted total >140). Misinformation was widely circulated in the Campania region, and racism-related information was widespread in Umbria and Basilicata. These monikers were frequently searched (APC weighted total >100) in more than 10 major cities in Italy, including Rome. Conclusions: We identified a growing regional and population-level interest in COVID-19 in Italy. The majority of searches were related to amuchina, face masks, health bulletins, and COVID-19 symptoms. Since a large number of infodemic monikers were observed across Italy, we recommend that health agencies use Google Trends to predict human behavior as well as to manage misinformation circulation in Italy. UR - http://publichealth.jmir.org/2020/2/e19374/ UR - http://dx.doi.org/10.2196/19374 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338613 ID - info:doi/10.2196/19374 ER - TY - JOUR AU - Park, Woo Han AU - Park, Sejung AU - Chong, Miyoung PY - 2020/5/5 TI - Conversations and Medical News Frames on Twitter: Infodemiological Study on COVID-19 in South Korea JO - J Med Internet Res SP - e18897 VL - 22 IS - 5 KW - infodemiology KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - Twitter KW - South Korea KW - medical news KW - social media KW - pandemic KW - outbreak KW - infectious disease KW - public health N2 - Background: SARS-CoV-2 (severe acute respiratory coronavirus 2) was spreading rapidly in South Korea at the end of February 2020 following its initial outbreak in China, making Korea the new center of global attention. The role of social media amid the current coronavirus disease (COVID-19) pandemic has often been criticized, but little systematic research has been conducted on this issue. Social media functions as a convenient source of information in pandemic situations. Objective: Few infodemiology studies have applied network analysis in conjunction with content analysis. This study investigates information transmission networks and news-sharing behaviors regarding COVID-19 on Twitter in Korea. The real time aggregation of social media data can serve as a starting point for designing strategic messages for health campaigns and establishing an effective communication system during this outbreak. Methods: Korean COVID-19-related Twitter data were collected on February 29, 2020. Our final sample comprised of 43,832 users and 78,233 relationships on Twitter. We generated four networks in terms of key issues regarding COVID-19 in Korea. This study comparatively investigates how COVID-19-related issues have circulated on Twitter through network analysis. Next, we classified top news channels shared via tweets. Lastly, we conducted a content analysis of news frames used in the top-shared sources. Results: The network analysis suggests that the spread of information was faster in the Coronavirus network than in the other networks (Corona19, Shincheon, and Daegu). People who used the word ?Coronavirus? communicated more frequently with each other. The spread of information was faster, and the diameter value was lower than for those who used other terms. Many of the news items highlighted the positive roles being played by individuals and groups, directing readers? attention to the crisis. Ethical issues such as deviant behavior among the population and an entertainment frame highlighting celebrity donations also emerged often. There was a significant difference in the use of nonportal (n=14) and portal news (n=26) sites between the four network types. The news frames used in the top sources were similar across the networks (P=.89, 95% CI 0.004-0.006). Tweets containing medically framed news articles (mean 7.571, SD 1.988) were found to be more popular than tweets that included news articles adopting nonmedical frames (mean 5.060, SD 2.904; N=40, P=.03, 95% CI 0.169-4.852). Conclusions: Most of the popular news on Twitter had nonmedical frames. Nevertheless, the spillover effect of the news articles that delivered medical information about COVID-19 was greater than that of news with nonmedical frames. Social media network analytics cannot replace the work of public health officials; however, monitoring public conversations and media news that propagates rapidly can assist public health professionals in their complex and fast-paced decision-making processes. UR - http://www.jmir.org/2020/5/e18897/ UR - http://dx.doi.org/10.2196/18897 UR - http://www.ncbi.nlm.nih.gov/pubmed/32325426 ID - info:doi/10.2196/18897 ER - TY - JOUR AU - Pérez Sust, Pol AU - Solans, Oscar AU - Fajardo, Carles Joan AU - Medina Peralta, Manuel AU - Rodenas, Pepi AU - Gabaldà, Jordi AU - Garcia Eroles, Luis AU - Comella, Adrià AU - Velasco Muñoz, César AU - Sallent Ribes, Josuè AU - Roma Monfa, Rosa AU - Piera-Jimenez, Jordi PY - 2020/5/4 TI - Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak JO - JMIR Public Health Surveill SP - e19106 VL - 6 IS - 2 KW - digital health KW - eHealth KW - telemedicine KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - public health KW - policymaking UR - http://publichealth.jmir.org/2020/2/e19106/ UR - http://dx.doi.org/10.2196/19106 UR - http://www.ncbi.nlm.nih.gov/pubmed/32339998 ID - info:doi/10.2196/19106 ER - TY - JOUR AU - Zhao, Yuxin AU - Cheng, Sixiang AU - Yu, Xiaoyan AU - Xu, Huilan PY - 2020/5/4 TI - Chinese Public's Attention to the COVID-19 Epidemic on Social Media: Observational Descriptive Study JO - J Med Internet Res SP - e18825 VL - 22 IS - 5 KW - COVID-19 KW - Sina Microblog KW - public attention KW - social media KW - China KW - public health emergency KW - infodemic N2 - Background: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. Objective: This study aims to investigate and analyze the public?s attention to events related to COVID-19 in China at the beginning of the COVID-19 epidemic (December 31, 2019, to February 20, 2020) through the Sina Microblog hot search list. Methods: We collected topics related to the COVID-19 epidemic on the Sina Microblog hot search list from December 31, 2019, to February 20, 2020, and described the trend of public attention on COVID-19 epidemic-related topics. ROST Content Mining System version 6.0 was used to analyze the collected text for word segmentation, word frequency, and sentiment analysis. We further described the hot topic keywords and sentiment trends of public attention. We used VOSviewer to implement a visual cluster analysis of hot keywords and build a social network of public opinion content. Results: The study has four main findings. First, we analyzed the changing trend of the public?s attention to the COVID-19 epidemic, which can be divided into three stages. Second, the hot topic keywords of public attention at each stage were slightly different. Third, the emotional tendency of the public toward the COVID-19 epidemic-related hot topics changed from negative to neutral, with negative emotions weakening and positive emotions increasing as a whole. Fourth, we divided the COVID-19 topics with the most public concern into five categories: the situation of the new cases of COVID-19 and its impact, frontline reporting of the epidemic and the measures of prevention and control, expert interpretation and discussion on the source of infection, medical services on the frontline of the epidemic, and focus on the worldwide epidemic and the search for suspected cases. Conclusions: Our study found that social media (eg, Sina Microblog) can be used to measure public attention toward public health emergencies. During the epidemic of the novel coronavirus, a large amount of information about the COVID-19 epidemic was disseminated on Sina Microblog and received widespread public attention. We have learned about the hotspots of public concern regarding the COVID-19 epidemic. These findings can help the government and health departments better communicate with the public on health and translate public health needs into practice to create targeted measures to prevent and control the spread of COVID-19. UR - https://www.jmir.org/2020/5/e18825 UR - http://dx.doi.org/10.2196/18825 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314976 ID - info:doi/10.2196/18825 ER - TY - JOUR AU - Bhagavathula, Srikanth Akshaya AU - Aldhaleei, Ali Wafa AU - Rahmani, Jamal AU - Mahabadi, Ashrafi Mohammadjavad AU - Bandari, Kumar Deepak PY - 2020/4/30 TI - Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e19160 VL - 6 IS - 2 KW - coronavirus KW - outbreak KW - COVID-19 KW - knowledge KW - perception KW - health care KW - questionnaire KW - health care worker N2 - Background: During the first week of March, the coronavirus disease 2019 (COVID-19) outbreak reached more than 100 countries with over 100,000 cases. Health care authorities have already initiated awareness and preparedness activities worldwide. A poor understanding of the disease among health care workers (HCWs) may result in delayed treatment and result in the rapid spread of the infection. Objective: This study aimed to investigate the knowledge and perceptions of HCWs about COVID-19. Methods: A cross-sectional, web-based study was conducted among HCWs about COVID-19 during the first week of March 2020. A 23-item survey instrument was developed and distributed randomly to HCWs using social media; it required 5 minutes to complete. A chi-square test was used to investigate the level of association among variables, with significance set to P<.05. Results: Of 529 participants, a total of 453 HCWs completed the survey (response rate: 85.6%); 51.6% (n=234) were male, 32.1% (n=147) were aged 25-34 years, and most were doctors (n=137, 30.2%) and medical students (n=134, 29.6%). Most participants (n=276, 61.0%) used social media to obtain information on COVID-19. A significant proportion of HCWs had poor knowledge of its transmission (n=276, 61.0%) and symptom onset (n=288, 63.6%) and showed positive perceptions of COVID-19. Factors such as age and profession were associated with inadequate knowledge and a poor perception of COVID-19. Conclusions: As the global threat of COVID-19 continues to emerge, it is critical to improve the knowledge and perceptions of HCWs. Educational interventions are urgently needed to reach HCWs worldwide, and further studies are warranted. UR - http://publichealth.jmir.org/2020/2/e19160/ UR - http://dx.doi.org/10.2196/19160 UR - http://www.ncbi.nlm.nih.gov/pubmed/32320381 ID - info:doi/10.2196/19160 ER - TY - JOUR AU - Espinoza, Juan AU - Crown, Kelly AU - Kulkarni, Omkar PY - 2020/4/30 TI - A Guide to Chatbots for COVID-19 Screening at Pediatric Health Care Facilities JO - JMIR Public Health Surveill SP - e18808 VL - 6 IS - 2 KW - chatbots KW - COVID-19: pediatrics KW - digital health KW - screening UR - http://publichealth.jmir.org/2020/2/e18808/ UR - http://dx.doi.org/10.2196/18808 UR - http://www.ncbi.nlm.nih.gov/pubmed/32325425 ID - info:doi/10.2196/18808 ER - TY - JOUR AU - Whelan, Pauline AU - Stockton-Powdrell, Charlotte AU - Jardine, Jenni AU - Sainsbury, John PY - 2020/4/27 TI - Comment on ?Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow?: A UK Perspective JO - JMIR Ment Health SP - e19547 VL - 7 IS - 4 KW - digital mental health KW - digital psychiatry KW - COVID-19 KW - mhealth KW - mobile apps KW - learning health system UR - http://mental.jmir.org/2020/4/e19547/ UR - http://dx.doi.org/10.2196/19547 UR - http://www.ncbi.nlm.nih.gov/pubmed/32330113 ID - info:doi/10.2196/19547 ER - TY - JOUR AU - Ekong, Iniobong AU - Chukwu, Emeka AU - Chukwu, Martha PY - 2020/4/27 TI - COVID-19 Mobile Positioning Data Contact Tracing and Patient Privacy Regulations: Exploratory Search of Global Response Strategies and the Use of Digital Tools in Nigeria JO - JMIR Mhealth Uhealth SP - e19139 VL - 8 IS - 4 KW - COVID-19 KW - contact tracing KW - Nigeria?s National Data Protection Regulation KW - General Data Protection Regulation KW - GDPR KW - coronavirus KW - surveillance KW - mHealth KW - eHealth KW - digital health N2 - Background: The coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology. Objective: The objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria?s data privacy regulations. Methods: We conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR). Results: Despite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria?s response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR. Conclusions: Our study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse. UR - http://mhealth.jmir.org/2020/4/e19139/ UR - http://dx.doi.org/10.2196/19139 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310817 ID - info:doi/10.2196/19139 ER - TY - JOUR AU - Utunen, Heini AU - Ndiaye, Ngouille AU - Piroux, Corentin AU - George, Richelle AU - Attias, Melissa AU - Gamhewage, Gaya PY - 2020/4/27 TI - Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data JO - J Med Internet Res SP - e19076 VL - 22 IS - 4 KW - online learning KW - OpenWHO KW - novel coronavirus KW - COVID-19 KW - coronavirus KW - pandemic KW - WHO KW - e-learning KW - MOOC KW - public health N2 - Background: At the onset of the coronavirus outbreak, the World Health Organization?s (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO?s health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID?19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users? professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses? statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform?s own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99%) of all course enrollments, and the English language course was comprised of 38.21% (n=88,988) of enrollments. The WHO?s Region of the Americas accounted for most of the course enrollments, with more than 72.47% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10% enrollment for each. A total of 32.43% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as ?Other.? With the COVID-19 introductory course, the largest number of users selected ?Other? (16,527/52,214, 31.65%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO?s technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform?s aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. UR - https://www.jmir.org/2020/4/e19076 UR - http://dx.doi.org/10.2196/19076 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293580 ID - info:doi/10.2196/19076 ER - TY - JOUR AU - Luo, Hongxing AU - Lie, Yongchan AU - Prinzen, W. Frits PY - 2020/4/27 TI - Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China JO - JMIR Public Health Surveill SP - e18576 VL - 6 IS - 2 KW - coronavirus KW - surveillance KW - syndromic surveillance KW - participatory surveillance KW - online questionnaire KW - Wuhan KW - COVID-19 N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18576/ UR - http://dx.doi.org/10.2196/18576 UR - http://www.ncbi.nlm.nih.gov/pubmed/32319956 ID - info:doi/10.2196/18576 ER - TY - JOUR AU - Sullivan, Sean Patrick AU - Sailey, Charles AU - Guest, Lynn Jodie AU - Guarner, Jeannette AU - Kelley, Colleen AU - Siegler, Julius Aaron AU - Valentine-Graves, Mariah AU - Gravens, Laura AU - del Rio, Carlos AU - Sanchez, Howard Travis PY - 2020/4/24 TI - Detection of SARS-CoV-2 RNA and Antibodies in Diverse Samples: Protocol to Validate the Sufficiency of Provider-Observed, Home-Collected Blood, Saliva, and Oropharyngeal Samples JO - JMIR Public Health Surveill SP - e19054 VL - 6 IS - 2 KW - SARS-CoV-2 KW - RNA-PCR KW - serology KW - COVID-19 KW - PCR KW - public health KW - outbreak KW - infectious disease KW - diagnostic KW - telemedicine KW - testing N2 - Background: The response in the United States to the coronavirus disease (COVID-19) pandemic has been hampered by a lack of aggressive testing for the infection. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cornerstone of an effective public health response. However, efforts to test have been hampered by limited reagents, limitations in the availability of swabs used for the collection of nasopharyngeal swab (NPS) specimens, limitations in personal protective equipment (PPE) for health care providers collecting the NPS specimens, and limitations in viral transport media for transporting the specimens. Therefore, more flexible options for screening for SARS-CoV-2 RNA and serologic responses are critical to inform clinical and public health responses. Objective: We aim to document the ability of patients to self-collect sufficient specimens for SARS-CoV-2 viral detection and serology. Methods: Patient self-collection of samples will be done with observation by a health care provider during a telemedicine session. Participants will be mailed a specimen collection kit, engage in a telehealth session with a provider through a HIPPA (Health Insurance Portability and Accountability Act of 1996)-compliant video meeting, and collect specimens while being observed by the provider. Providers will record whether they are confident in the suitability of the specimen for laboratory testing that would inform clinical decision making. We will objectively assess the sufficiency of biological material in the mailed-in specimens. Results: The protocol was approved by the Emory University Institutional Review Board (IRB) on March 30, 2020 (Protocol number 371). To date, we have enrolled 159 participants. Conclusions: Defining a conceptual framework for assessing the sufficiency of patient-collected samples for the detection of SARS-CoV-2 RNA and serologic responses to infection is critical for facilitating public health responses and providing PPE-sparing options to increase testing. Validation of alternative methods of specimen collection should include objective measures of the sufficiency of specimens for testing. A strong evidence base for diversifying testing modalities will improve tools to guide public health responses to the COVID-19 pandemic. UR - http://publichealth.jmir.org/2020/2/e19054/ UR - http://dx.doi.org/10.2196/19054 UR - http://www.ncbi.nlm.nih.gov/pubmed/32310815 ID - info:doi/10.2196/19054 ER - TY - JOUR AU - Oksanen, Atte AU - Kaakinen, Markus AU - Latikka, Rita AU - Savolainen, Iina AU - Savela, Nina AU - Koivula, Aki PY - 2020/4/24 TI - Regulation and Trust: 3-Month Follow-up Study on COVID-19 Mortality in 25 European Countries JO - JMIR Public Health Surveill SP - e19218 VL - 6 IS - 2 KW - mortality KW - infectious diseases KW - sociability KW - trust KW - prevention KW - Europe N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19218/ UR - http://dx.doi.org/10.2196/19218 UR - http://www.ncbi.nlm.nih.gov/pubmed/32301734 ID - info:doi/10.2196/19218 ER - TY - JOUR AU - Gong, Mengchun AU - Liu, Li AU - Sun, Xin AU - Yang, Yue AU - Wang, Shuang AU - Zhu, Hong PY - 2020/4/22 TI - Cloud-Based System for Effective Surveillance and Control of COVID-19: Useful Experiences From Hubei, China JO - J Med Internet Res SP - e18948 VL - 22 IS - 4 KW - COVID-19 KW - cloud system KW - syndromic surveillance KW - clinical decision support KW - stakeholders involvement KW - pandemic KW - medical informatics N2 - Background: Coronavirus disease (COVID-19) has been an unprecedented challenge to the global health care system. Tools that can improve the focus of surveillance efforts and clinical decision support are of paramount importance. Objective: The aim of this study was to illustrate how new medical informatics technologies may enable effective control of the pandemic through the development and successful 72-hour deployment of the Honghu Hybrid System (HHS) for COVID-19 in the city of Honghu in Hubei, China. Methods: The HHS was designed for the collection, integration, standardization, and analysis of COVID-19-related data from multiple sources, which includes a case reporting system, diagnostic labs, electronic medical records, and social media on mobile devices. Results: HHS supports four main features: syndromic surveillance on mobile devices, policy-making decision support, clinical decision support and prioritization of resources, and follow-up of discharged patients. The syndromic surveillance component in HHS covered over 95% of the population of over 900,000 people and provided near real time evidence for the control of epidemic emergencies. The clinical decision support component in HHS was also provided to improve patient care and prioritize the limited medical resources. However, the statistical methods still require further evaluations to confirm clinical effectiveness and appropriateness of disposition assigned in this study, which warrants further investigation. Conclusions: The facilitating factors and challenges are discussed to provide useful insights to other cities to build suitable solutions based on cloud technologies. The HHS for COVID-19 was shown to be feasible and effective in this real-world field study, and has the potential to be migrated. UR - http://www.jmir.org/2020/4/e18948/ UR - http://dx.doi.org/10.2196/18948 UR - http://www.ncbi.nlm.nih.gov/pubmed/32287040 ID - info:doi/10.2196/18948 ER - TY - JOUR AU - Li, Jiawei AU - Xu, Qing AU - Cuomo, Raphael AU - Purushothaman, Vidya AU - Mackey, Tim PY - 2020/4/21 TI - Data Mining and Content Analysis of the Chinese Social Media Platform Weibo During the Early COVID-19 Outbreak: Retrospective Observational Infoveillance Study JO - JMIR Public Health Surveill SP - e18700 VL - 6 IS - 2 KW - COVID-19 KW - coronavirus KW - infectious disease KW - social media, surveillance KW - infoveillance KW - infodemiology N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18700/ UR - http://dx.doi.org/10.2196/18700 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293582 ID - info:doi/10.2196/18700 ER - TY - JOUR AU - Basch, E. Charles AU - Basch, H. Corey AU - Hillyer, C. Grace AU - Jaime, Christie PY - 2020/4/21 TI - 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 JO - JMIR Public Health Surveill SP - e19145 VL - 6 IS - 2 KW - YouTube KW - COVID-19 KW - social media KW - pandemic KW - outbreak KW - infectious disease KW - public health KW - prevention N2 - 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. UR - http://publichealth.jmir.org/2020/2/e19145/ UR - http://dx.doi.org/10.2196/19145 UR - http://www.ncbi.nlm.nih.gov/pubmed/32297593 ID - info:doi/10.2196/19145 ER - TY - JOUR AU - Abd-Alrazaq, Alaa AU - Alhuwail, Dari AU - Househ, Mowafa AU - Hamdi, Mounir AU - Shah, Zubair PY - 2020/4/21 TI - Top Concerns of Tweeters During the COVID-19 Pandemic: Infoveillance Study JO - J Med Internet Res SP - e19016 VL - 22 IS - 4 KW - coronavirus, COVID-19 KW - SARS-CoV-2 KW - 2019-nCov KW - social media KW - public health KW - Twitter KW - infoveillance KW - infodemiology KW - health informatics KW - disease surveillance N2 - Background: The recent coronavirus disease (COVID-19) pandemic is taking a toll on the world?s health care infrastructure as well as the social, economic, and psychological well-being of humanity. Individuals, organizations, and governments are using social media to communicate with each other on a number of issues relating to the COVID-19 pandemic. Not much is known about the topics being shared on social media platforms relating to COVID-19. Analyzing such information can help policy makers and health care organizations assess the needs of their stakeholders and address them appropriately. Objective: This study aims to identify the main topics posted by Twitter users related to the COVID-19 pandemic. Methods: Leveraging a set of tools (Twitter?s search application programming interface (API), Tweepy Python library, and PostgreSQL database) and using a set of predefined search terms (?corona,? ?2019-nCov,? and ?COVID-19?), we extracted the text and metadata (number of likes and retweets, and user profile information including the number of followers) of public English language tweets from February 2, 2020, to March 15, 2020. We analyzed the collected tweets using word frequencies of single (unigrams) and double words (bigrams). We leveraged latent Dirichlet allocation for topic modeling to identify topics discussed in the tweets. We also performed sentiment analysis and extracted the mean number of retweets, likes, and followers for each topic and calculated the interaction rate per topic. Results: Out of approximately 2.8 million tweets included, 167,073 unique tweets from 160,829 unique users met the inclusion criteria. Our analysis identified 12 topics, which were grouped into four main themes: origin of the virus; its sources; its impact on people, countries, and the economy; and ways of mitigating the risk of infection. The mean sentiment was positive for 10 topics and negative for 2 topics (deaths caused by COVID-19 and increased racism). The mean for tweet topics of account followers ranged from 2722 (increased racism) to 13,413 (economic losses). The highest mean of likes for the tweets was 15.4 (economic loss), while the lowest was 3.94 (travel bans and warnings). Conclusions: Public health crisis response activities on the ground and online are becoming increasingly simultaneous and intertwined. Social media provides an opportunity to directly communicate health information to the public. Health systems should work on building national and international disease detection and surveillance systems through monitoring social media. There is also a need for a more proactive and agile public health presence on social media to combat the spread of fake news. UR - http://www.jmir.org/2020/4/e19016/ UR - http://dx.doi.org/10.2196/19016 UR - http://www.ncbi.nlm.nih.gov/pubmed/32287039 ID - info:doi/10.2196/19016 ER - TY - JOUR AU - Abeler, Johannes AU - Bäcker, Matthias AU - Buermeyer, Ulf AU - Zillessen, Hannah PY - 2020/4/20 TI - COVID-19 Contact Tracing and Data Protection Can Go Together JO - JMIR Mhealth Uhealth SP - e19359 VL - 8 IS - 4 KW - COVID-19 KW - app KW - contact tracing KW - proximity tracing KW - privacy KW - data protection KW - Bluetooth UR - http://mhealth.jmir.org/2020/4/e19359/ UR - http://dx.doi.org/10.2196/19359 UR - http://www.ncbi.nlm.nih.gov/pubmed/32294052 ID - info:doi/10.2196/19359 ER - TY - JOUR AU - Mavragani, Amaryllis PY - 2020/4/20 TI - Tracking COVID-19 in Europe: Infodemiology Approach JO - JMIR Public Health Surveill SP - e18941 VL - 6 IS - 2 KW - big data KW - coronavirus KW - COVID-19 KW - infodemiology KW - infoveillance KW - Google Trends N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18941/ UR - http://dx.doi.org/10.2196/18941 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250957 ID - info:doi/10.2196/18941 ER - TY - JOUR AU - Mahmood, Sultan AU - Hasan, Khaled AU - Colder Carras, Michelle AU - Labrique, Alain PY - 2020/4/16 TI - Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health JO - JMIR Public Health Surveill SP - e18980 VL - 6 IS - 2 KW - informatics KW - global health KW - developing countries KW - internet KW - infection KW - control KW - COVID-19 KW - pandemic UR - http://publichealth.jmir.org/2020/2/e18980/ UR - http://dx.doi.org/10.2196/18980 UR - http://www.ncbi.nlm.nih.gov/pubmed/32297868 ID - info:doi/10.2196/18980 ER - TY - JOUR AU - Garg, Suneela AU - Bhatnagar, Nidhi AU - Gangadharan, Navya PY - 2020/4/16 TI - A Case for Participatory Disease Surveillance of the COVID-19 Pandemic in India JO - JMIR Public Health Surveill SP - e18795 VL - 6 IS - 2 KW - participatory KW - surveillance KW - COVID-19 KW - pandemic KW - outbreak KW - public health KW - infectious disease KW - India UR - http://publichealth.jmir.org/2020/2/e18795/ UR - http://dx.doi.org/10.2196/18795 UR - http://www.ncbi.nlm.nih.gov/pubmed/32287038 ID - info:doi/10.2196/18795 ER - TY - JOUR AU - Khairat, Saif AU - Meng, Chenlu AU - Xu, Yuxuan AU - Edson, Barbara AU - Gianforcaro, Robert PY - 2020/4/15 TI - Interpreting COVID-19 and Virtual Care Trends: Cohort Study JO - JMIR Public Health Surveill SP - e18811 VL - 6 IS - 2 KW - virtual care KW - COVID-19 KW - trends KW - patterns KW - pandemic KW - outbreak KW - infectious disease KW - public health N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18811/ UR - http://dx.doi.org/10.2196/18811 UR - http://www.ncbi.nlm.nih.gov/pubmed/32252023 ID - info:doi/10.2196/18811 ER - TY - JOUR AU - Gong, Kai AU - Xu, Zhong AU - Cai, Zhefeng AU - Chen, Yuxiu AU - Wang, Zhanxiang PY - 2020/4/14 TI - Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study JO - J Med Internet Res SP - e18908 VL - 22 IS - 4 KW - internet hospital KW - telemedicine KW - novel coronavirus disease KW - pandemic KW - prevention KW - control KW - coronavirus KW - COVID-19 KW - public health KW - infectious disease N2 - 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. UR - http://www.jmir.org/2020/4/e18908/ UR - http://dx.doi.org/10.2196/18908 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250962 ID - info:doi/10.2196/18908 ER - TY - JOUR AU - Zamberg, Ido AU - Manzano, Sergio AU - Posfay-Barbe, Klara AU - Windisch, Olivier AU - Agoritsas, Thomas AU - Schiffer, Eduardo PY - 2020/4/14 TI - A Mobile Health Platform to Disseminate Validated Institutional Measurements During the COVID-19 Outbreak: Utilization-Focused Evaluation Study JO - JMIR Public Health Surveill SP - e18668 VL - 6 IS - 2 KW - covid-19 KW - novel coronavirus KW - smartphone KW - SARS-COV-2 KW - mHealth KW - knowledge KW - information KW - dissemination KW - health policy KW - infectious disease KW - outbreak KW - public health KW - preparation N2 - 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. UR - http://publichealth.jmir.org/2020/2/e18668/ UR - http://dx.doi.org/10.2196/18668 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250958 ID - info:doi/10.2196/18668 ER - TY - JOUR AU - Lai, Yuan AU - Yeung, Wesley AU - Celi, Anthony Leo PY - 2020/4/14 TI - Urban Intelligence for Pandemic Response: Viewpoint JO - JMIR Public Health Surveill SP - e18873 VL - 6 IS - 2 KW - urban informatics KW - urban science KW - data science KW - health emergency KW - medical informatics KW - COVID-19 KW - pandemic KW - outbreak KW - public health KW - infectious disease UR - http://publichealth.jmir.org/2020/2/e18873/ UR - http://dx.doi.org/10.2196/18873 UR - http://www.ncbi.nlm.nih.gov/pubmed/32248145 ID - info:doi/10.2196/18873 ER - TY - JOUR AU - Ayyoubzadeh, Mohammad Seyed AU - Ayyoubzadeh, Mehdi Seyed AU - Zahedi, Hoda AU - Ahmadi, Mahnaz AU - R Niakan Kalhori, Sharareh PY - 2020/4/14 TI - Predicting COVID-19 Incidence Through Analysis of Google Trends Data in Iran: Data Mining and Deep Learning Pilot Study JO - JMIR Public Health Surveill SP - e18828 VL - 6 IS - 2 KW - coronavirus KW - COVID-19 KW - prediction KW - incidence KW - Google Trends KW - linear regression KW - LSTM KW - pandemic KW - outbreak KW - public health N2 - Background: The recent global outbreak of coronavirus disease (COVID-19) is affecting many countries worldwide. Iran is one of the top 10 most affected countries. Search engines provide useful data from populations, and these data might be useful to analyze epidemics. Utilizing data mining methods on electronic resources? data might provide a better insight into the COVID-19 outbreak to manage the health crisis in each country and worldwide. Objective: This study aimed to predict the incidence of COVID-19 in Iran. Methods: Data were obtained from the Google Trends website. Linear regression and long short-term memory (LSTM) models were used to estimate the number of positive COVID-19 cases. All models were evaluated using 10-fold cross-validation, and root mean square error (RMSE) was used as the performance metric. Results: The linear regression model predicted the incidence with an RMSE of 7.562 (SD 6.492). The most effective factors besides previous day incidence included the search frequency of handwashing, hand sanitizer, and antiseptic topics. The RMSE of the LSTM model was 27.187 (SD 20.705). Conclusions: Data mining algorithms can be employed to predict trends of outbreaks. This prediction might support policymakers and health care managers to plan and allocate health care resources accordingly. UR - http://publichealth.jmir.org/2020/2/e18828/ UR - http://dx.doi.org/10.2196/18828 UR - http://www.ncbi.nlm.nih.gov/pubmed/32234709 ID - info:doi/10.2196/18828 ER - TY - JOUR AU - Khader, Yousef AU - Al Nsour, Mohannad AU - Al-Batayneh, Barakat Ola AU - Saadeh, Rami AU - Bashier, Haitham AU - Alfaqih, Mahmoud AU - Al-Azzam, Sayer AU - AlShurman, Abdallah Bara? PY - 2020/4/9 TI - Dentists? Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists JO - JMIR Public Health Surveill SP - e18798 VL - 6 IS - 2 KW - COVID-19 KW - infection KW - dentist KW - infection control N2 - Background: Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control. Objective: This study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists. Methods: The study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists? demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19. Results: This study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission. Conclusions: Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches. UR - http://publichealth.jmir.org/2020/2/e18798/ UR - http://dx.doi.org/10.2196/18798 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250959 ID - info:doi/10.2196/18798 ER - TY - JOUR AU - Cuan-Baltazar, Yunam Jose AU - Muñoz-Perez, José Maria AU - Robledo-Vega, Carolina AU - Pérez-Zepeda, Fernanda Maria AU - Soto-Vega, Elena PY - 2020/4/9 TI - Misinformation of COVID-19 on the Internet: Infodemiology Study JO - JMIR Public Health Surveill SP - e18444 VL - 6 IS - 2 KW - HONcode KW - JAMA benchmarks KW - DISCERN instrument KW - Wuhan coronavirus KW - COVID-19 KW - nCoV KW - epidemiology KW - health information seeking KW - information quality KW - misinformation KW - public health N2 - Background: The internet has become an important source of health information for users worldwide. The novel coronavirus caused a pandemic search for information with broad dissemination of false or misleading health information. Objective: The aim of this study was to evaluate the quality and readability of online information about the coronavirus disease (COVID-19), which was a trending topic on the internet, using validated instruments and relating the quality of information to its readability. Methods: The search was based on the term ?Wuhan Coronavirus? on the Google website (February 6, 2020). At the search time, the terms ?COVID-19? or ?SARS-CoV-2? (severe acute respiratory syndrome coronavirus 2) did not exist. Critical analysis was performed on the first 110 hits using the Health on the Net Foundation Code of Conduct (HONcode), the Journal of the American Medical Association (JAMA) benchmark, the DISCERN instrument, and Google ranking. Results: The first 110 websites were critically analyzed, and only 1.8% (n=2) of the websites had the HONcode seal. The JAMA benchmark showed that 39.1% (n=43) of the websites did not have any of the categories required by this tool, and only 10.0% (11/110) of the websites had the four quality criteria required by JAMA. The DISCERN score showed that 70.0% (n=77) of the websites were evaluated as having a low score and none were rated as having a high score. Conclusions: Nonhealth personnel and the scientific community need to be aware about the quality of the information they read and produce, respectively. The Wuhan coronavirus health crisis misinformation was produced by the media, and the misinformation was obtained by users from the internet. The use of the internet has a risk to public health, and, in cases like this, the governments should be developing strategies to regulate health information on the internet without censuring the population. By February 6, 2020, no quality information was available on the internet about COVID-19. UR - http://publichealth.jmir.org/2020/2/e18444/ UR - http://dx.doi.org/10.2196/18444 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250960 ID - info:doi/10.2196/18444 ER - TY - JOUR AU - Yasaka, M. Tyler AU - Lehrich, M. Brandon AU - Sahyouni, Ronald PY - 2020/4/7 TI - Peer-to-Peer Contact Tracing: Development of a Privacy-Preserving Smartphone App JO - JMIR Mhealth Uhealth SP - e18936 VL - 8 IS - 4 KW - COVID-19 KW - smartphone KW - privacy KW - contact tracing KW - peer-to-peer KW - epidemic KW - personal data KW - mobile phone KW - coronavirus KW - pandemic N2 - Background: The novel coronavirus disease 2019 (COVID-19) pandemic is an urgent public health crisis, with epidemiologic models predicting severe consequences, including high death rates, if the virus is permitted to run its course without any intervention or response. Contact tracing using smartphone technology is a powerful tool that may be employed to limit disease transmission during an epidemic or pandemic; yet, contact tracing apps present significant privacy concerns regarding the collection of personal data such as location. Objective: The aim of this study is to develop an effective contact tracing smartphone app that respects user privacy by not collecting location information or other personal data. Methods: We propose the use of an anonymized graph of interpersonal interactions to conduct a novel form of contact tracing and have developed a proof-of-concept smartphone app that implements this approach. Additionally, we developed a computer simulation model that demonstrates the impact of our proposal on epidemic or pandemic outbreak trajectories across multiple rates of adoption. Results: Our proof-of-concept smartphone app allows users to create ?checkpoints? for contact tracing, check their risk level based on their past interactions, and anonymously self-report a positive status to their peer network. Our simulation results suggest that higher adoption rates of such an app may result in a better controlled epidemic or pandemic outbreak. Conclusions: Our proposed smartphone-based contact tracing method presents a novel solution that preserves privacy while demonstrating the potential to suppress an epidemic or pandemic outbreak. This app could potentially be applied to the current COVID-19 pandemic as well as other epidemics or pandemics in the future to achieve a middle ground between drastic isolation measures and unmitigated disease spread. UR - https://mhealth.jmir.org/2020/4/e18936 UR - http://dx.doi.org/10.2196/18936 UR - http://www.ncbi.nlm.nih.gov/pubmed/32240973 ID - info:doi/10.2196/18936 ER - TY - JOUR AU - Hong, Young-Rock AU - Lawrence, John AU - Williams Jr, Dunc AU - Mainous III, Arch PY - 2020/4/7 TI - Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data JO - JMIR Public Health Surveill SP - e18961 VL - 6 IS - 2 KW - COVID-19 KW - telehealth KW - telemedicine KW - screening KW - pandemic KW - outbreak KW - infectious disease KW - public health N2 - Background: As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation?s health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic. Objective: We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states. Methods: We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities. Results: We found that US population?level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation (r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth (r=0.055, P=.70) nor hospitals having tele-ICU capability (r=?0.073, P=.61). Conclusions: As the number of COVID-19 cases increases, so does the US population?s interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge. UR - http://publichealth.jmir.org/2020/2/e18961/ UR - http://dx.doi.org/10.2196/18961 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250963 ID - info:doi/10.2196/18961 ER - TY - JOUR AU - Gibson, Lesley AU - Rush, David PY - 2020/4/6 TI - Novel Coronavirus in Cape Town Informal Settlements: Feasibility of Using Informal Dwelling Outlines to Identify High Risk Areas for COVID-19 Transmission From A Social Distancing Perspective JO - JMIR Public Health Surveill SP - e18844 VL - 6 IS - 2 KW - COVID-19 KW - Cape Town KW - informal settlements KW - social distancing KW - GIS KW - pandemic KW - outbreak KW - infectious disease KW - public health KW - geographic data KW - risk N2 - Background: The challenges faced by the Global South during the coronavirus disease (COVID-19) pandemic are compounded by the presence of informal settlements, which are typically densely populated and lacking in formalized sanitation infrastructure. Social distancing measures in informal settlements may be difficult to implement due to the density and layout of settlements. This study measures the distance between dwellings in informal settlements in Cape Town to identify the risk of COVID-19 transmission. Objective: The aim of this paper is to determine if social distancing measures are achievable in informal settlements in Cape Town, using two settlements as an example. We will first examine the distance between dwellings and their first, second, and third nearest neighbors and then identify clusters of dwellings in which residents would be unable to effectively practice social isolation due to the close proximity of their homes. Methods: Dwellings in the settlements of Masiphumelele and Klipfontein Glebe were extracted from a geographic information system data set of outlines of all informal dwellings in Cape Town. The distance to each dwelling?s first, second, and third nearest neighbors was calculated for each settlement. A social distance measure of 2 m was used (buffer of 1 m, as dwellings less than 2 m apart are joined) to identify clusters of dwellings that are unable to effectively practice social distancing in each settlement. Results: The distance to each dwelling?s first 3 nearest neighbors illustrates that the settlement of Masiphumelele is constructed in a denser fashion as compared to the Klipfontein Glebe settlement. This implies that implementing social distancing will likely be more challenging in Masiphumelele than in Klipfontein Glebe. However, using a 2-m social distancing measure, it was demonstrated that large portions of Klipfontein Glebe would also be unable to effectively implement social distancing. Conclusions: Effectively implementing social distancing may be a challenge in informal settlements due to their density. This paper uses dwelling outlines for informal settlements in the city of Cape Town to demonstrate that with a 2 m measure, effective social distancing will be challenging. UR - http://publichealth.jmir.org/2020/2/e18844/ UR - http://dx.doi.org/10.2196/18844 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250283 ID - info:doi/10.2196/18844 ER - TY - JOUR AU - Padala, R. Prasad AU - Jendro, M. Ashlyn AU - Padala, P. Kalpana PY - 2020/4/6 TI - Conducting Clinical Research During the COVID-19 Pandemic: Investigator and Participant Perspectives JO - JMIR Public Health Surveill SP - e18887 VL - 6 IS - 2 KW - clinical research KW - COVID-19 KW - pandemic KW - outbreak KW - infectious disease KW - public health KW - ethics UR - http://publichealth.jmir.org/2020/2/e18887/ UR - http://dx.doi.org/10.2196/18887 UR - http://www.ncbi.nlm.nih.gov/pubmed/32250281 ID - info:doi/10.2196/18887 ER - TY - JOUR AU - Guest, L. Jodie AU - del Rio, Carlos AU - Sanchez, Travis PY - 2020/4/6 TI - The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will JO - JMIR Public Health Surveill SP - e19043 VL - 6 IS - 2 KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 UR - https://publichealth.jmir.org/2020/2/e19043 UR - http://dx.doi.org/10.2196/19043 UR - http://www.ncbi.nlm.nih.gov/pubmed/32240972 ID - info:doi/10.2196/19043 ER - TY - JOUR AU - Geldsetzer, Pascal PY - 2020/4/2 TI - Use of Rapid Online Surveys to Assess People's Perceptions During Infectious Disease Outbreaks: A Cross-sectional Survey on COVID-19 JO - J Med Internet Res SP - e18790 VL - 22 IS - 4 KW - rapid online surveys KW - perceptions KW - knowledge KW - coronavirus KW - SARS-CoV-2 KW - pandemic KW - infectious disease KW - outbreak KW - survey KW - COVID-19 KW - public health N2 - 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. UR - http://www.jmir.org/2020/4/e18790/ UR - http://dx.doi.org/10.2196/18790 UR - http://www.ncbi.nlm.nih.gov/pubmed/32240094 ID - info:doi/10.2196/18790 ER - TY - JOUR AU - Basch, H. Corey AU - Hillyer, C. Grace AU - Meleo-Erwin, C. Zoe AU - Jaime, Christie AU - Mohlman, Jan AU - Basch, E. Charles PY - 2020/4/2 TI - Preventive Behaviors Conveyed on YouTube to Mitigate Transmission of COVID-19: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e18807 VL - 6 IS - 2 KW - YouTube KW - COVID-19 KW - social media KW - pandemic KW - outbreak KW - infectious disease KW - public health KW - prevention N2 - Background: Accurate information and guidance about personal behaviors that can reduce exposure to severe acute respiratory syndrome coronavirus 2 are among the most important elements in mitigating the spread of coronavirus disease 2019 (COVID-19). With over 2 billion users, YouTube is a media channel that millions turn to when seeking information. Objective: At the time of this study, there were no published studies investigating the content of YouTube videos related to COVID-19. This study aims to address this gap in the current knowledge. Methods: The 100 most widely viewed YouTube videos uploaded throughout the month of January 2020 were reviewed and the content covered was described. Collectively, these videos were viewed over 125 million times. Results: Fewer than one-third of the videos covered any of the seven key prevention behaviors listed on the US Centers for Disease Control and Prevention website. Conclusions: These results represent an important missed opportunity for disease prevention. UR - http://publichealth.jmir.org/2020/2/e18807/ UR - http://dx.doi.org/10.2196/18807 UR - http://www.ncbi.nlm.nih.gov/pubmed/32240096 ID - info:doi/10.2196/18807 ER - TY - JOUR AU - de Lusignan, Simon AU - Lopez Bernal, Jamie AU - Zambon, Maria AU - Akinyemi, Oluwafunmi AU - Amirthalingam, Gayatri AU - Andrews, Nick AU - Borrow, Ray AU - Byford, Rachel AU - Charlett, André AU - Dabrera, Gavin AU - Ellis, Joanna AU - Elliot, J. Alex AU - Feher, Michael AU - Ferreira, Filipa AU - Krajenbrink, Else AU - Leach, Jonathan AU - Linley, Ezra AU - Liyanage, Harshana AU - Okusi, Cecilia AU - Ramsay, Mary AU - Smith, Gillian AU - Sherlock, Julian AU - Thomas, Nicholas AU - Tripathy, Manasa AU - Williams, John AU - Howsam, Gary AU - Joy, Mark AU - Hobbs, Richard PY - 2020/4/2 TI - 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 JO - JMIR Public Health Surveill SP - e18606 VL - 6 IS - 2 KW - general practice KW - medical record systems KW - computerized KW - sentinel surveillance KW - coronavirus KW - COVID-19 KW - SARS-CoV-2 KW - surveillance KW - infections KW - pandemic KW - records as topic KW - serology N2 - 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 UR - https://publichealth.jmir.org/2020/2/e18606 UR - http://dx.doi.org/10.2196/18606 UR - http://www.ncbi.nlm.nih.gov/pubmed/32240095 ID - info:doi/10.2196/18606 ER - TY - JOUR AU - Ohannessian, Robin AU - Duong, Anh Tu AU - Odone, Anna PY - 2020/4/2 TI - Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action JO - JMIR Public Health Surveill SP - e18810 VL - 6 IS - 2 KW - telemedicine KW - telehealth KW - digital health KW - digital medicine KW - COVID-19 KW - coronavirus KW - SARS-CoV-2 KW - public health KW - surveillance KW - outbreak KW - pandemic UR - https://publichealth.jmir.org/2020/2/e18810 UR - http://dx.doi.org/10.2196/18810 UR - http://www.ncbi.nlm.nih.gov/pubmed/32238336 ID - info:doi/10.2196/18810 ER - TY - JOUR AU - Hernández-García, Ignacio AU - Giménez-Júlvez, Teresa PY - 2020/4/1 TI - Assessment of Health Information About COVID-19 Prevention on the Internet: Infodemiological Study JO - JMIR Public Health Surveill SP - e18717 VL - 6 IS - 2 KW - COVID-19 KW - coronavirus KW - prevention KW - internet KW - information KW - evaluation KW - authorship KW - World Health Organization KW - official public health organizations KW - digital media KW - infodemic KW - infodemiology N2 - Background: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods: On February 29, 2020, we performed a Google search with the terms ?Prevention coronavirus,? ?Prevention COVID-19,? ?Prevención coronavirus,? and ?Prevención COVID-19?. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was ?wash your hands frequently? (n=65, 81%). A less frequent recommendation was to ?stay home if you feel unwell? (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as ?wash your hands frequently? (OR 9.82), ?cover your mouth and nose with your bent elbow or tissue when you cough or sneeze? (OR 4.59), or ?stay home if you feel unwell? (OR 0.31). Conclusions: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them. UR - https://publichealth.jmir.org/2020/2/e18717 UR - http://dx.doi.org/10.2196/18717 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217507 ID - info:doi/10.2196/18717 ER - TY - JOUR AU - Al Nsour, Mohannad AU - Bashier, Haitham AU - Al Serouri, Abulwahed AU - Malik, Elfatih AU - Khader, Yousef AU - Saeed, Khwaja AU - Ikram, Aamer AU - Abdalla, Mohammed Abdalla AU - Belalia, Abdelmounim AU - Assarag, Bouchra AU - Baig, Amir Mirza AU - Almudarra, Sami AU - Arqoub, Kamal AU - Osman, Shahd AU - Abu-Khader, Ilham AU - Shalabi, Dana AU - Majeed, Yasir PY - 2020/3/27 TI - 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 JO - JMIR Public Health Surveill SP - e18503 VL - 6 IS - 1 KW - COVID-19 KW - outbreak KW - preparedness KW - response KW - public health UR - http://publichealth.jmir.org/2020/1/e18503/ UR - http://dx.doi.org/10.2196/18503 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217506 ID - info:doi/10.2196/18503 ER - TY - JOUR AU - Torous, John AU - Jän Myrick, Keris AU - Rauseo-Ricupero, Natali AU - Firth, Joseph PY - 2020/3/26 TI - Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow JO - JMIR Ment Health SP - e18848 VL - 7 IS - 3 KW - digital health KW - emergency response KW - telehealth KW - apps UR - http://mental.jmir.org/2020/3/e18848/ UR - http://dx.doi.org/10.2196/18848 UR - http://www.ncbi.nlm.nih.gov/pubmed/32213476 ID - info:doi/10.2196/18848 ER -