形成性研究

从即兴演讲的声学和语言特征筛选广泛性焦虑障碍:预测模型评估研究

2022 - 10 - 28 - t09:00:22内

背景:需要经常与精神卫生专业人员进行互动，以筛查、诊断和跟踪精神卫生障碍。然而，高昂的成本和不足的访问可能会使频繁的交互变得困难。被动地和频繁地评估精神健康障碍的能力可能是传统治疗的有益补充。通过表征使用个人智能手机或其他可穿戴设备收集的语音变化，有可能被动地高频评估临床症状。言语特征和心理健康障碍之间的联系可以作为一种客观的筛查工具。目的:本研究旨在评估一个模型的性能，该模型从即兴演讲的声学和语言特征中预测广泛性焦虑障碍(GAD)的存在，比以往的研究更大，更广泛。方法:总共招募了2000名参与者，他们参加了一个基于网络的会议。他们完成了广泛性焦虑障碍-7项量表评估，并提供了一个即兴演讲样本，以回应修改版的特里尔社会压力测试。我们使用先前研究中发现的与焦虑症相关的语言和声学特征以及人口统计学信息来预测参与者是否高于或低于基于广泛性焦虑症-7项量表阈值10的广泛性焦虑症筛查阈值。对不同性别的模型也进行了评估。 We reported the mean area under the receiver operating characteristic (AUROC) from a repeated 5-fold cross-validation to evaluate the performance of the models. Results: A logistic regression model using only acoustic and linguistic speech features achieved a significantly greater prediction accuracy than a random model did (mean AUROC 0.57, SD 0.03; P<.001). When separately assessing samples from female participants, we observed a mean AUROC of 0.55 (SD 0.05; P=.01). The model constructed from the samples from male participants achieved a mean AUROC of 0.57 (SD 0.07; P=.002). The mean AUROC increased to 0.62 (SD 0.03; P<.001) on the all-sample data set when demographic information (age, sex, and income) was included, indicating the importance of demographics when screening for anxiety disorders. The performance also increased for the female sample to a mean of 0.62 (SD 0.04; P<.001) when using demographic information (age and income). An increase in performance was not observed when demographic information was added to the model constructed from the male samples. Conclusions: A logistic regression model using acoustic and linguistic speech features, which have been suggested to be associated with anxiety disorders in prior studies, can achieve above-random accuracy for predicting GAD. Importantly, the addition of basic demographic variables further improves model performance, suggesting a role for speech and demographic information to be used as automated, objective screeners of GAD.

远程健康运动到音乐以增加脑瘫青少年的身体活动参与:试点随机对照试验

2022 - 10 - 28 - t09:00:03内

活动受限的脑瘫(CP)青少年几乎没有机会获得廉价而愉快的家庭项目，这些项目可以大规模传播，帮助他们通过参与休闲体育活动(LTPA)独立管理自己的健康。目的:本研究的主要目的是确定成人运动到音乐(M2M)计划早期采用阶段的初步疗效，与等待名单对照组相比，增加LTPA和活动参与。次要目的是探索该计划对疼痛和疲劳感知水平的影响。第三个目的是定性评估影响依从性的因素，并发展一种理论，为这一群体更有针对性的M2M远程医疗计划的发展提供信息。这项随机对照试验在58名步行或使用轮椅的CP青少年中进行了为期4周的M2M计划，每周进行行为远程指导。参与者被随机分为两组:M2M组或对照组，维持他们的日常活动。M2M包括参与者被要求每周在家完成3次的视频(异步训练)。使用基于云的分析客观地衡量视频时长。分别使用儿童参与和享受评估总领域得分和积极的体育娱乐领域得分，在干预前后测量活动和LTPA参与的变化。使用美国国立卫生研究院的神经质量简表来测量感知的疼痛和疲劳。用协方差分析比较各组间评分的变化。 A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children’s Assessment of Participation and Enjoyment Active Physical Recreation–Intensity domain scores in favor of the intervention group (F_1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390

新型冠状病毒疫苗筛查智能系统COVID-Bot的设计与开发

2022 - 10 - 27 - t09:00:22内

背景:冠状病毒继续在全球传播，造成各种健康和经济干扰。控制这种疾病传播的最重要方法之一是使用基于人工智能(AI)的技术干预，例如聊天机器人系统。聊天机器人可以帮助抗击COVID-19的传播。本文介绍了一种智能交互系统COVID-Bot，可以帮助筛选学生并确认他们的COVID-19疫苗接种情况。方法: COVID-Bot的设计和开发遵循了设计科学研究(DSR)过程的原则，这是一种创造新的科学工件的研究方法。COVID-Bot是使用SnatchBot聊天机器人应用程序编程接口(API)及其预定义工具开发和实现的，这些工具由各种自然语言处理算法驱动。结果:通过对106名大学生的调查进行了评估，以确定COVID-Bot的功能、兼容性、可靠性和可用性。调查结果显示，92人(86.8%)认为聊天机器人功能良好，85人(80.2%)认为聊天机器人很适合他们的移动设备和生活方式，86人(81.1%)认为聊天机器人有可能产生准确和一致的响应，85人(80.2%)认为聊天机器人易于使用。得到的平均α为。87，表明满意的可靠性。结论:这项研究表明，将聊天机器人技术融入教育系统可以对抗COVID-19在大学生中的传播。 The intelligent system does this by interacting with students to determine their vaccination status.

量身定制的性别敏感移动健康减肥干预(I-GENDO):发展和过程评估

2022 - 10 - 27 - t09:00:04内

背景:鉴于全球范围内超重和肥胖患病率的增加，数字减肥干预的数量也有所增加。然而，这些干预措施往往缺乏长期有效性的理论背景和数据。考虑体重相关心理参数的个体和性别差异可能会提高基于移动的减肥干预的有效性和可持续性。本文介绍了结合基于计算机的和自我剪裁的特征的12周性别敏感的移动健康(mHealth)减肥干预(I-GENDO)的介绍和过程评估。在2020年8月至2021年8月期间，德国的一项多中心研究I- gendo项目招募了超重(BMI 25.0-29.9 kg/m²)、I级肥胖(BMI 30.0-34.9 kg/m²)和II级肥胖(BMI 35.0-39.9 kg/m²)的受试者。移动健康干预旨在利用基于计算机的裁剪，针对与超重和肥胖的发展和持续有关的个人心理因素(例如，情绪化进食)。此外，干预措施采取了对性别敏感的方法，实现了针对性别的模块版本的自我定制。在考虑性别的同时，评估了主要模块的计算机分配、针对性别的模块版本的自我选择和使用模式。此外，还分析了可用性评估中的性别差异。结果:处理了研究干预组的数据。 A total of 116 individuals with overweight and obesity (77/116, 66.4% women; age mean 47.28, SD 11.66 years; BMI mean 33.58, SD 3.79 kg/m²) were included in the analyses. Overall, the compliance (90/109, 82.6%) and satisfaction with the app (mean 86% approval) were high and comparable with those of other mobile weight loss interventions. The usability of the intervention was rated with 71% (5.0/7.0 points) satisfaction. More women obtained the main module that focused on emotion regulation skills. Most men and women selected women-targeted versions of the main modules. Women used the app more frequently and longer than men. However, women and men did not differ in the progress of use patterns throughout the intervention. Conclusions: We developed a tailored gender-sensitive mHealth weight loss intervention. The usability of and engagement with the intervention were satisfactory, and the overall satisfaction with the intervention was also high. Gender differences must be considered in the evaluation of the effectiveness and sustainability of the intervention.

血压降低、体重减轻和参与基于数字应用程序的高血压护理计划之间的关系:观察性研究

2022 - 10 - 27 - t08:45:19内

<强>背景:高血压患者建议家庭血压监测;然而，荟萃分析表明，血压的改善与额外的指导支持结合自我监测有关，仅自我监测效果甚微或没有效果。高接触的教练需要大量的资源，可能很难通过人力教练模型来实现。这项观察性研究评估了参与一个名为Lark Hypertension Care的全数字项目后血压和体重的变化，该项目由人工智能(AI)指导。受试者(N=864)基线收缩压(SBP)≥120 mm Hg，提供其基线体重，并且至少在项目中达到第三个月。主要结果是3个月和6个月时收缩压的变化，次要结果是体重变化以及收缩压和体重变化与参与者人口统计学、特征和项目参与程度的相关性。结果:到第3个月，显著下降-5.4 mm Hg (95% CI -6.5至-4.3;P<.001)。在两个时间点都提供读数的参与者，在3到6个月期间血压没有显著变化(即收缩压下降保持不变)(P=.49)。一半的参与者在第3个月(178/349,51.0%)和第6个月(98/199,49.2%)实现了有临床意义的≥5 mm Hg下降。 The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of –12.4 mm Hg (SE 1.2 mm Hg) by month 3 and –13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by –5.2 mm Hg (SE 0.8) mm Hg by month 3 and –7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by –1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=–.36; P=.02), and initial BMI (β=–.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was –0.0024 (95% CI –0.0052 to 0; P=.002). Conclusions: A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss.

移动应用程序在重度抑郁症管理中增强患者激活和患者-提供者沟通:协作，随机对照试点研究

2022 - 10 - 27 - t08:45:02内

背景:增强患者-提供者参与可以改善慢性疾病患者的健康结果，包括重度抑郁症(MDD)。我们评估了数字化护理移动应用程序path的影响，该应用程序旨在提高MDD患者-提供者的参与度。患者使用移动界面来评估治疗进展，并与初级保健提供者(pcp)共享这一信息。在这项为期52周的、在初级保健诊所进行的现实世界有效性和可行性研究中，40名最近服用抗抑郁药物单一疗法的重度抑郁症患者被随机分为两组，一组使用移动应用程序进行常规护理(20/ 40,50%)，另一组仅使用常规护理(20/ 40,50%)。应用程序组的患者每天都使用该应用程序，持续18周;每隔6周生成一份报告，并与pcp共享，以促进共享治疗决策讨论。患者在第18周停用了应用程序，并一直随访到第1年。通过研究访问评估的辅助预后指标包括第18周13项患者激活测量(PAM-13)和7项患者-提供者参与量表评分较基线的变化。其他结果测量包括抑郁严重程度(9项患者健康问卷[PHQ-9])和认知症状(5项感知缺陷问卷-抑郁症)。结果:所有37例患者(应用组:n= 18,49%; usual care arm: n=19, 51%) who completed the 18-week follow-up period (n=31, 84% female, mean age 36, SD 11.3 years) had moderate to moderately severe depression. Improvements in PAM-13 and PHQ-9 scores were observed in both arms. Increases in PAM-13 scores from baseline to 18 weeks were numerically greater in the app arm than in the usual care arm (mean 10.5, SD 13.2 vs mean 8.8, SD 9.4; P=.65). At 52 weeks, differences in PAM-13 scores from baseline demonstrated significantly greater improvements in the app arm than in the usual care arm (mean 20.2, SD 17.7 vs mean 1.6, SD 14.2; P=.04). Compared with baseline, PHQ-9 scores decreased in both the app arm and the usual care arm at 18 weeks (mean 7.8, SD 7.2 vs mean 7.0, SD 6.5; P=.73) and 52 weeks (mean 9.5, SD 4.0 vs mean 4.7, SD 6.0; P=.07). Improvements in 7-item Patient-Provider Engagement Scale and WHO-5 scores were observed in both arms at 18 weeks and were sustained through 52 weeks in the app arm. Improvements in WHO-5 scores at 52 weeks were significantly greater in the app arm than in the usual care arm (41.5 vs 20.0; P=.02). Conclusions: Patients with MDD will engage with a mobile app designed to track treatment and disease progression. PCPs will use the data generated as part of their assessment to inform clinical care. The study results suggest that an app-enabled clinical care pathway may enhance patient activation and benefit MDD management. Trial Registration: ClinicalTrials.gov NCT03242213; https://clinicaltrials.gov/ct2/show/NCT03242213

基于数字智能手机的自我管理工具(R+营养师)用于住院癌症患者的营养风险筛查和饮食评估:评估和诊断准确性研究

2022 - 10 - 26 - t08:45:34内

背景:营养不良是癌症患者普遍存在的严重问题，直接增加了并发症的发生率，显著降低了生活质量。营养风险筛查和膳食评估至关重要，因为它们是提供个性化营养支持的基础。目前还没有基于数字智能手机的癌症住院患者营养风险筛查和膳食评估自我管理工具的开发和评估。本研究旨在开发基于智能手机的数字化癌症住院患者营养风险筛查和膳食评估自我管理小程序，并评估小程序的有效性。我们开发了R+营养师小程序，包括3个部分:(1)收集患者基本信息，(2)营养风险筛查，(3)膳食能量和蛋白质评估。以面对面的纸质营养风险筛查(NRS-2002)、患者生成的主观整体评估简表(PG-SGA-SF)和3天24小时饮食回忆(3d-24HRs)问卷作为参考方法，由2名训练过的营养师按照标准程序进行。计算R+ Dietitian对参考方法筛选的营养风险的敏感性、特异性、阳性预测值、阴性预测值、κ值和相关系数(CCs)，以及R+ Dietitian与3d-24HRs估计的膳食能量和蛋白质摄入量的差值和cc，以评价R+ Dietitian的有效性。结果:共招募244名住院癌症患者评估R+营养师的有效性。R+ Dietitian的NRS-2002和PG-SGA-SF工具具有较高的准确性、敏感性和特异性(分别为77.5%、81.0%和76.7%、69.3%、84.5%和64.5%)，且一致性良好(κ分别为0.42和0.37;CC分别为0.62和0.56)，由营养师使用NRS-2002和PG-SGA-SF工具。 The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions: The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528

在加拿大阿尔茨海默氏症宣传月期间，研究Twitter上关于痴呆症的话语:信息流行病学研究

2022 - 10 - 26 - t08:45:16内

推特已经成为从心理健康宣传周到糖尿病宣传月等公共卫生运动的主要平台。然而，人们对Twitter在健康活动中如何使用知之甚少，尤其是在阿尔茨海默病宣传月。目的:我们研究的目的是在加拿大一月份的阿尔茨海默氏症宣传月期间检查痴呆症话语，为未来的宣传活动提供信息。从2022年1月1日到1月31日，我们使用Python中的Twint应用程序收集了1289条相关推文。采用专题分析方法对数据进行分析。结果:在我们的分析指导下，确定了4个主要主题:痴呆症教育和宣传，筹款和宣传，痴呆症的经历，以及未来行动的机会。虽然我们的研究发现了许多教育、宣传和筹款推文来支持对痴呆症的认识，但我们也发现了许多推文带有粗略的信息(例如，简单地将1月作为加拿大的阿尔茨海默病宣传月)。虽然这些推文提高了公众意识，但它们也强调了有针对性的教育内容的机会，以对抗关于痴呆症的污名化信息和错误信息。此外，与不同利益攸关方(如名人、社交媒体影响者、痴呆症患者及其护理伙伴)合作的提高认识战略可能在促进痴呆症对话和教育方面发挥关键作用。需要进一步的研究来开发、实施和评估Twitter上的痴呆症意识策略。 Increased knowledge, partnerships, and research are essential to enhancing dementia awareness during Canada’s Alzheimer’s Awareness Month and beyond.

在初级保健机构中合并远程眼科以改善糖尿病视网膜病变筛查:回顾性描述性评价

2022 - 10 - 26 - t08:45:02内

背景:糖尿病患者的年度视网膜检查是至关重要的，因为糖尿病视网膜病变是美国工作年龄成年人可预防失明的第一大原因。目前，在美国，大多数糖尿病患者接受初级保健提供者的转诊，去看眼科医生进行一年一度的眼睛扩张检查，这可能会增加不便和费用。因此，在门诊网络中需要替代筛查策略。在初级保健环境中使用远程医疗平台是一种提高糖尿病视网膜病变筛查率的新策略。为了为我们的患者提供更好的糖尿病视网膜病变筛查，2017年10月，作为8个月试点项目的一部分，我们在3个初级保健诊所放置了摄像机。智能视网膜成像系统(IRIS)的专用摄像机用于获取图像，这些图像可由生命桥健康网络中的眼科医生远程解释，用于糖尿病性视网膜病变的诊断和其他类型的病理(如黄斑水肿)的检测。目的:本回顾性描述性研究的目的是研究远程医疗平台是否可以作为一种具有成本效益的方式，在初级保健环境中提高糖尿病视网膜病变的筛查率。在为期8个月的试验期间(2017年10月30日至2018年6月30日)，收集3个实践地点的总筛查量和诊断数据。此外，付款人报销数据和设备成本数据被用于确定三个实践地点的回收期。结果:试点项目证明了在3个实践地点实施IRIS摄像机的商业案例，可以在最多2年内使足够多的患者接受筛查，从而支付摄像机的费用。 The 3 practices showed increased diabetic retinopathy screening rates of 1%, 6%, and 24%, respectively, and were all able to screen enough patients to be on track to pay off the cost of the camera within 2 years of implementation. Aggregate data from the pilot period showed that of the 1213 patients who were screened, approximately 17.1% (n=207) were diagnosed with diabetic retinopathy and an additional 17.7% (n=215) were suspected of having some other form of pathology. Of note, 10.1% (n=123) were also identified as being “IRIS saves,” defined as having pathology identified that was severe enough to be considered an imminent threat to their vision. Conclusions: This retrospective descriptive study suggests that a telemedicine platform can be used to improve diabetic retinopathy screening rates in the primary care setting within a large health care system in a cost-effective way that allows for the cost of the equipment to be recouped through billing within a maximum of 2 years.

使用远程保健和营养平台的个人的粮食不安全变化:纵向研究

2022 - 10 - 25 - t09:00:47内

背景:食品不安全是一个复杂的公共卫生问题，影响着美国的许多人。促进行为改变和提供负担得起的健康食品的数字卫生干预措施可能有助于缓解粮食不安全。本研究的目的是对Foodsmart(一个具有膳食计划、订餐、营养教育、预算和杂货折扣功能的远程健康和营养平台)的食品不安全用户进行特征描述，并评估饮食和食品不安全的变化。我们回顾性分析了从2021年2月至10月期间使用Foodsmart平台的4595名成年人收集的数据。参与者在一份56项问卷中自我报告了他们的饮食、人口统计、生物特征和粮食不安全状况。在回答“你买的食物多久吃不完，又没钱买更多的?”的问题时，如果参与者回答“有时”或“经常”，他们就会被报告为食物不安全?来自美国农业部的家庭食品安全调查。我们通过粮食不安全状况、特征与基线粮食不安全之间的关系、饮食质量的变化和粮食不安全状况来检查参与者的基线特征。为了评估扭转粮食不安全的潜在原因，根据上一次对粮食不安全问题的回答，在实现了粮食安全的粮食不安全参与者与仍然处于粮食不安全状态的粮食不安全参与者之间进行了6个Foodsmart特征的比较。结果:我们发现16%(742/4595)的参与者在基线时处于食品不安全状态。在基线时食物不安全的参与者更有可能肥胖，至少有一种慢性疾病，饮食质量较低，在家做饭的频率较低，认为健康食品太贵，不太可能叫外卖或在餐馆吃饭。 Among participants who were food insecure at baseline, 61% (451/742) improved their nutrition and 29% (217/742) responded that they were food secure at follow-up, with an increasing percentage achieving food security with longer enrollment time. Using a multivariable logistic regression model, we found that age, diabetes, prediabetes, BMI categories, and diet quality at baseline were statistically significantly associated with the likelihood of being food insecure at baseline. Among those who were food insecure at baseline, there was a higher relative proportion of participants who achieved food security and used the “deals” (28.6% higher), “CookItNow” (36.4% higher), and “telenutrition” (27.5% higher) features compared to those who remained food insecure. Conclusions: This study assesses the characteristics of individuals enrolled on the Foodsmart platform who answered the food insecurity question. We found that a significant number of participants who were food insecure at enrollment achieved food security. This finding shows that telehealth and nutrition platforms may potentially help users improve household food security.