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Public Health in Practice (Oxford,... Dec 2023This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America. (Review)
Review
OBJECTIVE
This review summarizes women's acceptability of vaginal self-sampling for cervical cancer screening in Latin America.
STUDY DESIGN
Systematic review.
METHOD
A systematic literature search was performed in PubMed, Web of Science, and Embase regarding the acceptance of HPV vaginal self-sampling by women over 18 years old. Articles were selected for research that was conducted in Latin America and published between January 1st, 1993, and December 31st, 2022.
RESULTS
Fifteen publications were included. Eight publications reported an acceptance of HPV self-sampling as high as 80%, six papers found an acceptance rate between 50 and 80% and only one found an acceptance rate of less than 50%. Based on non-standardized questionnaires, women considered self-sampling more comfortable, easier, and less painful than conventional cytology. The procedure was associated with less embarrassment and a greater sense of privacy.
CONCLUSION
HPV vaginal-self sampling appears to be an acceptable screening method amongst eligible Latin American women.
PubMed: 37564780
DOI: 10.1016/j.puhip.2023.100417 -
BMC Health Services Research Oct 2023With the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention....
BACKGROUND
With the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention. The purpose of this systematic review is to express facilitators and barriers of using mobile health (mHealth) interventions during the Covid-19 pandemic.
METHODS
In this systematic review, original studies were searched using keywords in the electronic database of PubMed until August 2022. The objectives and outcomes of these studies were extracted. Finally, to identify the facilitators and barriers of mHealth interventions, a qualitative content analysis was conducted based on the strengths, weaknesses, opportunities, and threats (SWOT) analysis method with Atlas.ti 8 software. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT).
RESULTS
In total, 1598 articles were identified and 55 articles were included in this study. Most of the studies used mobile applications to provide and receive health services during the Covid-19 pandemic (96.4%). The purpose of the applications was to help prevention (17), follow-up (15), treatment (12), and diagnosis (8). Using SWOT analysis, 13 facilitators and 18 barriers to patients' use of mHealth services were identified.
CONCLUSION
Mobile applications are very flexible technologies that can be customized for each person, patient, and population. During the Covid-19 pandemic, the applications designed due to lack of interaction, lack of time, lack of attention to privacy, and non-academic nature have not met their expectations of them.
Topics: Humans; COVID-19; Mobile Applications; Pandemics; Telemedicine
PubMed: 37898755
DOI: 10.1186/s12913-023-10171-w -
Journal of Medical Internet Research Oct 2023Frailty syndrome (FS) is one of the most common noncommunicable diseases, which is associated with lower physical and mental capacities in older adults. FS diagnosis is... (Review)
Review
BACKGROUND
Frailty syndrome (FS) is one of the most common noncommunicable diseases, which is associated with lower physical and mental capacities in older adults. FS diagnosis is mostly focused on biological variables; however, it is likely that this diagnosis could fail owing to the high biological variability in this syndrome. Therefore, artificial intelligence (AI) could be a potential strategy to identify and diagnose this complex and multifactorial geriatric syndrome.
OBJECTIVE
The objective of this scoping review was to analyze the existing scientific evidence on the use of AI for the identification and diagnosis of FS in older adults, as well as to identify which model provides enhanced accuracy, sensitivity, specificity, and area under the curve (AUC).
METHODS
A search was conducted using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines on various databases: PubMed, Web of Science, Scopus, and Google Scholar. The search strategy followed Population/Problem, Intervention, Comparison, and Outcome (PICO) criteria with the population being older adults; intervention being AI; comparison being compared or not to other diagnostic methods; and outcome being FS with reported sensitivity, specificity, accuracy, or AUC values. The results were synthesized through information extraction and are presented in tables.
RESULTS
We identified 26 studies that met the inclusion criteria, 6 of which had a data set over 2000 and 3 with data sets below 100. Machine learning was the most widely used type of AI, employed in 18 studies. Moreover, of the 26 included studies, 9 used clinical data, with clinical histories being the most frequently used data type in this category. The remaining 17 studies used nonclinical data, most frequently involving activity monitoring using an inertial sensor in clinical and nonclinical contexts. Regarding the performance of each AI model, 10 studies achieved a value of precision, sensitivity, specificity, or AUC ≥90.
CONCLUSIONS
The findings of this scoping review clarify the overall status of recent studies using AI to identify and diagnose FS. Moreover, the findings show that the combined use of AI using clinical data along with nonclinical information such as the kinematics of inertial sensors that monitor activities in a nonclinical context could be an appropriate tool for the identification and diagnosis of FS. Nevertheless, some possible limitations of the evidence included in the review could be small sample sizes, heterogeneity of study designs, and lack of standardization in the AI models and diagnostic criteria used across studies. Future research is needed to validate AI systems with diverse data sources for diagnosing FS. AI should be used as a decision support tool for identifying FS, with data quality and privacy addressed, and the tool should be regularly monitored for performance after being integrated in clinical practice.
Topics: Humans; Aged; Artificial Intelligence; Frail Elderly; Frailty; Machine Learning; Area Under Curve
PubMed: 37862082
DOI: 10.2196/47346 -
Human Vaccines & Immunotherapeutics Aug 2023Globally, healthcare services have begun to show interest in switching from paper-based to electronic-based vaccination records through Vaccination Information Systems... (Review)
Review
Globally, healthcare services have begun to show interest in switching from paper-based to electronic-based vaccination records through Vaccination Information Systems (VIS). VIS have been implemented in various countries, but the study on the challenges of implementing VIS in these countries is still limited. The challenges of implementing VIS need to be understood to become a subject of discussion and anticipation by other countries that are just starting to implement VIS. We analyzed 32 selected publications from 634 initially retrieved. Fourteen challenges were successfully identified when implementing VIS, including interoperability, data quality, security and privacy, standardization, usability, internet connectivity, infrastructure, workflow, funding, government regulations, awareness, skeptical response, computer literacy, and staff-related challenges. The challenges of interoperability and data quality were found to be the most widely discussed by previous studies. In addition to identifying the challenges, this study includes a series of solutions that can be applied to overcome each challenge.
Topics: Humans; Data Accuracy; Government Regulation; Internet; Vaccination
PubMed: 37747287
DOI: 10.1080/21645515.2023.2257054 -
Journal of Medical Internet Research Jul 2023The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. Telemedicine has emerged as an ideal tool to... (Review)
Review
BACKGROUND
The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in health care access, especially for the most susceptible populations.
OBJECTIVE
We aimed to characterize the determinant factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic and to identify the main opportunities and challenges (technological, ethical, legal, and social) generated by the use of telemedicine in the context of the COVID-19 pandemic.
METHODS
We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases (Scopus, Web of Science, PubMed, and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3, 2020, and December 31, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and the results were integrated into a thematic synthesis. The identification of the main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results.
RESULTS
Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States. The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and the need for complementary diagnostic tests or the delivery of test results.
CONCLUSIONS
The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of a technological nature (access to technological devices and internet services and level of digital literacy), a sociocultural and demographic nature (ethnic and racial disparities, geographic disparities, language barriers, and age), a socioeconomic nature (income level and health insurance coverage), and an ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most susceptible communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses.
Topics: Humans; COVID-19; Pandemics; Transition to Adult Care; SARS-CoV-2; Telemedicine; Health Services Accessibility; Referral and Consultation; Hospitals
PubMed: 37262124
DOI: 10.2196/44188 -
Pain Physician Nov 2023Remimazolam is a novel ultrashort-effect benzodiazepine. In 2020, the US Food and Drug Administration approved it for procedural sedation. Remimazolam is beneficial for... (Meta-Analysis)
Meta-Analysis
Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
BACKGROUND
Remimazolam is a novel ultrashort-effect benzodiazepine. In 2020, the US Food and Drug Administration approved it for procedural sedation. Remimazolam is beneficial for consistent sedation and quick recovery in painless gastrointestinal endoscopy. Propofol is one of the most commonly used intravenous anesthetics in clinical practice. Recently, only a few studies have compared propofol with remimazolam for general anesthesia induction.
OBJECTIVES
The purpose of our systematic review and meta-analysis was to compare the hemodynamic effects of remimazolam and propofol during the induction of general anesthesia.
STUDY DESIGN
Systematic review and meta-analysis of randomized, controlled trials.
METHODS
The authors retrieved the PubMed, Embase, Cochrane Library, and Web of Science databases for studies published through September 30, 2022, which reported relevant prospective randomized controlled trials (RCTs) comparing remimazolam with propofol for general anesthesia. The primary outcome was hemodynamic changes, including the absolute value of fluctuation of mean arterial pressure (delta MAP) and heart rate delta HR). The secondary outcomes were the following 2 indicators: the occurrence of total adverse events and the quality of recovery from general anesthesia at 24 hours postsurgery. RevMan 5.4.1 (The Nordic Cochrane Centre for The Cochrane Collaboration) and trial sequential analysis were used to execute the statistical analyses. The different domains of bias were judged by the Cochrane risk of the bias assessment tool.
RESULTS
The authors identified 189 papers in PubMed, Embase, Cochrane Library, and Web of Science. Eight articles with 964 patients were selected. The included studies had moderate quality. For primary outcomes, the lower delta HR (mean difference [MD] = -4.99; 95% CI, -7.97 to -2.00; I² = 41.6%; P = 0.001] and delta MAP (MD = -5.91; 95% CI. -8.57 to -3.24; I² = 0%; P < 0.0001) represent more stable hemodynamic characteristics in the remimazolam group. Regarding secondary outcomes, a considerably lower incidence of total adverse events was noted in the remimazolam group than that for the propofol group (odds ratio [OR] = 0.40; 95% CI, 0.28 to 0.58; I² = 63%; P < 0.00001). In comparison to the propofol group, remimazolam achieved an advantage score of quality of recovery -15 in 24 hours postsurgery (MD = 5.31, 95% CI, 1.51 to 9.12; I² = 87%; P = 0.006).
LIMITATION
Firstly, there are only a handful of published RCTs on the administration of remimazolam in general anesthesia. In addition, due to patient privacy, we could not extract individual patient data, therefore we could not combine and assess any variations in patient characteristics.
CONCLUSION
Evidence suggests that remimazolam has a lower hemodynamic effect during general anesthesia and fewer perioperative adverse effects after general anesthesia than propofol; however, which agent is superior regarding quality benefit in postoperative recovery based on the studies included here remains inconclusive. Additional RCTs with updated meta-analyses to enlarge the sample size and properly analyze the benefit-to-risk ratio to patients are needed to determine the evidence for such a relatively new medicine.
Topics: Humans; Propofol; Randomized Controlled Trials as Topic; Anesthesia, General; Benzodiazepines; Hemodynamics
PubMed: 37976477
DOI: No ID Found -
Journal of Medical Internet Research Oct 2023Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living... (Review)
Review
BACKGROUND
Studies have shown that mobile apps have the potential to serve as nonpharmacological interventions for dementia care, improving the quality of life of people living with dementia and their informal caregivers. However, little is known about the needs for and privacy aspects of these mobile apps in dementia care.
OBJECTIVE
This review seeks to understand the landscape of existing mobile apps in dementia care for people living with dementia and their caregivers with respect to app features, usability testing, privacy, and security.
METHODS
ACM Digital Library, Cochrane Central Register of Controlled Trials, Compendex, Embase, Inspec, Ovid MEDLINE, PsycINFO, and Scopus were searched. Studies were included if they included people with dementia living in the community, their informal caregivers, or both; focused on apps in dementia care using smartphones or tablet computers; and covered usability evaluation of the app. Records were independently screened, and 2 reviewers extracted the data. The Centre for Evidence-Based Medicine critical appraisal tool and Mixed Methods Appraisal Tool were used to assess the risk of bias in the included studies. Thematic synthesis was used, and the findings were summarized and tabulated based on each research aim.
RESULTS
Overall, 44 studies were included in this review, with 39 (89%) published after 2015. In total, 50 apps were included in the study, with more apps developed for people living with dementia as end users compared with caregivers. Most studies (27/44, 61%) used tablet computers. The most common app feature was cognitive stimulation. This review presented 9 app usability themes: user interface, physical considerations, screen size, interaction challenges, meeting user needs, lack of self-awareness of app needs, stigma, technological inexperience, and technical support. In total, 5 methods (questionnaires, interviews, observations, logging, and focus groups) were used to evaluate usability. There was little focus on the privacy and security aspects, including data transfer and protection, of mobile apps for people living with dementia.
CONCLUSIONS
The limitations of this review include 1 reviewer conducting the full-text screening, its restriction to studies published in English, and the exclusion of apps that lacked empirical usability testing. As a result, there may be an incomplete representation of the available apps in the field of dementia care. However, this review highlights significant concerns related to the usability, privacy, and security of existing mobile apps for people living with dementia and their caregivers. The findings of this review provide a valuable framework to guide app developers and researchers in the areas of privacy policy development, app development strategies, and the importance of conducting thorough usability testing for their apps. By considering these factors, future work in this field can be advanced to enhance the quality and effectiveness of dementia care apps.
TRIAL REGISTRATION
PROSPERO CRD42020216141; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216141.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1159/000514838.
Topics: Humans; Mobile Applications; Caregivers; Quality of Life; Smartphone; Dementia
PubMed: 37824187
DOI: 10.2196/46188 -
Frontiers in Public Health 2023The Hyperledger Fabric (HF) framework is widely studied for securing electronic health records (EHRs) in the healthcare sector. Despite the various cross-domain... (Review)
Review
The Hyperledger Fabric (HF) framework is widely studied for securing electronic health records (EHRs) in the healthcare sector. Despite the various cross-domain blockchain technology (BCT) applications, little is known about the role of the HF framework in healthcare. The purpose of the systematic literature review (SLR) is to review the existing literature on the HF framework and its applications in healthcare. This SLR includes literature published between January 2015 and March 2023 in the ACM digital library, IEEE Xplore, SCOPUS, Springer, PubMed, and Google Scholar databases. Following the inclusion and exclusion criteria, a total of 57 articles emerged as eligible for this SLR. The HF framework was found to be useful in securing health records coming from the Internet of Medical Things (IoMT) and many other devices. The main causes behind using the HF framework were identified as privacy and security, integrity, traceability, and availability of health records. Additionally, storage issues with transactional data over the blockchain are reduced by the use of the HF framework. This SLR also highlights potential future research trends to ensure the high-level security of health records.
Topics: Blockchain; Electronic Health Records; Delivery of Health Care; Privacy; Technology
PubMed: 38089022
DOI: 10.3389/fpubh.2023.1272787 -
BMC Medical Informatics and Decision... Oct 2023An awareness of antecedents of acceptance of digital contact tracing (DCT) can enable healthcare authorities to design appropriate strategies for fighting COVID-19 or... (Meta-Analysis)
Meta-Analysis
An awareness of antecedents of acceptance of digital contact tracing (DCT) can enable healthcare authorities to design appropriate strategies for fighting COVID-19 or other infectious diseases that may emerge in the future. However, mixed results about these antecedents are frequently reported. Most prior DCT acceptance review studies lack statistical synthesis of their results. This study aims to undertake a systematic review and meta-analysis of antecedents of DCT acceptance and investigate potential moderators of these antecedents. By searching multiple databases and filtering studies by using both inclusion and exclusion criteria, 76 and 25 studies were included for systematic review and meta-analysis, respectively. Random-effects models were chosen to estimate meta-analysis results since Q, I , and H index signified some degree of heterogeneity. Fail-safe N was used to assess publication bias. Most DCT acceptance studies have focused on DCT related factors. Included antecedents are all significant predictors of DCT acceptance except for privacy concerns and fear of COVID-19. Subgroup analysis showed that individualism/collectivism moderate the relationships between norms/privacy concerns and intention to use DCT. Based on the results, the mean effect size of antecedents of DCT acceptance and the potential moderators may be more clearly identified. Appropriate strategies for boosting the DCT acceptance rate can be proposed accordingly.
Topics: Humans; Contact Tracing; COVID-19; Databases, Factual; Group Processes; Health Facilities
PubMed: 37821864
DOI: 10.1186/s12911-023-02313-1 -
Journal of Child Health Care : For... Apr 2024Adolescents face issues regarding physical health, mental health, sexual health, drug and alcohol problems, stress, and peer pressure. Little is known about adolescents'... (Review)
Review
Adolescents face issues regarding physical health, mental health, sexual health, drug and alcohol problems, stress, and peer pressure. Little is known about adolescents' help-seeking behaviours in relation to health concerns. The general practitioner (GP) is usually the first point of contact for adolescents. The aim of this systematic review was to identify, describe, and summarize evidence on barriers and enablers experienced by adolescents when accessing GP-led primary care services. Systematic searches using four electronic databases (PsycINFO, MEDLINE, CINAHL, and SocINDEX) were conducted and the quality of the included studies was appraised. Six studies were included in this review. Findings indicate that barriers to GP access relate to trust, confidentiality, privacy, and communication. Adolescents also reported barriers such as transport, cost, and lack of information. Adolescents reported enablers being services that are sensitive to their needs, healthcare professionals who understand them, and services that are flexible regarding out of hours access. Listening to and acting on the voice of adolescents is important to developing youth-friendly services.
PubMed: 38629615
DOI: 10.1177/13674935241239837