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The leading peer-reviewed journal for digital medicine, and health & healthcare in the Internet age
The Journal of Medical Internet Research (JMIR), now in its' 20th year, is the pioneering open access eHealth journal, and is the flagship journal of JMIR Publications. It is the leading digital health journal globally, in terms of quality/visibility (Impact Factor 2016: 5.175, ranked #1 out of 22 journals) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals.
As open access journal we are read by clinicians, allied health professionals, informal caregivers and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (e.g. in grant proposals), and for open peer-review purposes. We also invite patients to participate, e.g. as peer-reviewers, and have patient representatives on editorial boards.
Be a widely cited leader in the digitial health revolution and submit your paper today!
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Background: Reductions in health insurance enrollment outreach could have negative effects on the individual health insurance market. Specifically, consumers may not be informed about the availability...
Background: Reductions in health insurance enrollment outreach could have negative effects on the individual health insurance market. Specifically, consumers may not be informed about the availability of coverage and if some healthier consumers fail to enroll, there could be a worse risk pool for insurers. Kentucky created its own Marketplace, known as kynect, and adopted Medicaid expansion under the ACA, which yielded the largest decline in adult uninsured rate in the country from 2013 to 2016. The state sponsored an award-winning media campaign yet declined to renew the advertising contract for kynect and canceled all pending television ads with over a month remaining in the 2016 open enrollment period after the election of a new governor in 2015. Objective: The objective of this study is to examine the stark variation in advertising across multiple open enrollment periods in Kentucky and to use this variation to estimate the dose-response effect of state-sponsored advertising on consumer engagement with the Marketplace. In addition, we assess to what extent private insurers can potentially help fill the void when governments reduce or eliminate television advertising. Methods: We obtained advertising (Kantar Media/CMAG) and Marketplace data (Kentucky Health Benefit Exchange) for the period of October 1, 2013 through January 31, 2016 for Kentucky. Advertising data at the spot level were collapsed to state-week counts by sponsor type. Similarly, a state-week series of Marketplace engagement and enrollment measures were derived from state reports to CMS. We use linear regression models to estimate associations between health insurance advertising volume and measures of information seeking (calls to call center; page views, visits, and unique visitors to website) and enrollment (online and total applications, Marketplace enrollment). Results: We find significant dose-response effects of weekly state-sponsored advertising volume during open enrollment on information-seeking behavior (page views: 7,972.9, visits: 390.2, and unique visitors: 387.5) and enrollment activity (applications, online: 61.4 and total: 55.9). Conclusions: State-sponsored television advertising was associated with nearly 40% of unique visitors and online applications. Insurance company advertising was not a significant driver of engagement, an important consideration if cuts to government-sponsored advertising persist.
Background: Cervical Spondylotic Myelopathy (CSM) is a common debilitating condition resulting from degeneration of the cervical spine. Whilst decompressive surgery can halt disease progression, exist...
Background: Cervical Spondylotic Myelopathy (CSM) is a common debilitating condition resulting from degeneration of the cervical spine. Whilst decompressive surgery can halt disease progression, existing spinal cord damage is often permanent, leaving patients with lifelong disability. Treatment within 6 months improves the likelihood of recovery, yet most patients wait over 2 years for a diagnosis. The majority of delays occur initially, before and within primary care, mainly due to a lack of recognition. Symptom checkers are widely used by patients before medical consultation and can be useful for preliminary triage and diagnosis. Lack of recognition of CSM by symptom checkers may contribute to the delay in diagnosis. Objective: The present study sought to investigate whether online symptom checkers are able to recognise relevant symptoms of CSM, to characterise the CSM differential returned, and to evaluate the diagnostic performance of its recognised symptoms. Methods: Textbook CSM symptoms were pooled from leading review articles. These symptoms were entered into the algorithms used by the top 20 symptom checker websites (N=4) (Google Search). The most widely cited symptom checker, WebMD, was used to characterise the differential diagnosis for CSM symptoms. Results: 31 textbook CSM symptoms were identified, of which 14 (45%) listed CSM as a differential and 3 (10%) placed CSM in the top third of the differential. The mean differential rank for motor symptoms was significantly better than for arthritic symptoms (P = .0093) and the average differential rank for all symptoms (P = .048). The symptom checker WebMD performed best at recognising CSM, placing it nearer the top of the differential list (average rank of 5.6) than both Healthline (rank of 12.9, P = .015) and Healthtools.AARP (rank of 15.5, P = .0014). On WebMD, only one combination of symptoms resulted in CSM as the primary differential: neck, shoulder and arm pain with hand weakness. 151 differential diagnoses for CSM symptoms were recorded on WebMD. Multiple sclerosis and peripheral neuropathy were the most common differentials, shortlisted for 52% and 32% of CSM symptoms respectively. Conclusions: CSM symptoms perform poorly in online symptom checkers and lead to a large differential of many other common conditions. Whilst a diagnosis becomes more likely as the number of symptoms increases, this will not support much needed earlier diagnosis. Symptom checkers remain an attractive concept with potential. Further research is required to support their optimisation.
Background: There is wide recognition that the lack of health data interoperability has significant impacts. Traditionally health data standards are complex, and test-driven methods played important r...
Background: There is wide recognition that the lack of health data interoperability has significant impacts. Traditionally health data standards are complex, and test-driven methods played important roles in achieving interoperability. HL7 FHIR may be a technical solution that aligns with policy, but systems need to be validated and tested. Objective: Our objective is to explore the question of whether or not the regular use of validation and testing tools improves server compliance with the HL7 FHIR specification. Methods: We used two independent validation and testing tools, Crucible and Touchstone, and analyzed the usage and result data to determine their impact on server compliance with the HL7 FHIR specification. Results: The use of validation and testing tools such as Crucible and Touchstone are strongly correlated with increased compliance, and “practice makes perfect.” Additional data analysis reveals trends over time with respect to vendors, use-cases, and FHIR versions. Conclusions: Validation and testing tools can aid in the transition to an interoperable health care infrastructure. Developers that use testing and validation tools tend to produce more compliant FHIR implementations. When it comes to health data interoperability, “practice makes perfect.”
Background: Telemedicine is increasingly evaluated for rehabilitation of stroke survivors. However, little is known about the utility of telerehabilitation in stroke survivors. Objective: To summarize...
Background: Telemedicine is increasingly evaluated for rehabilitation of stroke survivors. However, little is known about the utility of telerehabilitation in stroke survivors. Objective: To summarize the evidence on the utility of telerehabilitation in stroke survivors. Methods: Eligible randomized controlled trials (RCTs) were selected from Medline, Cochrane Central and Web of Science databases. Continuous data on the outcomes were analyzed using the RevMan software as standardized mean difference (SMD) and 95% confidence interval (95% CI) in a fixed effect meta-analysis model. Results: Fifteen studies, providing data on 1,339 stroke survivors were eligible for inclusion. The combined effect estimate showed that telerehabilitation is as good as usual care as Barthel index (SMD = -0.05, 95% CI [-0.18, 0.08]), Berg Balance Scale (SMD = -0.04, 95% CI [-0.34, 0.26]), Fugl-Meyer Upper Extremity (SMD = 0.50, 95% CI [-0.09, 1.09]) and Stroke Impact Scale [mobility] (SMD = 0.18, 95% CI [-0.13, 0.48]) scores were statistically similar in both groups. Further, quality of life (of the stroke survivor), caregiver strain index and patients' satisfaction with care scores were also similar for both the groups. One study showed that the cost of telerehabilitation was lower than usual care by $654. Conclusions: Telerehabilitation can be a suitable alternative to usual rehabilitation care in post-stroke patients, especially in remote or underserved areas.
Background: The quality and quantity of families’ support systems during pregnancy can affect maternal and fetal outcomes. The support systems of expecting families can include many elements, such a...
Background: The quality and quantity of families’ support systems during pregnancy can affect maternal and fetal outcomes. The support systems of expecting families can include many elements, such as family members, friends, and work or community groups. Emerging health information technologies such as social media, Internet websites, and mobile apps provide new resources for pregnant families to augment their support systems and to fill information gaps. Objective: This study sought to determine the number and nature of the components of the support systems of pregnant women and their caregivers, and the role of health information technologies in these support systems. We examined the differences between pregnant women’s support systems and those of their caregivers and the associations between support system composition and stress levels. Methods: We enrolled pregnant women and caregivers from an advanced maternal fetal and group prenatal care clinics. Participants completed surveys assessing sociodemographic characteristics, health literacy, numeracy, and stress levels, and they were asked to draw a picture of their support system. Support system elements were extracted from drawings, categorized by type (i.e., individual persons, groups, technologies, and other), and summarized for pregnant women and caregivers. Participant characteristics and support system elements were compared using Pearson Chi-square test for categorical variables and Wilcoxon ranked sum test for continuous variables. Associations between support system characteristics and stress levels were measured with Spearman correlation coefficient. Results: The study enrolled 100 participants: 71 pregnant women and 29 caregivers. The support systems of pregnant women were significantly larger than those of caregivers, with an average of 7.4 components for pregnant women and 5.4 components for caregivers (P=0.003). For all participants, the most commonly reported support system elements were individual persons (60.3% of support systems), followed by people groups (19.3%), technologies (16.2%), and other resources (4.2%). Pregnant women’s and caregivers’ technology preferences within their support systems differed: pregnant women more often identified informational websites, apps, and social media as parts of their support systems, whereas caregivers more frequently reported general Internet search engines. The size and components of these support systems were not associated with levels of stress. Conclusions: This study is one of the first demonstrating that technologies comprise a substantial portion of the support systems of pregnant women and their caregivers. Pregnant women more frequently reported specific medical information websites as part of their support system, whereas caregivers more often reported general Internet search engines. Although social support is important for maternal and fetal health outcomes, no associations among stress, support system size, and support system components were found in this study. As health information technologies continue to evolve and their adoption increases, their role in patient and caregiver support systems and their effects should be further explored.
Background: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the...
Background: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease, and patients with cardiovascular disease require more extensive dietary counseling to reduce their risk of myocardial infarction, stroke and hypertension. Objective: Our study tested the hypothesis that asynchronous dietary counseling supplied through a custom smartphone application results in better adherence to a Mediterranean diet in a non-Mediterranean population compared with traditional standard-of-care counseling. Methods: 100 patients presenting to the cardiology clinic of an academic medical center in Washington D.C. were randomized to either the standard-of-care (SOC) or smartphone app-based (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietician. Participants in EXP received a custom smartphone application that reinforced the Mediterranean diet while participants in SOC received two additional sessions of in-person dietary counseling with the registered dietician – 30 minutes at 1 month and 30 minutes at 3 months. Pre-existing knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score instrument (MDS). Baseline height, weight, blood pressure and laboratory biomarkers were collected. At 1, 3 and 6 months, participants presented for a follow up appointment to assess compliance to the Mediterranean diet using the MDS, as well as a patient satisfaction survey, blood pressure and weight. Repeat laboratory biomarkers were performed at 3 and 6 months. Results: Enrolled participants had a mean age with standard error of 56.6 ± 1.7 for SOC and 57.2 ± 1.8 for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with respect to blood pressure, lipid parameters, HgbA1C, or CRP. Participants in EXP achieved a significantly greater weight loss on average of 3.3 lbs vs. 3.1 lbs for participants in SOC, p=0.04. Adherence to the Mediterranean diet increased significantly over time for both groups (p<0.001), but there was no significant difference between groups (p=0.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as MDS ≥ 9) increased significantly over time (p<0.001) – from 18.4 to 57.1% for SOC and 27.5 to 64.7% for EXP – however, there was no significant difference between the groups. Conclusions: Both traditional standard-of-care counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet in this US-based study of cardiology patients, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This study demonstrates that the American cardiology patient can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling.