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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 pioneer 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 (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, 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: Disclosure is a difficult but important process for victims of child maltreatment. There is limited research on child maltreatment disclosure, but Young people have been reluctant to discl...
Background: Disclosure is a difficult but important process for victims of child maltreatment. There is limited research on child maltreatment disclosure, but Young people have been reluctant to disclose victimization to adults, but short message service (SMS) crisis services may represent one novel method of engaging young people around sensitive topics. Objective: The purpose of this study was to determine characteristics of child maltreatment disclosure to Crisis Text Line (CTL), a SMS-based crisis service. Methods: We conducted a content analysis of all conversations (n = 244) that resulted in a mandatory report by CTL between October 2015 and July 2017. We coded characteristics of the disclosure process, including the reason for initial contact, phrase used to disclose abuse, perpetrator, type of abuse, and length of victimization. After identifying terms used by young people to disclose child abuse, we randomly selected and analyzed 50 conversations using those terms to determine if use of the terms differed between conversations that did and did not result in mandatory report. Results: Parents were the most common perpetrator. Physical abuse was the most common form of abuse discussed in the initial abuse disclosure (n = 106), followed by psychological abuse (n = 83), sexual abuse (n = 38), and neglect (n = 15). More than half of texters discussed abuse or other significant family issues in the first message. “Abuse”, other definite language (e.g., rape, molested), or an explicit description of the experience was common in disclosures. Conclusions: Early disclosure, combined with explicit language, may suggest at least a portion of young victims are actively seeking safe ways to talk about their experiences, rather than incidentally sharing experiences while seeking support for other issues. SMS may be a valuable way to engage with young people around sensitive topics, but these approaches will require careful consideration in their development, implementation, and evaluation to ensure a positive experience for young people.
Background: Physical inactivity is a major risk factor for non-alcoholic fatty liver disease (NAFLD). Improvement of cardiorespiratory fitness (CRF) by exercise based prevention interventions is a rec...
Background: Physical inactivity is a major risk factor for non-alcoholic fatty liver disease (NAFLD). Improvement of cardiorespiratory fitness (CRF) by exercise based prevention interventions is a recommended complementary treatment for NAFLD. Enabling patients to achieve minimally effective physical activity recommendations to improve CRF, typically requires high personal and financial expenses in face-to-face settings. Here we designed an eHealth approach for patients with NAFLD to overcome typical intrinsic and extrinsic barriers for the improvement of CRF (HELP-Study). Objective: We assessed the effectiveness of an 8-week tailored Web-based exercise intervention for the improvement of CRF, expressed as VO2peak, in patients with histologically confirmed NAFLD. Methods: In a 24-month period, 44 patients were enrolled into an 8-week prospective, single-arm study. After a medical examination and performance diagnostics, a sports therapist introduced the patients to a Web-based platform for individualized training support. Regular individual patient feedback, was used to systematically adapt the weekly exercise schedule. This enabled to monitor and warrant patient adherence to strength and endurance training and to optimize the step-wise progressive exercise load. Exercise progression was based on an a priori algorithm taking the subjective rate for both, perceived exhaustion and general physical discomfort into account. VO2peak was assessed at baseline and at the end of the study by spiroergometry. Results: Forty-three patients completed the intervention with no adverse events reported. VO2peak significantly increased 8.5 % by 2.4 ml/kg/min (95% CI: 1.48 - 3.27, P < .0001) accompanied by a 1.0 kg (95% CI: 0.33 – 1.58, P = .004) body weight reduction and a 1.3 kg (95% CI: 0.27 – 2.27, P = .01) body fat mass reduction. In an exploratory analysis step-wise logistic regression analysis revealed low body fat and low VO2peak at baseline as well as the total minutes of endurance training during the intervention as main contributors to a positive change in VO2peak. Our predictive model indicated that the average NAFLD patient needed 223 min for stabilization of VO2peak, while 628 min were required to achieve average improvement in VO2peak. However, in patients with a roughly 20 % higher than average VO2peak these 628 min were only sufficient to stabilize VO2peak and a more than 40 % lower than average fat mass would be required for such subjects with high VO2peak to achieve an average outcome. Conclusions: Here we show for the first time that patients with NAFLD can be effectively supported by a Web-based approach enabling similar increases in VO2peak as face-to-face interventions. Patients with low body fat and low VO2peak turned out to profit the most from our intervention. In terms of future treatment strategies, this implies that NAFLD patients with high body fat may particularly benefit from body fat reduction by a sharp nutritional intervention in first place thus enabling a more effective exercise intervention, subsequently. Clinical Trial: Clinicaltrials.gov: NCT02526732
Background: With health research practices shifting towards rapid recruitment of samples through the use of online approaches, little is known about the impact of these recruitment methods on continue...
Background: With health research practices shifting towards rapid recruitment of samples through the use of online approaches, little is known about the impact of these recruitment methods on continued participation in cohort studies. Objective: Report on the retention of a cohort of young women who were recruited using an open recruitment strategy. Methods: Women from the 1989-95 cohort of the Australian Longitudinal Study on Women’s Health, recruited in 2012-13 were followed up annually via online surveys in 2014, 2015 and 2016. Prevalence ratios for survey response were calculated using log-binomial model with generalised estimating equations with demographic, health-related and recruitment method characteristics examined as explanatory factors. Results: Of the 17,012 women who completed the baseline survey, approximately two-thirds completed the second survey, and just over half completed surveys 3 and 4, respectively. Women demonstrated transient patterns of responding with only 38% of women completing all four surveys. While retention of young women was associated with age, education, health status and health behaviours, method of recruitment was a key determinant of study participation in the multivariate model. Although women were more likely to be recruited into the cohort via social media (e.g. Facebook), retention over time was higher for women recruited through traditional media and referral approaches. Conclusions: A balance must be obtained between achieving representativeness, achieving rapid cohort recruitment and mitigating the pitfalls of attrition based on recruitment method in the new era of cohort studies, where traditional recruitment methods are no longer exclusively viable options.
Background: Stress urinary incontinence (SUI) affects 10–39% of women. First-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed superv...
Background: Stress urinary incontinence (SUI) affects 10–39% of women. First-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät® app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial (RCT), which demonstrated efficacy regarding incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment. Objective: To explore women’s experiences of using an app-based treatment program for SUI. Methods: A qualitative study based on telephone interviews with 15 selected women, with a mean age of 47, who had used the app in the previous RCT. A semi-structured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to Grounded Theory. Results: The results were grouped into three categories: “Something new!”, “Keeping motivation up!”, and “Good enough?” A core category, “Enabling my independence”, was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing. The closeness to their smartphone and app features like reminders and visual graphs helped to support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They experienced that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment. Conclusions: Using the app-based treatment program for SUI empowered the women and helped them self-manage their incontinence treatment. They appreciated the app as a new tool supporting their motivation to carry through a somewhat challenging PFMT program.
Background: In the United States, rare diseases are defined as those affecting fewer than 200,000 patients at any given time. Patients with rare diseases are frequently either misdiagnosed or left und...
Background: In the United States, rare diseases are defined as those affecting fewer than 200,000 patients at any given time. Patients with rare diseases are frequently either misdiagnosed or left undiagnosed, possibly due in part to a lack of knowledge or experience with the rare disease on the part of care providers. With an exponentially growing volume of electronically accessible medical data, a large volume of information on thousands of rare diseases and their potentially associated diagnostic information is buried in electronic medical records (EMRs) and medical literature. Objective: We hypothesize that patients’ phenotypic information available within these heterogeneous resources (e.g., electronic medical records and biomedical literature) can be leveraged to accelerate disease diagnosis. In this study, we aimed to leverage information contained in heterogeneous datasets to assist rare disease diagnosis. Methods: In a previous study, we proposed utilizing a collaborative filtering recommendation system enriched with natural language processing and semantic techniques to assist rare disease diagnosis based on phenotypic characterizations derived solely from EMR data. In this study, in order to further investigate the performance of collaborative filtering on heterogeneous datasets, we studied EMR data generated at Mayo Clinic as well as published article abstracts retrieved from the Semantic MEDLINE Database. Specifically, in this study, we applied Tanimoto coefficient similarity, overlap coefficient similarity, Fager & McGowan coefficient similarity, and log likelihood ratio similarity with K nearest neighbor and threshold based patient neighbor algorithms on various combinations of datasets. Results: We evaluated different approaches to this problem using characterizations derived from various combinations of EMR data and literature, as well as with solely EMR data. We extracted 12.8 million EMRs from the Mayo Clinic unstructured patient cohort generated between 2010 through 2015 and retrieved all article abstracts from the semi-structured Semantic MEDLINE Database that were published through the end of 2016. We applied a collaborative filtering model and compared the performance generated by different metrics. Log likelihood ratio similarity combined with K nearest neighbor on heterogeneous datasets showed the optimal performance in patient recommendation with PRAUC 0.475 (string match), 0.511 (SNOMED match), and 0.752 (GARD match). Log likelihood ratio similarity also performed the best with mean average precision 0.465 (string match), 0.5 (SNOMED match), and 0.749 (GARD match). Performance of rare disease prediction was also demonstrated by using the optimal algorithm. Macro-average F-measure for string, SNOMED-CT, and GARD match were 0.32, 0.42, and 0.63, respectively. Conclusions: This study demonstrated potential utilization of heterogeneous datasets in a collaborative filtering model to support rare disease diagnosis. In addition to phenotypic-based analysis, in the future, we plan to resolve the heterogeneity issue and reduce miscommunication between EMR and literature by mining genotypic information to establish a comprehensive disease-phenotype-gene network for rare disease diagnosis.
Background: A handful of clinics in the U.S. routinely offer patients audio or video recordings of their clinic visits. While interest in the practice of clinic visit recording has increased, to date...
Background: A handful of clinics in the U.S. routinely offer patients audio or video recordings of their clinic visits. While interest in the practice of clinic visit recording has increased, to date there is no data on the prevalence of recording in clinical practice in the U.S. Objective: Our objectives were to 1) determine the prevalence of sharing audio-recorded clinic visits for patients’ personal use in the U.S., 2) assess the attitudes of clinicians and the public toward recording, and 3) identify whether or not policies exist to guide recording practices in 49 of the largest health systems in the U.S. Methods: Two parallel cross-sectional surveys were administered in July 2017 to Internet Panels of U.S. based clinicians (SERMO Panel) and the U.S. public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from eight specialties. Quotas were also applied to the public survey based on U.S. Census data (gender, race, ethnicity and language other than English spoken at home) to approximate views among U.S. adults. Forty-nine of the largest health systems (by clinician number) in the U.S. were contacted by email and telephone to determine the existence, or absence, of policies to guide audio-recordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording. Results: A total of 456 clinicians and 524 public respondents completed surveys. Approximately 28% of clinicians reported that they had recorded a clinic visit for patients’ personal use, while 18% of the public reported doing so, including 3% who recorded visits without the clinician’s permission. Of the 327 clinicians who had not recorded a clinic visit, 50% would be willing to do so in the future, while 66% of the public would be willing to record in the future. Clinician specialty was associated with prior recording: oncology, OR=5.1 (95% CI 1.9 to 14.9; P=0.002) and physical rehabilitation OR=3.9 (95% CI 1.4 to 11.6; P=0.01). Public respondents who were male, OR=2.11 (95% CI 1.26 to 3.61; P=0.005), younger age, OR=0.73 for a 10-year increase in age (95% CI 0.60 to 0.89; P=0.002); or spoke a language other than English at home, OR=1.99 (95% CI 1.09 to 3.59; P=0.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy, however 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. Perceived benefits of recording included improved patient understanding and recall. Privacy and medico-legal concerns were raised. Conclusions: U.S. clinicians and public are taking the lead on recording clinic visits, while health systems seem to be lagging. Policy guidance from health systems and further examination of the impact of recordings, positive or negative, on the delivery of care and patients’ behavioral and health-related outcomes is urgently required.