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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 2017: 4.671, 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.
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Background: There have been mixed results of the studies checking whether prayers do actually extend the life duration of the people prayed for. Most studies on the topic included a small number of pr...
Background: There have been mixed results of the studies checking whether prayers do actually extend the life duration of the people prayed for. Most studies on the topic included a small number of prayers and most of them focused on people already struggling with a medical condition. Intercessory prayer’s influence on health is of scholarly interest, yet it is unclear if its effect may be dependent on the number of prayers for a named individual received per annum. Objective: We sought to examine if there is a noticeable increased longevity effect of intercessory prayer for a named individual’s well-being, if he receives a very high number of prayers per annum for an extended period. Methods: We retrieved and conducted a statistical analysis of the data about the length of life for 857 Roman Catholic bishops, 500 Catholic priests, and 3038 male academics from the US, France, Italy, Poland, Brazil, and Mexico. We obtained information for these individuals who died between 1988 and 2018 from Wikidata, and conducted an observational cohort study. Bishops were chosen for the study, as they receive millions of individual prayers for well being, according to conservative estimates. Results: There was a main effect for occupation F(2, 4391) = 4.07, p = .017, ηp 2 = .002, with pairwise comparisons indicating significant differences between the mean life duration of bishops (M=30489) and of priests (M=29894), but none between the academic teachers (M=30147) and either of the other groups. A comparison analysis between bishops from the largest and the smallest dioceses showed no significant difference t(67.31)=1.61, p = .11. Our main outcome measure is covariance of the mean length of life in each of the categories: bishops, priests, academic teachers, controlled for nationality. Conclusions: The first analysis proved that bishops live longer than priests, but due to a marginal effect size this result should be treated with caution. No difference was found between the mean length of life of bishops from the largest and the smallest dioceses. We found no difference between bishops and male academics. These results show that the impact of intercessory prayers on longevity is not observable.
Background: Quality of life (QoL) assessments, or patient-reported outcome measures (PROMs), are becoming increasingly important and can improve decision making, satisfaction, and outcomes of care. S...
Background: Quality of life (QoL) assessments, or patient-reported outcome measures (PROMs), are becoming increasingly important and can improve decision making, satisfaction, and outcomes of care. Some physicians and patients find questionnaires too burdensome, which could be reduced by using computerized adaptive testing. Furthermore, questionnaire user experience might increase by making a questionnaire more interesting, for example by providing graphical and contextualized feedback. However, little is known about how shorter assessments and feedback impact user experience. Objective: We conducted a controlled experiment to assess the impact of tailored multimodal feedback and computerized adaptive testing on user experience in QoL assessment using validated PROMs. Methods: We recruited a representative sample from the general population in the United Kingdom using the Oxford Prolific academic web panel. Participants completed either a computer adaptive testing version of the World Health Organization Quality of Life assessment (WHOQOL-CAT) or the fixed-length WHOQOL-BREF. We randomly assigned participants to conditions in which they would receive either no feedback, graphical feedback only, or graphical and adaptive text feedback. Participants rated the assessment in terms of perceived acceptability, engagement, clarity, and accuracy. Results: We included 1386 participants in our analysis. Assessment experience was improved when graphical and tailored text feedback was provided together alongside PROMs (p<0.001, Δ=0.22). Providing graphical feedback alone was not associated with improvement in overall experience (p=0.006, Δ=0.10). Graphical and text feedback made the questionnaire more interesting and users were more likely to share the results with a physician or family member (p<0.001, Δ=0.17, and p<0.001, Δ=0.17, respectively). No difference was found in perceived accuracy of the graphical feedback scores of the WHOQOL-CAT and WHOQOL-BREF (p=0.05, Δ = 0.06). Computerized adaptive testing resulted in a 25% item reduction (SE<0.45) compared to the fixed-length assessment but did not result in an increased user experience (p=0.21). Conclusions: Using tailored text feedback to contextualize numeric scores maximized the acceptability of electronic QoL assessment. Improving user experience may increase response rates and reduce attrition in research and clinical use of PROMs. In this study, CAT administration was associated with a modest decrease in assessment length but did not improve user experience. Patient perceived accuracy of feedback was equivalent when comparing CAT with fixed-length assessment. Further research is warranted to explore the relationship between assessment length, feedback, and response burden in diverse populations.
Background: Post-vaccination fever (PVF) is a mild adverse event that is naturally reversible without complications, but is highly prevalent and, in some cases, accompanied by febrile convulsions. The...
Background: Post-vaccination fever (PVF) is a mild adverse event that is naturally reversible without complications, but is highly prevalent and, in some cases, accompanied by febrile convulsions. These adverse effects may cause parents to delay or abandon vaccinating their children. Objective: The aim of this paper was to identify PVF patterns and the ability of antipyretics to affect changes in these patterns. Methods: We used the data collected by the parents of the feverish children in the mobile application named Fever Coach to identify the PVF patterns according to the vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained 5 or more body temperature readings performed within 48 hours of vaccination and analyzed PVF onset, offset, duration, and maximum temperature. By observing PVF response to vaccination, we identified effects of antipyretic drugs on PVF onset, offset, and duration times; the extent of fever; and rate of decline. We also performed the logistic regression test to determine demographic variables (age, weight, and gender) to produce relatively high fevers (≥39 ° C). Results: The highest body temperature at which infants and young children received antipyretic drugs was 38 ° C (9.8% of the total data). The number of instances where this temperature threshold was reached was more than four times greater than the number reaching 37.9 ° C. Analyses showed no significant difference in onset time between antipyretic and non-antipyretic cases, but offset time and duration time were significantly shorter in non-antipyretic cases (P < .001). In non-antipyretic cases, offset times and duration times were, on average, 9.9 hours and 10.1 hours shorter, respectively than antipyretic cases. Body temperatures also decreased faster in non-antipyretic cases. Besides, we found that fevers associated with the influenza vaccine lasted relatively long, while fevers associated with the pneumococcus vaccine were relatively short-lived. Conclusions: These findings suggest that PVF has its own fever pattern that is dependent upon vaccine type and presence of antipyretic drugs, and post-vaccination temperature monitoring may ease fever phobia and reduce unnecessary use of antipyretics and medical care.
Background: Although there are more than 60 smartphone applications (apps) for smoking cessation in China, many do not include the content and features that smokers prefer—which may make them imprac...
Background: Although there are more than 60 smartphone applications (apps) for smoking cessation in China, many do not include the content and features that smokers prefer—which may make them impractical and/or ineffective. Objective: We therefore investigated what Chinese smokers want from a smartphone app for smoking cessation. Methods: Between May 1, 2016 and August 31, 2016, eligible Chinese smokers who own smartphones (N = 357) responded to a survey collecting data on their socio-demographic characteristics and their opinions on the importance of 20 smoking cessation app design features validated in previous research. Results: Few smokers (14/319, 4.4%) had ever downloaded a smoking cessation app. More than 60% of smokers rated the following four features as very or extremely important: allow sharing the process of smoking cessation with family members and friends (67.7%), help smokers track their progress (such as amount of smoking per day) (66.8%), help with the side effects of medications and nicotine withdrawal symptoms (63.0%), and adapt to ongoing needs and interests of smokers (60.8%). Among subgroups of smokers, supportive content (e.g., information about cessation medications) features were rated as more important among females (vs. males; all p<.05) and among those age 35 and younger (vs. age 36 and older; all ps<.05). Conclusions: Contrary to a similar study of American smokers (McClure et al., 2016), Chinese smokers highly value a smoking cessation app’s reputation and ability to communicate with family members and friends as important features whereas privacy and security were less important. Women and those age 36 and over tend to value more supportive features. Overall, design of health behavior change apps should consider cultural and demographic differences.
Background: New models of scalable population-based data collection that integrate digital and mobile health data are necessary. Objective: To describe a cardiovascular digital and mobile health e-coh...
Background: New models of scalable population-based data collection that integrate digital and mobile health data are necessary. Objective: To describe a cardiovascular digital and mobile health e-cohort embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). Methods: We invited eligible and consenting FHS Generation 3 and Omni participants to download the eFHS app onto their smartphones and co-deployed a digital blood pressure (BP) cuff. Soon thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements and to wear the smartwatch daily. Results: Up to July 2017, we have enrolled 790 eFHS participants, representing 75.7% of potentially eligible FHS participants. eFHS participants were, on average, 538 years of age and 57% were women. 85% (n=675) of eFHS participants completed all of the baseline survey and 59% (n=470) completed the 3-month survey. 42% (n=241 of 573) and 76% (n=306 of 405) of eFHS participants adhered to weekly digital BP and HR uploads, respectively over 12 weeks. Conclusions: We have designed an e-cohort focused on identifying novel CVD risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable.
Background: Technological interventions such as mobile applications (apps), online social networks and wearable trackers have the potential to influence physical activity; yet, few studies have examin...
Background: Technological interventions such as mobile applications (apps), online social networks and wearable trackers have the potential to influence physical activity; yet, few studies have examined the efficacy of an intervention bundle combining these different technologies. Objective: To pilot test an intervention composed of a social networking mobile app, connected with a wearable tracker and investigate its efficacy in improving physical activity, as well as explore participant engagement, and the usability of the app. Methods: Pre-post quasi-experimental study with one arm, where participants were subjected to the intervention for a six-month period. The primary outcome measure was the difference in daily step count between baseline and six months. Secondary outcome measures included engagement with the intervention and system usability. Descriptive and inferential statistical tests were conducted; post-hoc subgroup analyses were carried out for participants with different levels of: steps at baseline, app usage and social features usage. Results: Fifty-five participants were enrolled in the study; the mean age was 23.6 years and 28 (50.1%) were female. At six months, the retention rate was 81.8% (45/55). There was a non-significant increase of 1039 steps per day in average daily step count between baseline and 6 months (P = 0.06, 95% confidence interval [-61, 2139]). Subgroup analysis comparing the high and low physical activity groups at baseline showed that the latter significantly increased their daily step count by throughout the study 2677 steps per day (P = 0.002, 95% confidence interval [785, 3658]). Conclusions: Our study showed the efficacy of a mobile social networking intervention, integrated with a wearable tracker to promote physical activity, particularly for physically inactive subgroups of the population. Future research should explore how to address challenges faced by physically inactive people to provide tailored advices. Additionally, users’ perspectives should be explored to shed light on factors that might influence their engagement with the intervention.