One measure national governments took to react to the acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic was mobile applications (apps). This study aims to provide a high-level ...overview of published reviews of mobile apps used in association with coronavirus disease 19 (COVID-19), examine factors that contributed to the success of these apps, and provide data for further research into this topic.
We conducted a systematic review of reviews (also referred to as an umbrella review) and searched two databases, Medline and Embase, for peer-reviewed reviews of COVID-19 mobile apps that were written in English and published between January 1st 2020 and April 25th 2022.
Out of the initial 17,611 studies, 24 studies were eligible for the analysis. Publication dates ranged from May 2020 to January 2022. In total, 54% (
= 13) of the studies were published in 2021, and 33% (
= 8) were published in 2020. Most reviews included in our review of reviews analyzed apps from the USA, the UK, and India. Apps from most of the African and Middle and South American countries were not analyzed in the reviews included in our study. Categorization resulted in four clusters (app overview, privacy and security, MARS rating, and miscellaneous).
Our study provides a high-level overview of 24 reviews of apps for COVID-19, identifies factors that contributed to the success of these apps, and identifies a gap in the current literature. The study provides data for further analyses and further research.
In the face of demographic change and constantly increasing health care costs, health care system decision-makers face ever greater challenges. Mobile health applications (mHealth apps) have the ...potential to combat this trend. However, in order to integrate mHealth apps into care structures, an evaluation of such apps is needed. In this paper, we focus on the criteria and methods of evaluating mHealth apps for cardiovascular disease and the implications for developing a widely applicable evaluation framework for mHealth interventions. Our aim is to derive substantiated patterns and starting points for future research by conducting a quasi-systematic scoping review of relevant peer-reviewed literature published in English or German between 2000 and 2021. We screened 4066 articles and identified
= 38 studies that met our inclusion criteria. The results of the data derived from these studies show that usability, motivation, and user experience were evaluated primarily using standardized questionnaires. Usage protocols and clinical outcomes were assessed primarily via laboratory diagnostics and quality-of-life questionnaires, and cost effectiveness was tested primarily based on economic measures. Based on these findings, we propose important considerations and elements for the development of a common evaluation framework for professional mHealth apps, including study designs, data collection tools, and perspectives.
In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated ...development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs.
This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement.
A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation.
Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies.
This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation.
Homozygous SMN1 loss causes spinal muscular atrophy (SMA), the most common lethal genetic childhood motor neuron disease. SMN1 encodes SMN, a ubiquitous housekeeping protein, which makes the ...primarily motor neuron-specific phenotype rather unexpected. SMA-affected individuals harbor low SMN expression from one to six SMN2 copies, which is insufficient to functionally compensate for SMN1 loss. However, rarely individuals with homozygous absence of SMN1 and only three to four SMN2 copies are fully asymptomatic, suggesting protection through genetic modifier(s). Previously, we identified plastin 3 (PLS3) overexpression as an SMA protective modifier in humans and showed that SMN deficit impairs endocytosis, which is rescued by elevated PLS3 levels. Here, we identify reduction of the neuronal calcium sensor Neurocalcin delta (NCALD) as a protective SMA modifier in five asymptomatic SMN1-deleted individuals carrying only four SMN2 copies. We demonstrate that NCALD is a Ca2+-dependent negative regulator of endocytosis, as NCALD knockdown improves endocytosis in SMA models and ameliorates pharmacologically induced endocytosis defects in zebrafish. Importantly, NCALD knockdown effectively ameliorates SMA-associated pathological defects across species, including worm, zebrafish, and mouse. In conclusion, our study identifies a previously unknown protective SMA modifier in humans, demonstrates modifier impact in three different SMA animal models, and suggests a potential combinatorial therapeutic strategy to efficiently treat SMA. Since both protective modifiers restore endocytosis, our results confirm that endocytosis is a major cellular mechanism perturbed in SMA and emphasize the power of protective modifiers for understanding disease mechanism and developing therapies.
Study objective We examine functional profiles and presence of geriatric syndromes among older patients attending 13 emergency departments (EDs) in 7 nations. Methods This was a prospective ...observational study of a convenience sample of patients, aged 75 years and older, recruited sequentially and mainly during normal working hours. Clinical observations were drawn from the interRAI Emergency Department Screener, with assessments performed by trained nurses. Results A sample of 2,282 patients (range 98 to 549 patients across nations) was recruited. Before becoming unwell, 46% were dependent on others in one or more aspects of personal activities of daily living. This proportion increased to 67% at presentation to the ED. In the ED, 26% exhibited evidence of cognitive impairment, and 49% could not walk without supervision. Recent falls were common (37%). Overall, at least 48% had a geriatric syndrome before becoming unwell, increasing to 78% at presentation to the ED. This pattern was consistent across nations. Conclusion Functional problems and geriatric syndromes affect the majority of older patients attending the ED, which may have important implications for clinical protocols and design of EDs.
The use of drugs is always accompanied by the risk of adverse drug reactions (ADRs) and adverse events (AE). Generally physicians, pharmaceutical manufacturers, and pharmacists use a paper-based form ...for sending spontaneous ADR and AE reports to the national drug regulatory authority. Besides underreporting, reporting lag-time and errors through data transformation are a major issue. In order to improve the current reporting situation we have set up a new computer-based, network-driven system for storing, transferring, and evaluating ADR reports. The system consists of three regional centres, one coordinating centre, and the central ADR database of the national drug regulatory authority. In the regional centres, clinical pharmacologists collect ADR data in local databases. There is a comfortable user-interface with an online help-function available. New reports are sent automatically to the Federal Agency using EUROSCAPE as a standardized electronic report form of the EU. The coordinating centre in Munich is responsible for overall performance and quality assurance. This model for a clinical health information network is of a high level of data security, is reliable and easily expandable through the use of standard tools, is fast and also inexpensive by using standard shareware products.
Objectives
Identifying older emergency department (ED) patients with clinical features associated with adverse postdischarge outcomes may lead to improved clinical reasoning and better targeting for ...preventative interventions. Previous studies have used single‐country samples to identify limited sets of determinants for a limited number of proxy outcomes. The objective of this study was to identify and compare geriatric syndromes that influence the probability of postdischarge outcomes among older ED patients from a multinational context.
Methods
A multinational prospective cohort study of ED patients aged 75 years or older was conducted. A total of 13 ED sites from Australia, Belgium, Canada, Germany, Iceland, India, and Sweden participated. Patients who were expected to die within 24 hours or did not speak the native language were excluded. Of the 2,475 patients approached for inclusion, 2,282 (92.2%) were enrolled. Patients were assessed at ED admission with the interRAI ED Contact Assessment, a geriatric ED assessment. Outcomes were examined for patients admitted to a hospital ward (62.9%, n = 1,436) or discharged to a community setting (34.0%, n = 775) after an ED visit. Overall, 3% of patients were lost to follow‐up. Hospital length of stay (LOS) and discharge to higher level of care was recorded for patients admitted to a hospital ward. Any ED or hospital use within 28 days of discharge was recorded for patients discharged to a community setting. Unadjusted and adjusted odds ratios (ORs) were used to describe determinants using standard and multilevel logistic regression.
Results
A multi‐country model including living alone (OR = 1.78, p ≤ 0.01), informal caregiver distress (OR = 1.69, p = 0.02), deficits in ambulation (OR = 1.94, p ≤ 0.01), poor self‐report (OR = 1.84, p ≤ 0.01), and traumatic injury (OR = 2.18, p ≤ 0.01) best described older patients at risk of longer hospital lengths of stay. A model including recent ED visits (OR = 2.10, p ≤ 0.01), baseline functional impairment (OR = 1.68, p ≤ 0.01), and anhedonia (OR = 1.73, p ≤ 0.01) best described older patients at risk of proximate repeat hospital use. A sufficiently accurate and generalizable model to describe the risk of discharge to higher levels of care among admitted patients was not achieved.
Conclusions
Despite markedly different health care systems, the probability of long hospital lengths of stay and repeat hospital use among older ED patients is detectable at the multinational level with moderate accuracy. This study demonstrates the potential utility of incorporating common geriatric clinical features in routine clinical examination and disposition planning for older patients in EDs.
Resumen
Objetivos
La identificación de los pacientes mayores del servicio de urgencias (SU) con hallazgos clínicos asociados con resultados adversos tras el alta puede conducir a mejorar el juicio clínico y a establecer mejores objetivos para las intervenciones preventivas. Estudios previos han utilizado muestras de un solo país para identificar conjuntos limitados de determinantes para un número limitado de resultados en la toma de decisiones. El objetivo de este estudio fue identificar y comparar los síndromes geriátricos que influyen en la probabilidad de los resultados tras el alta en los pacientes mayores del SU desde un contexto multinacional.
Metodología
Estudio de cohorte prospectivo multinacional que se llevó a cabo en pacientes del SU de 75 años o más. Participaron un total de 13 SU de Australia, Bélgica, Canadá, Alemania, Islandia, India y Suecia. Se excluyeron los pacientes que se esperaba fallecieran en las primeras 24 horas o aquéllos de habla no nativa. De los 2.475 pacientes valorados para la inclusión, se incluyeron 2.282 (92,2%). Los pacientes se valoraron al ingreso del SU mediante la interRAI ED Contact Assessment, una valoración geriátrica en el SU. Los resultados se evaluaron para los pacientes ingresados en un planta del hospital (62,9%, n = 1.436) o dados de alta a la comunidad (34,0%, n = 775) tras una visita al SU. Del total, en un 3% de los pacientes se perdió el seguimiento. La estancia hospitalaria y el alta a un nivel de atención mayor se documentaron para los pacientes ingresados en una planta del hospital. Cualquier uso del hospital o del SU en los primeros 28 días tras el alta se documentó en los pacientes dados de alta a la comunidad. La razón de ventajas (odds ratio, OR) ajustada y no ajustada se usó para describir los determinantes usando una regresión logística convencional y multinivel.
Resultados
Un modelo multinacional que incluye el vivir solo (OR = 1,78, p ≤ 0,01), el estrés del cuidador (OR = 1,69, p = 0,02), el deterioro en la deambulación (OR = 1,94, p ≤ 0,01), el documentar baja autoestima (OR = 1,84, p ≤ 0,01), y la lesión traumatológica (OR = 2,18, p ≤ 0,01) es el que mejor describió a los pacientes mayores con riesgo de estancias hospitalarias más prolongadas. Un modelo que incluye las visitas recientes al SU (OR = 2,10, p ≤ 0,01), el deterioro funcional basal (OR = 1,68, p ≤ 0,01) y la incapacidad para experimentar placer (OR = 1,73, p ≤ 0,01) es el que mejor describió a los pacientes mayores con riesgo incrementado de repetir el uso hospitalario a corto plazo. No se alcanzó un modelo suficientemente preciso ni generalizable para describir el riesgo al alta de necesitar niveles mayores de atención en los pacientes ingresados.
Conclusiones
A pesar de la diferencia marcada de los sistemas sanitarios, la probabilidad de estancia prolongada en el hospital y uso repetido del hospital entre los pacientes mayores del SU es detectable desde una perspectiva multinacional con una precisión moderada. Este estudio demuestra la potencial utilidad de incorporar los hallazgos clínicos geriátricos comunes en la valoración clínica rutinaria y en la planificación de la ubicación de los pacientes mayores en el SU.
In humans, low peak bone mass is a significant risk factor for osteoporosis. We report that LRP5, encoding the low-density lipoprotein receptor-related protein 5, affects bone mass accrual during ...growth. Mutations in LRP5 cause the autosomal recessive disorder osteoporosis-pseudoglioma syndrome (OPPG). We find that OPPG carriers have reduced bone mass when compared to age- and gender-matched controls. We demonstrate LRP5 expression by osteoblasts in situ and show that LRP5 can transduce Wnt signaling in vitro via the canonical pathway. We further show that a mutant-secreted form of LRP5 can reduce bone thickness in mouse calvarial explant cultures. These data indicate that Wnt-mediated signaling via LRP5 affects bone accrual during growth and is important for the establishment of peak bone mass.
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