Beyond mobile apps: a survey of technologies for mental well-being

Mental health problems are on the rise globally and strain national health systems worldwide. Mental disorders are closely associated with fear of stigma, structural barriers such as financial burden, and lack of available services and resources which often prohibit the delivery of frequent clinical advice and monitoring. Technologies for mental well-being exhibit a range of attractive properties, which facilitate the delivery of state-of-the-art clinical monitoring. This review article provides an overview of traditional techniques followed by their technological alternatives, sensing devices, behaviour changing tools, and feedback interfaces. The challenges presented by these technologies are then discussed with data collection, privacy, and battery life being some of the key issues which need to be carefully considered for the successful deployment of mental health toolkits. Finally, the opportunities this growing research area presents are discussed including the use of portable tangible interfaces combining sensing and feedback technologies. Capitalising on the data these ubiquitous devices can record, state of the art machine learning algorithms can lead to the development of robust clinical decision support tools towards diagnosis and improvement of mental well-being delivery in real-time

A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes:A qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback

BACKGROUND: Mobile health technologies have advanced to now allow monitoring of the acute physiological responses to lifestyle behaviours. Our aim was to explore how people engaged with real-time feedback on their physical activity and glucose levels over several weeks. METHODS: Semi-structured interviews with 26 participants (61.5% female, 56.6 years) at moderate-to-high risk of developing type 2 diabetes were conducted. Interviews were completed after participants took part in an intervention comprising a flash glucose monitor (Freestyle Libre) and a physical activity monitor (Fitbit Charge 2). Purposive sampling ensured representation of ages, genders and group allocations. RESULTS: Inductive thematic analysis revealed how individuals intuitively used, interpreted and acted on feedback from wearable technologies. Six key themes emerged: triggers of engagement with the technologies, links between behaviour and health, lack of confidence, changes to movement behaviours, changes to diet and barriers to lifestyle behaviour change. CONCLUSIONS: Our findings demonstrate that accessing behavioural and physiological feedback can increase self-awareness of how lifestyle impacts short-term health. Some participants noticed a link between the feedback presented by the two devices and changed their behaviour but many did not. Training and educational support, as well as efforts to optimize how feedback is presented to users, are needed to sustain engagement and behaviour change. Extensions of this work to involve people with diabetes are also warranted to explore whether behavioural and physiological feedback in parallel can encourage better diabetes self-management. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17545949 , 12/05/2017, prospectively registered

Anorectal Disorders

This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into 3 subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome and unspecified anorectal pain, the pain lasts more than 30 minutes, but in levator ani syndrome there is puborectalis tenderness. Functional defecation disorders are defined by ≥2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with ≥2 features of impaired evacuation, that is, abnormal evacuation pattern on manometry, abnormal balloon expulsion test, or impaired rectal evacuation by imaging. It includes 2 subtypes: dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating levator ani syndrome and defecatory disorders

Improving continence in children and young people with neurodisability: a systematic review and survey.

Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. This study is registered as PROSPERO CRD42018100572. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 25, No. 73. See the NIHR Journals Library website for further project information

An EMG-based eating behaviour monitoring system with haptic feedback to promote mindful eating

Mindless eating, or the lack of awareness of the food we are consuming, has been linked to health problems attributed to unhealthy eating behaviour, including obesity. Traditional approaches used to moderate eating behaviour often rely on inaccurate self-logging, manual observations or bulky equipment. Overall, there is a need for an intelligent and lightweight system which can automatically monitor eating behaviour and provide feedback. In this paper, we investigate: i) the development of an automated system for detecting eating behaviour using wearable Electromyography (EMG) sensors, and ii) the application of such a system in combination with real time wristband haptic feedback to facilitate mindful eating. Data collected from 16 participants were used to develop an algorithm for detecting chewing and swallowing. We extracted 18 features from EMG and presented those features to different classifiers. We demonstrated that eating behaviour can be automatically assessed accurately using the EMG-extracted features and a Support Vector Machine (SVM): F1-Score=0.94 for chewing classification, and F1-Score=0.86 for swallowing classification. Based on this algorithm, we developed a system to enable participants to self-moderate their chewing behaviour using haptic feedback. An experiment study was carried out with 20 additional participants showing that participants exhibited a lower rate of chewing when haptic feedback delivered in forms of wristband vibration was used compared to a baseline and non-haptic condition (F (2,38)=58.243, p<0.001). These findings may have major implications for research in eating behaviour, providing key new insights into the impacts of automatic chewing detection and haptic feedback systems on moderating eating behaviour with the aim to improve health outcomes

Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders.

BACKGROUND: Chronic constipation is a common, heterogeneous disorder with multiple symptoms and pathophysiological mechanisms. Patients are often referred to a gastroenterology provider after laxatives fail. However, there is limited knowledge of the spectrum and management of constipation disorders. AIM: To discuss the latest understanding of the spectrum of constipation disorders, tools for identifying a pathophysiologic-based diagnosis in the specialist setting, treatment options and the patient\u27s perspective of constipation. METHODS: Literature searches were conducted using PubMed for constipation diagnostic criteria, diagnostic tools and approved treatments. The authors provided insight from their own practices. RESULTS: Clinical assessment, stool diaries and Rome IV diagnostic criteria can facilitate diagnosis, evaluate severity and distinguish between IBS with constipation, chronic idiopathic constipation and dyssynergic defecation. Novel smartphone applications can help track constipation symptoms. Rectal examinations, anorectal manometry and balloon expulsion, assessments of neuromuscular function with colonic transit time and colonic manometry can provide mechanistic understanding of underlying pathophysiology. Treatments include lifestyle and diet changes, biofeedback therapy and pharmacological agents. Several classes of laxatives, as well as prokinetic and prosecretory agents, are available; here we describe their mechanisms of action, efficacy and side effects. CONCLUSIONS: Constipation includes multiple overlapping subtypes identifiable using detailed history, current diagnostic tools and smartphone applications. Recognition of individual subtype(s) could pave the way for optimal, evidence-based treatments by a gastroenterology provider

TANGIBLE INTERFACE TO SUPPORT THE EMOTIONAL DEVELOPMENT IN A DOMOTIC ENVIRONMENT

Observing the growing diffusion of personal quantification devices, the research aims to deepen an area within which it is possible to derive real added value through the acquisition of data. Starting from a theoretical approach regarding the analysis of the emotional state of an adult in an automatic way, the paper comes to the definition of a system grounded on a theoretical knowledge using a tangible prototype in order to increase the emotional skills of a child in the age of development (social emotional learning - SEL). This system is based on two fundamental components. On the one hand, a tangible object able to silently detect different types of data during the interaction with the user. On the other hand, it is proposed to use the current home automation technologies present on the market, to create an immersive system able to generate a dynamic feedback, based on the data acquired by the tangible object. The definition and generation of both visual and audio feedback, aims to replicate and outsource the degree of emotional activation of the user, this should help in understanding and adjusting the degree with the support of professionals like teachers, psychologists, etc. The creation of a dynamic immersive context increases the ability to understand and engage children, compared to normal learning techniques; it can expand them also to passive participants of the experiment. The aim of the research is therefore twofold: to be able to quantify a qualitative data, such as the degree of activation; the creation of a system capable of emulating and responding to the user's unconscious stimuli and facilitate the self-expressing

Continuous glucose monitoring for the routine care of type 2 diabetes mellitus.

peer reviewedAlthough continuous glucose monitoring (CGM) devices are now considered the standard of care for people with type 1 diabetes mellitus, the uptake among people with type 2 diabetes mellitus (T2DM) has been slower and is focused on those receiving intensive insulin therapy. However, increasing evidence now supports the inclusion of CGM in the routine care of people with T2DM who are on basal insulin-only regimens or are managed with other medications. Expanding CGM to these groups could minimize hypoglycaemia while allowing efficient adaptation and escalation of therapies. Increasing evidence from randomized controlled trials and observational studies indicates that CGM is of clinical value in people with T2DM on non-intensive treatment regimens. If further studies confirm this finding, CGM could soon become a part of routine care for T2DM. In this Perspective we explore the potential benefits of widening the application of CGM in T2DM, along with the challenges that must be overcome for the evidence-based benefits of this technology to be delivered for all people with T2DM

Using Hidden Markov Models to Segment and Classify Wrist Motions Related to Eating Activities

Advances in body sensing and mobile health technology have created new opportunities for empowering people to take a more active role in managing their health. Measurements of dietary intake are commonly used for the study and treatment of obesity. However, the most widely used tools rely upon self-report and require considerable manual effort, leading to underreporting of consumption, non-compliance, and discontinued use over the long term. We are investigating the use of wrist-worn accelerometers and gyroscopes to automatically recognize eating gestures. In order to improve recognition accuracy, we studied the sequential ependency of actions during eating. In chapter 2 we first undertook the task of finding a set of wrist motion gestures which were small and descriptive enough to model the actions performed by an eater during consumption of a meal. We found a set of four actions: rest, utensiling, bite, and drink; any alternative gestures is referred as the other gesture. The stability of the definitions for gestures was evaluated using an inter-rater reliability test. Later, in chapter 3, 25 meals were hand labeled and used to study the existence of sequential dependence of the gestures. To study this, three types of classifiers were built: 1) a K-nearest neighbor classifier which uses no sequential context, 2) a hidden Markov model (HMM) which captures the sequential context of sub-gesture motions, and 3) HMMs that model inter-gesture sequential dependencies. We built first-order to sixth-order HMMs to evaluate the usefulness of increasing amounts of sequential dependence to aid recognition. The first two were our baseline algorithms. We found that the adding knowledge of the sequential dependence of gestures achieved an accuracy of 96.5%, which is an improvement of 20.7% and 12.2% over the KNN and sub-gesture HMM. Lastly, in chapter 4, we automatically segmented a continuous wrist motion signal and assessed its classification performance for each of the three classifiers. Again, the knowledge of sequential dependence enhances the recognition of gestures in unsegmented data, achieving 90% accuracy and improving 30.1% and 18.9% over the KNN and the sub-gesture HMM