Effectiveness of Mobile Applications to Quit Smoking: Systematic Review and Meta-Analysis

Introduction: Tobacco is the leading cause of preventable mortality. The use of mobile phones has grown exponentially, becoming a powerful tool to be used in health care. Methods: In order to assess the effectiveness of mobile phones to quit smoking, we have carried out a systematic review and meta-analysis of randomized clinical trials evaluating interventions based on mobile applications for smartphones, that were not a smaller version of the same application, against other types of therapy. To address this, a bibliographic search was carried out in MEDLINE, EMBASE and COCHRANE LIBRARY. To obtain the combined effect, the relative risk and the 95% confidence interval were used. A heterogeneity and sensitivity analysis were also conducted. Results: A total of nine studies were identified, but five were excluded. Qualitative review was performed with four selected studies, but quantitative analysis was carried out for only three, given the impossibility of calculating the RR in one of the studies. After combining the results, an RR of 0.901 (95% CI: 0.57-1.423) was calculated comparing the effectiveness of mobile applications versus others type of interventions. This measure was robust, as shown by the sensitivity analysis. Conclusions: According to the results, it cannot be concluded that apps are effective for quitting tobacco. There are very few clinical trials published evaluating the effectiveness of mobile applications compared to other alternatives. Several clinical trials are still in progress, therefore their results have not been included in the present meta-analysis

Cost-Effectiveness Analysis of Text Messaging to Support Health Advice for Smoking Cessation

Background: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. Methods: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. Results: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of euro7.4 and euro1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. Conclusions: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centresThis paper has been co-funded by the European Union through the European Regional Development Fund (ERDF) and by the European Social Fund (ESF). Call for proposals: Accion Estrategica en Salud 2017. Reference number PI17/01502

Knowledge about COVID-19 and vaccine acceptability among priority groups defined for vaccination: A cross-sectional study in Araba/Alava, Spain, before the vaccination against SARS-CoV-2

Background: The acceptability of COVID-19 vaccine varies depending on the time, place, type of vaccine and information available at the time. Knowledge of attitudes and practices towards COVID-19 among the population at high risk of developing the disease would help to tailor the strategy to improve adherence to vaccination recommendations. Aim: To analyze the willingness, knowledge and risk perception of patients and health care workers (HCW) to get the vaccines against SARS-CoV-2. Methods: Cross-sectional survey in Araba/alava province (Spain). Subjects who met the criteria for the influenza vaccination in 2019 and HCWS from the Basque Public Health Service were included. The participants answered a questionnaire on the knowledge, attitudes and practices towards COVID-19 before starting vaccination against SARS-CoV-2. The intention to vaccinate was compared using the chi-squared test. Results: 316 HCWs and 389 patients responded to the survey. Around 90% of the patients and 80% of HCW would accept vaccination in all scenarios according to the questionnaire (p < 0.001). Only 3-12% hesitated about the COVID-19 vaccines. Compared to 40-70% of patients, 60-80% of HCWs perceived a high risk of COVID-19 (p < 0.001). Statistically significant differences were found in 10 of the 17 questions regarding the mechanism of transmission and symptoms. Conclusion: HCWs had a better knowledge and risk perception of COVID-19 than the surveyed patients. They had a higher proportion of hesitancy to get COVID-19 vaccine, probably related to doubts about the effectiveness of the new vaccines and the scientific evidence.Funding for the study was provided by the Caja Vital Foundation

The Impact of Digital Health on Smoking Cessation

Background: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients’ quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation–relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. Objective: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. Methods: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. Results: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. Conclusions: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resource

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking

[EN] Objective: The main objective is to transfer to clinical practice a new smoking cessation appli- M-health; cation ("Vive sin Tabaco" a) in all health centers of the public Basque Health Service. Design: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. Site: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. Intervention and main measurement: Development of "Vive sin Tabaco"; a corporate toot for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. Results: The percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. Conclusions: The conception of "Vive sin tabaco" as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a toot that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice

Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis

Objective, and material and methods: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library. Source of data: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform. Selection of studies: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed. Data extraction: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies.Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure. Results: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56–0.94. Conclusions: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease. Resumen: Objetivo, y material y métodos: Se realizó una revisión sistemática y un metaanálisis para evaluar la eficacia de los antidepresivos en la reducción de la mala evolución de la enfermedad COVID-19 (variable compuesta que incluye muerte, hospitalización y necesidad de ventilación mecánica), y mortalidad, según las directrices para Revisiones Sistemáticas de Intervenciones publicadas por la biblioteca Cochrane. Fuente de datos: Se consultaron MEDLINE, EMBASE y la biblioteca Cochrane hasta el 25 de febrero de 2022. Se realizaron búsquedas de estudios no publicados en la plataforma clinicaltrials.gov. Selección de estudios: Se seleccionaron estudios observacionales y experimentales, enmascarados y no enmascarados, que evaluaron la muerte, la hospitalización y la necesidad de ventilación mecánica. Se realizó un segundo análisis de subgrupos con la variable mortalidad. Extracción de datos: Se realizó una evaluación completa del riesgo de sesgo que abordó temas como el sesgo de información y los factores de confusión. Se emplearon las herramientas Rob2 y Robins-I para los estudios aleatorios y no aleatorios, respectivamente. En el análisis cuantitativo, se analizó el sesgo de publicación, heterogeneidad, y se estimó la medida combinada global. La medida final se calculó como odds ratio con su correspondiente intervalo de confianza del 95%. Para ello se utilizó un modelo de efectos aleatorios debido a la heterogeneidad entre los estudios incluidos.Finalmente, se realizó un análisis de sensibilidad para evaluar la robustez de la medida final estimada. Resultados: Se consideraron 7 estudios para calcular la medida agrupada final. El efecto de la intervención (tratamiento con antidepresivos) fue OR 0,73; IC 95% 0,56-0,94. Conclusiones: El uso de antidepresivos, y especialmente de ISRS, podría ser eficaz para reducir el riesgo de mala evolución y mortalidad de la enfermedad COVID-19