An mHealth intervention for the treatment of patients with an eating disorder: A multicenter randomized controlled trial

Objective: The current multicentre randomized controlled trial assessed the clinicalefficacy of a combined mHealth intervention for eating disorders (EDs) based on cog-nitive behavioral therapy (CBT).Method: A total of 106 ED patients from eight different public and private mentalhealth services in Spain were randomly assigned to two parallel groups. Patients ofthe experimental group (N = 53) received standard face-to-face CBT plus a mobileintervention through an application called “TCApp,” which provides self-monitoringand an online chat with the therapist. The control group (N = 53) received standard face-to-face CBT only. Patients completed self-report questionnaires on ED symp-tomatology, anxiety, depression, and quality of life, before and after treatment.Results: Significant reductions in primary and secondary outcomes were observedfor participants of both groups, with no differences between groups. Results alsosuggested that the frequency with which patients attended their referral mentalhealth institution after the intervention was lower for patients in the experimentalgroup than for those in the control group.Discussion: The current study showed that CBT can help to reduce symptoms relat-ing to ED, regardless of whether its delivery includes online components in additionto traditional face-to-face treatment. Besides, the additional component offered bythe TCApp does not appear to be promising from a purely therapeutic perspectivebut perhaps as a cost-effective tool, reducing thus the costs and time burden associ-ated with weekly visits to health professionals.The current study is part of a broader project titled “mHealth: Chal-lenges and opportunities for health systems” which receives funding from RecerCaixa of “La Caixa” Foundation.Peer ReviewedPostprint (author's final draft

Unfair Commercial Practices in a Pit Market: Evidence from an Artefactual Field Experiment

Commercial practices such as drip pricing, reference pricing and best-price guarantee can be used to set higher prices and mislead consumers, but protective measures can restore efficiency. In a placebo-controlled market experiment, we examined a treatment allowing for the use and misuse of commercial practices. Three additional treatments tested the effects of formal sanctions, informal sanctions and a regret nudge. We found that commercial practices led to higher prices, cheating was systematic and regret nudging was ineffective. Furthermore, formal and informal sanctions reduced both the likelihood of using commercial practices and the likelihood of cheating, leading to welfare increases

Maximizing opportunities and minimizing risks for children online: the role of digital skills in emerging strategies of parental mediation

As internet use becomes widespread at home, parents are trying to maximize their children’s online opportunities while also minimizing online risks. We surveyed parents of 6- to 14-year-olds in eight European countries (N=6,400). A factor analysis revealed two strategies. Enabling mediation is associated with increased online opportunities but also risks. This strategy incorporates safety efforts, responds to child agency and is employed when parent or child is relatively digitally skilled, so may not support harm. Restrictive mediation is associated with fewer online risks but at the cost of opportunities, reflecting policy advice that regards media use as primarily problematic. It is favoured when parent or child digital skills are lower, potentially keeping vulnerable children safe yet undermining their digital inclusion

Promoting Fruit and Vegetable Consumption for Childhood Obesity Prevention

Currently, food marketing for unhealthy foods is omnipresent. Foods high in fat, salt, and sugar (HFSS) are advertised intensively on several media platforms, including digital platforms that are increasingly used by children, such as social media, and can be bought almost everywhere. This could contribute to the obesity epidemic that we are facing. As the majority of children and adolescents do not eat the recommended amount of fruits and vegetables (F&V), which leads to chronic diseases, we need to change the obesogenic environment to a healthogenic environment. Reducing the marketing of energy-dense snacks to children and increasing the promotion of healthier foods, such as fruits and vegetables, may be an effective and necessary instrument to improve the dietary intake of children and reduce the risk of their experiencing some chronic diseases later in life. With this focused narrative review, we provide an overview of how children and adolescents react to food promotions and how food promotional efforts might be a useful tool to increase the attractiveness of fruit and vegetables. This review therefore contributes to the question of how changing the advertising and media environment of children and adolescents could help create a world where the healthy choice is the easier choice, which would reduce childhood obesity and improve children’s health, as well as to make the food system more sustainable

Food advertising and eating behavior in children

Systematic research reviews have repeatedly shown that food advertising affects children\u27s eating behavior. Given that most food advertising promotes unhealthy, palatable, and rewarding food products, it is considered to be a significant contributor to the current obesity epidemic. This review describes recent studies that have tested the effect of contemporary food advertisements on children\u27s eating behavior, including newly emerging data showing marketing effects on subconscious cognitive processes and studies illuminating the mechanistic underpinnings of these effects. In addition, this review presents an integration of empirical findings in a new theoretical framework that increases the understanding of the effects of food advertising on eating behavior and might be used for future research in this area

Negative Shocks Predict Change in Cognitive Function and Preferences: Assessing the Negative Affect and Stress Hypothesis

In the context of the current COVID-19 pandemic, households throughout the world have to cope with negative shocks. Previous research has shown that negative shocks impair cognitive function and change risk, time and social preferences. In this study, we analyze the results of a longitudinal multi-country survey conducted in Italy (N = 1652), Spain (N = 1660) and the United Kingdom (N = 1578). We measure cognitive function using the Cognitive Reflection Test and preferences traits (risk, time and social preferences) using an experimentally validated set of questions to assess the differences between people exposed to a shock compared to the rest of the sample. We measure four possible types of shocks: labor market shock, health shock, occurrence of stressful events, and mental health shock. Additionally, we randomly assign participants to groups with either a recall of negative events (more specifically, a mild reinforcement of stress or of fear/anxiety), or to a control group (to recall neutral or joyful memories), in order to assess whether or not stress and negative emotions drive a change in preferences. Results show that people affected by shocks performed worse in terms of cognitive functioning, are more risk loving, and are more prone to punish others (negative reciprocity). Data do not support the hypotheses that the result is driven by stress or by negative emotions

Does a ‘protective’ message reduce the impact of an advergame promoting unhealthy foods to children? an experimental study in Spain and The Netherlands

The weight of evidence points to the advertising of food affecting food consumption, especially among children. Such advertising often promotes unhealthy foods. Current policy deliberations focus on developing effective ‘protective’ messages to increase advertising literacy and consequent scepticism about advertising targeting children. This study examined whether incorporating a ‘protective’ message in an advergame promoting energy-dense snacks would reduce children's snack intake. A randomized between-subject design was conducted in the Netherlands (N = 215) and Spain (N = 382) with an advergame promoting either energy-dense snacks or nonfood products. The results showed that playing an advergame promoting energy-dense snacks increased caloric intake in both countries, irrespective of whether the ‘protective’ message was present or not. These results point to the limitations of ‘protective’ messages and advertising literacy and provide policy makers with a rationale for extending the current prohibition of food advertising to young children in the terrestrial media to online environments

Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study

Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled “GATEKEEPER,” conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer

GATEKEEPER’s Strategy for the Multinational Large-Scale Piloting of an eHealth Platform: Tutorial on How to Identify Relevant Settings and Use Cases

Background: The World Health Organization’s strategy toward healthy aging fosters person-centered integrated care sustained by eHealth systems. However, there is a need for standardized frameworks or platforms accommodating and interconnecting multiple of these systems while ensuring secure, relevant, fair, trust-based data sharing and use. The H2020 project GATEKEEPER aims to implement and test an open-source, European, standard-based, interoperable, and secure framework serving broad populations of aging citizens with heterogeneous health needs. Objective: We aim to describe the rationale for the selection of an optimal group of settings for the multinational large-scale piloting of the GATEKEEPER platform. Methods: The selection of implementation sites and reference use cases (RUCs) was based on the adoption of a double stratification pyramid reflecting the overall health of target populations and the intensity of proposed interventions; the identification of a principles guiding implementation site selection; and the elaboration of guidelines for RUC selection, ensuring clinical relevance and scientific excellence while covering the whole spectrum of citizen complexities and intervention intensities. Results: Seven European countries were selected, covering Europe’s geographical and socioeconomic heterogeneity: Cyprus, Germany, Greece, Italy, Poland, Spain, and the United Kingdom. These were complemented by the following 3 Asian pilots: Hong Kong, Singapore, and Taiwan. Implementation sites consisted of local ecosystems, including health care organizations and partners from industry, civil society, academia, and government, prioritizing the highly rated European Innovation Partnership on Active and Healthy Aging reference sites. RUCs covered the whole spectrum of chronic diseases, citizen complexities, and intervention intensities while privileging clinical relevance and scientific rigor. These included lifestyle-related early detection and interventions, using artificial intelligence–based digital coaches to promote healthy lifestyle and delay the onset or worsening of chronic diseases in healthy citizens; chronic obstructive pulmonary disease and heart failure decompensations management, proposing integrated care management based on advanced wearable monitoring and machine learning (ML) to predict decompensations; management of glycemic status in diabetes mellitus, based on beat to beat monitoring and short-term ML-based prediction of glycemic dynamics; treatment decision support systems for Parkinson disease, continuously monitoring motor and nonmotor complications to trigger enhanced treatment strategies; primary and secondary stroke prevention, using a coaching app and educational simulations with virtual and augmented reality; management of multimorbid older patients or patients with cancer, exploring novel chronic care models based on digital coaching, and advanced monitoring and ML; high blood pressure management, with ML-based predictions based on different intensities of monitoring through self-managed apps; and COVID-19 management, with integrated management tools limiting physical contact among actors. Conclusions: This paper provides a methodology for selecting adequate settings for the large-scale piloting of eHealth frameworks and exemplifies with the decisions taken in GATEKEEPER the current views of the WHO and European Commission while moving forward toward a European Data Space

Systematically testing the effects of promotion techniques on children’s fruit and vegetables intake on the long term: a protocol study of a multicenter randomized controlled trial

BACKGROUND: Eating a diet rich in fruit and vegetables is essential for healthy development, protects against chronicle diseases, and increases mental well-being. Numerous studies have consistently shown that children do not consume enough fruit and vegetables, especially among children from low socioeconomic status, while foods high in fat, sugar and salt are over-consumed. In order to improve children's eating behavior, there is an urgent need to systematically test novel and effective methods to make fruit and vegetables more appealing and increase the intake among children. Therefore, the main aim of the proposed project is to test if food promotion techniques increase children's fruit and vegetable intake, both on the short- and long-term. METHODS: Three studies will be conducted. First, to develop the vlogs in co-creation, multiple focus groups will be held with (1) children (N = 25, between 8 and 13 years), (2) parents (N = 10), (3) vloggers (N = 5), and (4) fruit and vegetable producers and marketers (N = 5). Second, a multicenter randomized clinical trial will be conducted among 10 primary schools. A mixed repeated measure design with three different conditions will be used: (1) control, (2) a vlog unboxing fruit and vegetables (preparing and tasting), and (3) a vlog doing a challenge with the fruit and vegetables (e.g., contests, tricks, games). Children between 7 and 13 will participate in the experiments (N = 350). Third, after 6 and 12 months follow-up measurements will take place. DISCUSSION: HFSS foods have higher intrinsically rewarding properties that make them more "wanted" and "liked" than fruit and vegetables, thereby inducing unhealthy eating behavior among children. Additionally, promotion for HFSS foods is omnipresent and increases the rewarding value of these foods. Moreover, some studies showed that the promotion of fruit and vegetables affects the intake, although a recent systematic review shows that evidence is inconclusive and a theoretical understanding for the underlying mechanism is missing. The current study aims to improve the existing knowledge by experimentally testing a newly developed theoretical model. TRIAL REGISTRATION: Netherlands Trial registration: NL8077, received on 12 October 2019