Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire

[EN] Background: Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. Objective: The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. Methods: We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients¿ interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). Results: In this study, 84.8% (89/105) of the patients had access to the internet and 88.6% (93/105) owned an electronic internet device. In total, 71.3% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). Conclusions: The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7% (23/80) of the studied patients rejected the use of internet interventions and 38.2% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments.This study was supported by Generalitat Valenciana (PROMETEO/2016/082 grant) and CIBERSAM and Fondo de Investigacion Sanitaria (PI01399, PI13/00447; PI17/00402, Cofunded FEDER).Bonet, L.; Llácer, B.; Hernandez-Viadel, M.; Arce Grilo, AD.; Blanquer Espert, I.; Cañete, C.; Escartí, MJ.... (2018). Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire. JMIR Mental Health. 5(3):1-12. https://doi.org/10.2196/mental.9950S11253Perkins, D. O., Gu, H., Boteva, K., & Lieberman, J. A. (2005). Relationship Between Duration of Untreated Psychosis and Outcome in First-Episode Schizophrenia: A Critical Review and Meta-Analysis. American Journal of Psychiatry, 162(10), 1785-1804. doi:10.1176/appi.ajp.162.10.1785Marshall, M., & Rathbone, J. (2011). Early intervention for psychosis. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd004718.pub3Amos, A. (2012). Assessing the cost of early intervention in psychosis: A systematic review. Australian & New Zealand Journal of Psychiatry, 46(8), 719-734. doi:10.1177/0004867412450470Bonet, L., Izquierdo, C., Escartí, M. J., Sancho, J. V., Arce, D., Blanquer, I., & Sanjuan, J. (2017). Utilización de tecnologías móviles en pacientes con psicosis: una revisión sistemática. Revista de Psiquiatría y Salud Mental, 10(3), 168-178. doi:10.1016/j.rpsm.2017.01.003World Health Organization2007Global Observatory for eHealth http://www.who.int/goe/en/Bucci, S., Barrowclough, C., Ainsworth, J., Morris, R., Berry, K., Machin, M., … Haddock, G. (2015). Using mobile technology to deliver a cognitive behaviour therapy-informed intervention in early psychosis (Actissist): study protocol for a randomised controlled trial. Trials, 16(1). doi:10.1186/s13063-015-0943-3Schlosser, D., Campellone, T., Kim, D., Truong, B., Vergani, S., Ward, C., & Vinogradov, S. (2016). Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia. JMIR Research Protocols, 5(2), e77. doi:10.2196/resprot.5450Garety, P. A., Ward, T., Freeman, D., Fowler, D., Emsley, R., Dunn, G., … Hardy, A. (2017). SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial. Trials, 18(1). doi:10.1186/s13063-017-2242-7Depp, C. A., Harmell, A. L., Vahia, I. V., & Mausbach, B. T. (2015). Neurocognitive and functional correlates of mobile phone use in middle-aged and older patients with schizophrenia. Aging & Mental Health, 20(1), 29-35. doi:10.1080/13607863.2015.1008987National Alliance on Mental Illness (NAMI)2017-10-10Health and Technology Study 2014https://www.nami.org/About-NAMI/Publications-Reports/Survey-Reports/Health-and-Technology-Study-(2014)SmithAThe Smartphone difference: U.S. Smartphone Use in2015Washington, DCPew Research Centrehttp://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015Tobitt, S., & Percival, R. (2017). Switched on or switched off? A survey of mobile, computer and Internet use in a community mental health rehabilitation sample. Journal of Mental Health, 28(1), 4-10. doi:10.1080/09638237.2017.1340623Firth, J., Cotter, J., Torous, J., Bucci, S., Firth, J. A., & Yung, A. R. (2015). Mobile Phone Ownership and Endorsement of «mHealth» Among People With Psychosis: A Meta-analysis of Cross-sectional Studies. Schizophrenia Bulletin, 42(2), 448-455. doi:10.1093/schbul/sbv132Thomas, N., Foley, F., Lindblom, K., & Lee, S. (2017). Are people with severe mental illness ready for online interventions? Access and use of the Internet in Australian mental health service users. Australasian Psychiatry, 25(3), 257-261. doi:10.1177/1039856217689913Gitlow, L., Abdelaal, F., Etienne, A., Hensley, J., Krukowski, E., & Toner, M. (2017). Exploring the Current Usage and Preferences for Everyday Technology among People with Serious Mental Illnesses. Occupational Therapy in Mental Health, 33(1), 1-14. doi:10.1080/0164212x.2016.1211061Trefflich, F., Kalckreuth, S., Mergl, R., & Rummel-Kluge, C. (2015). Psychiatric patients׳ internet use corresponds to the internet use of the general public. Psychiatry Research, 226(1), 136-141. doi:10.1016/j.psychres.2014.12.037Gay, K., Torous, J., Joseph, A., Pandya, A., & Duckworth, K. (2016). Digital Technology Use Among Individuals with Schizophrenia: Results of an Online Survey. JMIR Mental Health, 3(2), e15. doi:10.2196/mental.5379Berry, N., Lobban, F., Emsley, R., & Bucci, S. (2016). Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review. Journal of Medical Internet Research, 18(5), e121. doi:10.2196/jmir.5250Birnbaum, M. L., Rizvi, A. F., Correll, C. U., Kane, J. M., & Confino, J. (2015). Role of social media and the Internet in pathways to care for adolescents and young adults with psychotic disorders and non-psychotic mood disorders. Early Intervention in Psychiatry, 11(4), 290-295. doi:10.1111/eip.12237Ben-Zeev, D., Scherer, E. A., Gottlieb, J. D., Rotondi, A. J., Brunette, M. F., Achtyes, E. D., … Kane, J. M. (2016). mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge. JMIR Mental Health, 3(3), e34. doi:10.2196/mental.6348Kannisto, K. A., Adams, C. E., Koivunen, M., Katajisto, J., & Va lima ki, M. (2015). Feedback on SMS reminders to encourage adherence among patients taking antipsychotic medication: a cross-sectional survey nested within a randomised trial. BMJ Open, 5(11), e008574-e008574. doi:10.1136/bmjopen-2015-008574Instituto Nacional de EstadísticaEncuesta sobre equipamiento y uso de tecnologías de información y comunicación en los hogares2016 http://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736176741&menu=ultiDatos&idp=1254735976608Robotham, D., Satkunanathan, S., Doughty, L., & Wykes, T. (2016). Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up. Journal of Medical Internet Research, 18(11), e309. doi:10.2196/jmir.6511Miller, B. J., Stewart, A., Schrimsher, J., Peeples, D., & Buckley, P. F. (2015). How connected are people with schizophrenia? Cell phone, computer, email, and social media use. Psychiatry Research, 225(3), 458-463. doi:10.1016/j.psychres.2014.11.067Borzekowski, D. L. G., Leith, J., Medoff, D. R., Potts, W., Dixon, L. B., Balis, T., … Himelhoch, S. (2009). Use of the Internet and Other Media for Health Information Among Clinic Outpatients With Serious Mental Illness. Psychiatric Services, 60(9), 1265-1268. doi:10.1176/ps.2009.60.9.1265Aref-Adib, G., O’Hanlon, P., Fullarton, K., Morant, N., Sommerlad, A., Johnson, S., & Osborn, D. (2016). A qualitative study of online mental health information seeking behaviour by those with psychosis. BMC Psychiatry, 16(1). doi:10.1186/s12888-016-0952-0Baup, H., & Verdoux, H. (2017). Frequency and pattern of Internet use in patients with schizophrenia or bipolar disorders seeking medical information. Psychiatry Research, 247, 152-154. doi:10.1016/j.psychres.2016.11.028Digital Marketing Trends (DiTrendia)MT(Informe mobile en España y en el mundo20162018-07-122016 http://www.amic.media/media/files/file_352_1050.pdfLal, S., Dell’Elce, J., Tucci, N., Fuhrer, R., Tamblyn, R., & Malla, A. (2015). Preferences of Young Adults With First-Episode Psychosis for Receiving Specialized Mental Health Services Using Technology: A Survey Study. JMIR Mental Health, 2(2), e18. doi:10.2196/mental.4400Schrank, B., Sibitz, I., Unger, A., & Amering, M. (2010). How Patients With Schizophrenia Use the Internet: Qualitative Study. Journal of Medical Internet Research, 12(5), e70. doi:10.2196/jmir.1550Asociaciónpara la Investigación de Medios de Comunicación (AIMC)Encuesta AIMC a usuarios de internet2017-10-192017 http://www.aimc.es/-Navegantes-en-la-Red-.htmlNowland, R., Necka, E. A., & Cacioppo, J. T. (2017). Loneliness and Social Internet Use: Pathways to Reconnection in a Digital World? Perspectives on Psychological Science, 13(1), 70-87. doi:10.1177/1745691617713052Heinz, A., Deserno, L., & Reininghaus, U. (2013). Urbanicity, social adversity and psychosis. World Psychiatry, 12(3), 187-197. doi:10.1002/wps.20056Alvarez-Jimenez, M., Priede, A., Hetrick, S. E., Bendall, S., Killackey, E., Parker, A. G., … Gleeson, J. F. (2012). Risk factors for relapse following treatment for first episode psychosis: A systematic review and meta-analysis of longitudinal studies. Schizophrenia Research, 139(1-3), 116-128. doi:10.1016/j.schres.2012.05.007Berry, N., Bucci, S., & Lobban, F. (2017). Use of the Internet and Mobile Phones for Self-Management of Severe Mental Health Problems: Qualitative Study of Staff Views. JMIR Mental Health, 4(4), e52. doi:10.2196/mental.8311Bhugra, D., Tasman, A., Pathare, S., Priebe, S., Smith, S., Torous, J., … Ventriglio, A. (2017). The WPA- Lancet Psychiatry Commission on the Future of Psychiatry. The Lancet Psychiatry, 4(10), 775-818. doi:10.1016/s2215-0366(17)30333-4Lachmann, B., Sindermann, C., Sariyska, R. Y., Luo, R., Melchers, M. C., Becker, B., … Montag, C. (2018). The Role of Empathy and Life Satisfaction in Internet and Smartphone Use Disorder. Frontiers in Psychology, 9. doi:10.3389/fpsyg.2018.00398Stodt, B., Brand, M., Sindermann, C., Wegmann, E., Li, M., Zhou, M., … Montag, C. (2018). Investigating the Effect of Personality, Internet Literacy, and Use Expectancies in Internet-Use Disorder: A Comparative Study between China and Germany. International Journal of Environmental Research and Public Health, 15(4), 579. doi:10.3390/ijerph1504057

Dietary animal and plant protein intakes and their associations with obesity and cardio-metabolic indicators in European adolescents: The HELENA cross-sectional study

Background: Previous studies suggest that dietary protein might play a beneficial role in combating obesity and its related chronic diseases. Total, animal and plant protein intakes and their associations with anthropometry and serum biomarkers in European adolescents using one standardised methodology across European countries are not well documented. Objectives: To evaluate total, animal and plant protein intakes in European adolescents stratified by gender and age, and to investigate their associations with cardio-metabolic indicators (anthropometry and biomarkers). Methods: The current analysis included 1804 randomly selected adolescents participating in the HELENA study (conducted in 2006-2007) aged 12.5-17.5 y (47% males) who completed two non-consecutive computerised 24-h dietary recalls. Associations between animal and plant protein intakes, and anthropometry and serum biomarkers were examined with General linear Model multivariate analysis. Results: Average total protein intake exceeded the recommendations of World Health Organization and European Food Safety Authority. Mean total protein intake was 96 g/d (59% derived from animal protein). Total, animal and plant protein intakes (g/d) were significantly lower in females than in males and total and plant protein intakes were lower in younger participants (12.5-14.9 y). Protein intake was significantly lower in underweight subjects and higher in obese ones; the direction of the relationship was reversed after adjustments for body weight (g/(kg.d)). The inverse association of plant protein intakes was stronger with BMI z-score and body fat percentage (BF%) compared to animal protein intakes. Additionally, BMI and BF% were positively associated with energy percentage of animal protein. Conclusions: This sample of European adolescents appeared to have adequate total protein intake. Our findings suggest that plant protein intakes may play a role in preventing obesity among European adolescents. Further longitudinal studies are needed to investigate the potential beneficial effects observed in this study in the prevention of obesity and related chronic diseases

Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA Study

BACKGROUND/OBJECTIVES: To assess the iron status among European adolescents through selected biochemical parameters in a cross-sectional study performed in 10 European cities. SUBJECTS/METHODS: Iron status was defined utilising biochemical indicators. Iron depletion was defined as low serum ferritin (SF8.5 mg/l) plus iron depletion. Iron deficiency anaemia (IDA) was defined as ID with haemoglobin (Hb) below the WHO cutoff for age and sex: 12.0 g/dl for girls and for boys aged 12.5-14.99 years and 13.0 g/dl for boys aged ≥15 years. Enzyme linked immunosorbent assay was used as analytical method for SF, sTfR and C-reactive protein (CRP). Subjects with indication of inflammation (CRP >5 mg/l) were excluded from the analyses. A total of 940 adolescents aged 12.5-17.49 years (438 boys and 502 girls) were involved. RESULTS: The percentage of iron depletion was 17.6%, significantly higher in girls (21.0%) compared with boys (13.8%). The overall percentage of ID and IDA was 4.7 and 1.3%, respectively, with no significant differences between boys and girls. A correlation was observed between log (SF) and Hb (r = 0.36, P < 0.01), and between log (sTfR) and mean corpuscular haemoglobin (r = -0.30, P < 0.01). Iron body stores were estimated on the basis of log (sTfR/SF). A higher percentage of negative values of body iron was recorded in girls (16.5%) with respect to boys (8.3%), and body iron values tended to increase with age in boys, whereas the values remained stable in girls. CONCLUSIONS: To ensure adequate iron stores, specific attention should be given to girls at European level to ensure that their dietary intake of iron is adequate.status: publishe

Relationship between self-reported dietary intake and physical activity levels among adolescents: The HELENA study

Background Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. Therefore it is important to investigate associations between dietary and physical activity behavior, the two most important lifestyle behaviors influencing our energy balance and body composition. The objective of the present study is to describe the relationship between energy, nutrient and food intake and the physical activity level among a large group of European adolescents. Methods The study comprised a total of 2176 adolescents (46.2% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Dietary intake and physical activity were assessed using validated 24-h dietary recalls and self-reported questionnaires respectively. Analyses of covariance (ANCOVA) were used to compare the energy and nutrient intake and the food consumption between groups of adolescents with different physical activity levels (1st to 3rd tertile). Results In both sexes no differences were found in energy intake between the levels of physical activity. The most active males showed a higher intake of polysaccharides, protein, water and vitamin C and a lower intake of saccharides compared to less active males. Females with the highest physical activity level consumed more polysaccharides compared to their least active peers. Male and female adolescents with the highest physical activity levels, consumed more fruit and milk products and less cheese compared to the least active adolescents. The most active males showed higher intakes of vegetables and meat, fish, eggs, meat substitutes and vegetarian products compared to the least active ones. The least active males reported the highest consumption of grain products and potatoes. Within the female group, significantly lower intakes of bread and cereal products and spreads were found for those reporting to spend most time in moderate to vigorous physical activity. The consumption of foods from the remaining food groups, did not differ between the physical activity levels in both sexes. Conclusion It can be concluded that dietary habits diverge between adolescents with different self-reported physical activity levels. For some food groups a difference in intake could be found, which were reflected in differences in some nutrient intakes. It can also be concluded that physically active adolescents are not always inclined to eat healthier diets than their less active peers.The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034). This work was also partially supported by the European Union, in the framework of the Public Health Programme (ALPHA project, Ref: 2006120), the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education (EX-2007-1124, and EX-2008-0641), and the Spanish Ministry of Health, Maternal, Child Health and Development Network (number RD08/0072) (JPRL, LAM)

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Background and aims Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. Methods and results As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Conclusion Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention

A Proteomics Approach To Quantify Protein Levels Following RNA Interference:Case Study with Glutathione Transferase Superfamily from the Model Metazoan Caenorhabditis elegans

Loss-of-function phenotypic analysis via interference RNA (RNAi) technology is a revolutionary approach to assigning gene function. While transcript-based methodologies commonly validate RNAi gene suppression investigations, protein-based validation is less developed. This report illustrates the potential for two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (2-DE) and gel analysis to quantify protein levels following RNAi. This case study involves three glutathione transferase (GST) genes targeted by RNAi from the model organism Caenorhabditis elegans

In vivo exposure to carbon monoxide induces delayed soluble guanylate cyclase activation by nitric oxide in rat brain cortex and cerebellum

In rats, both acute and chronic exposure to carbon monoxide altered the activity of guanylate cyclase and its modulation by nitric oxide in brain cortex and cerebellum