An overview of the features of chatbots in mental health: A scoping review

Background: Chatbots are systems that are able to converse and interact with human users using spoken, written, and visual languages. Chatbots have the potential to be useful tools for individuals with mental disorders, especially those who are reluctant to seek mental health advice due to stigmatization. While numerous studies have been conducted about using chatbots for mental health, there is a need to systematically bring this evidence together in order to inform mental health providers and potential users about the main features of chatbots and their potential uses, and to inform future research about the main gaps of the previous literature. Objective: We aimed to provide an overview of the features of chatbots used by individuals for their mental health as reported in the empirical literature. Methods: Seven bibliographic databases (Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, IEEE Xplore, ACM Digital Library, and Google Scholar) were used in our search. In addition, backward and forward reference list checking of the included studies and relevant reviews was conducted. Study selection and data extraction were carried out by two reviewers independently. Extracted data were synthesised using a narrative approach. Chatbots were classified according to their purposes, platforms, response generation, dialogue initiative, input and output modalities, embodiment, and targeted disorders. Results: Of 1039 citations retrieved, 53 unique studies were included in this review. Those studies assessed 41 different chatbots. Common uses of chatbots were: therapy (n = 17), training (n = 12), and screening (n = 10). Chatbots in most studies were rule-based (n = 49) and implemented in stand-alone software (n = 37). In 46 studies, chatbots controlled and led the conversations. While the most frequently used input modality was writing language only (n = 26), the most frequently used output modality was a combination of written, spoken and visual languages (n = 28). In the majority of studies, chatbots included virtual representations (n = 44). The most common focus of chatbots was depression (n = 16) or autism (n = 10). Conclusion: Research regarding chatbots in mental health is nascent. There are numerous chatbots that are used for various mental disorders and purposes. Healthcare providers should compare chatbots found in this review to help guide potential users to the most appropriate chatbot to support their mental health needs. More reviews are needed to summarise the evidence regarding the effectiveness and acceptability of chatbots in mental health

New perspectives on health professions students' e-learning:Looking through the lens of the "visitor and resident" model

<p><b>Background:</b> The growth of e-learning in health professional education reflects expansion of personal use of online resources. Understanding the user perspective in a fast-changing digital world is essential to maintain the currency of our approach.</p> <p><b>Methods:</b> Mixed methods were used to investigate a cohort of postgraduate, e-learning healthcare students’ perspectives on their use of online resources for personal and/or professional roles, via questionnaire and student-constructed diagrams, capturing use of online resources (underpinned by White’s model of “resident” and “visitor” online engagement). Semistructured interviews explored the use and value of resources afforded via the online environment.</p> <p><b>Results:</b> The 45 study participants described a range of prior experiences with online resources in personal and professional capacities, but overall students tended to use online “tools” (“visitor” mode) rather than highly collaborative networks (“resident” mode). In relation to e-learning, the dominant interview theme was valuing knowledge transfer from the tutor and using “visitor” behaviors to maximize knowledge acquisition. Peer-learning opportunities were less valued and barriers to collaborative “resident” modes were identified.</p> <p><b>Conclusions:</b> These findings help to inform e-learning course design to promote engagement. The results enable recommendations for use of the “Visitor and Residents” model and for planning activities that learners might utilize effectively.</p

Ethical Issues of Social Media Usage in Healthcare

Accepted manuscript version. This article is not an exact copy of the original published article in The IMIA Yearbook of Medical Informatics. The definitive publisher-authenticated version of "Ethical Issues of Social Media Usage in Healthcare" is available online at http://doi.org/10.15265/IY-2015-001.OBJECTIVE: Social media, web and mobile technologies are increasingly used in healthcare and directly support patientcentered care. Patients benefit from disease self-management tools, contact to others, and closer monitoring. Researchers study drug efficiency, or recruit patients for clinical studies via these technologies. However, low communication barriers in socialmedia, limited privacy and security issues lead to problems from an ethical perspective. This paper summarizes the ethical issues to be considered when social media is exploited in healthcare contexts. METHODS: Starting from our experiences in social-media research, we collected ethical issues for selected social-media use cases in the context of patient-centered care. Results were enriched by collecting and analyzing relevant literature and were discussed and interpreted by members of the IMIA Social Media Working Group. RESULTS: Most relevant issues in social-media applications are confidence and privacy that need to be carefully preserved. The patient-physician relationship can suffer from the new information gain on both sides since private information of both healthcare provider and consumer may be accessible through the Internet. Physicians need to ensure they keep the borders between private and professional intact. Beyond, preserving patient anonymity when citing Internet content is crucial for research studies. CONCLUSION: Exploiting medical social-media in healthcare applications requires a careful reflection of roles and responsibilities. Availability of data and information can be useful in many settings, but the abuse of data needs to be prevented. Preserving privacy and confidentiality of online users is a main issue, as well as providing means for patients or Internet users to express concerns on data usage

Prevalence of overweight and obesity based on the body mass index; a cross-sectional study in Alkharj, Saudi Arabia

Background: Obesity and overweight are accompanied with several different chronic diseases. Overweight and obesity can be measured by using body mass index (BMI) and is also used widely as an index of relative adiposity among any population. The aim of the study is to evaluate the prevalence of overweight and obesity among general population in Al-Kharj, Saudi Arabia.Methods: Cross-sectional analysis was undertaken from a representative sample (N = 1019) of the Al Kharj population. Anthropometric measurements including the waist circumference (in centimeters), height (in meters), and weight (in kilograms) of the subjects were undertaken by means of standard apparatus. SPSS 24.0 was utilized for statistical analysis of the data.Results: Majority of respondents in this study were overweight and obese (54.3%) compared with 45.7% being non-obese. A linear positive association of increasing BMI with older age groups was present in males and females. Men had larger waist circumference, weight and height measures as compared with their female counterparts. Regression analysis showed increasing age, being married and high serum cholesterol to be the significant predictors of overweight and obesity while gender, education level, job status, and having diabetes were not.Conclusions: The obesity-overweight prevalence in the Saudi population is high mainly across both genders. However, the associated factors are potentially preventable and modifiable. The regional barriers to lifestyle modifications and interventions to encourage active lifestyles, especially among adolescents to limit the occurrence of obesity and ultimately promote health and wellbeing, are warranted. Furthermore, prospective studies are needed in future to confirm the aetiological nature of such associations

Social Media for e-Government in the Public Health Sector: Protocol for a Systematic Review

Background: Public sector organizations worldwide are engaging with social media as part of a growing e-Government agenda. These include government departments of health, public health agencies and state-funded healthcare and research organizations. Although examples of social media in health have been described in the literature, little is known about their overall scope or how they are achieving the objectives of e-Government. A systematic literature review is underway to capture and synthesize existing evidence on the adoption, use and impacts of social media in the public health sector. A series of parallel scoping exercises has taken place to examine (1) relevant existing systematic reviews, to assess their focus, breadth and fit with our review topic (2) existing concepts related to e-Government, public health and the public health sector, to assess how semantic complexity might influence the review process and (3) the results of pilot searches, to examine the fit of social media within the e-government and health literatures. The methods and observations of the scoping exercises are reported in this protocol, alongside the methods and interim results for the systematic review itself. Objectives: The systematic review has three main objectives: To capture the corpus of published studies on the uses of social media by public health organizations; to classify the objectives for which social media have been deployed in these contexts and the methods used; and to analyse and synthesize evidence of the uptake, use and impacts of social media on various outcomes. Methods: A set of scoping exercises were undertaken, to inform the search strategy and analytic framework. Searches have been carried out in Medline, the Cochrane Library, Web of Science and the Scopus international electronic databases, and appropriate grey literature sources. Articles published between 01/01/2004 and 12/07/2015 were included. There was no restriction by language. One reviewer has independently screened citations generated by the search terms and is extracting data from the selected articles. A second author is cross-checking the outputs to ensure the fit of selected articles with the inclusion criteria and appropriate data extraction. A PRISMA flow diagram will enable transparency and replicability. Results: Scoping work revealed that the literature on social media for e-government in the public health sector is complicated by heterogeneous terminologies and concepts, although studies at the intersection of these three topics exist. Not all types of e-government are evident in the healthcare literature. Interim results suggest that most relevant articles focus on usage alone. Conclusions: Public health organizations may be taking it for granted that social media deliver benefits, rather than attempting to evaluate their adoption or impacts. Published taxonomies of e-government hold promise for organizing and interpreting the review results. The systematic review is underway and completion is expected in the beginning of 2016

Practical mammography

‘Digital health’ is an overarching concept that currently lacks theoretical definition and common terminology. For instance, this broad and emerging field includes all of the following terms within its lexicon: mHealth, Wireless Health, Health 2.0, eHealth, e-Patient(s), Healthcare IT/Health IT, Big Data, Health Data, Cloud Computing, Quantified Self, Wearable Computing, Gamification, and Telehealth/Telemedicine [1]. However, whilst a definition is difficult to provide, in this overview it is considered that digital health is the use of digital media to transform the way healthcare provision is conceived and delivered. We consider it does this through three basic features

Patients’ Adoption of Electronic Personal Health Records in England: Secondary data analysis

Background: In England, almost all general practices (GPs) have implemented GP online services such as electronic personal health records (ePHRs) that allow people to schedule appointments, request repeat prescriptions, and access parts of their medical records. The overall adoption rate of GP online services has been low, reaching just 28% in October 2019. In a previous study, Abd-Alrazaq et al adopted a model to assess the factors that influence patients’ use of GP online services in England. According to the previous literature, the predictive power of the Abd-Alrazaq model could be improved by proposing new associations between the existing variables in the model. Objective: This study aims to improve the predictive power of the Abd-Alrazaq model by proposing new relationships between the existing variables in the model. Methods: The Abd-Alrazaq model was amended by proposing new direct, mediating, moderating, and moderated mediating effects. The amended model was examined using data from a previous study, which were collected by a cross-sectional survey of a convenience sample of 4 GPs in West Yorkshire, England. Structural equation modeling was used to examine the theoretical model and hypotheses. Results: The new model accounted for 53% of the variance in performance expectancy (PE), 76% of the variance in behavioral intention (BI), and 49% of the variance in use behavior (UB). In addition to the significant associations found in the previous study, this study found that social influence (SI) and facilitating conditions (FCs) are associated with PE directly and BI indirectly through PE. The association between BI and UB was stronger for younger women with higher levels of education, income, and internet access. The indirect effects of effort expectancy (EE), perceived privacy and security (PPS), and SI on BI were statistically stronger for women without internet access, patients with internet access, and patients without internet access, respectively. The indirect effect of PPS on BI was stronger for patients with college education or diploma than for those with secondary school education and lower, whereas the indirect effect of EE on BI was stronger for patients with secondary school education or lower than for those with college education or a diploma. Conclusions: The predictive power of the Abd-Alrazaq model improved by virtue of new significant associations that were not examined before in the context of ePHRs. Further studies are required to validate the new model in different contexts and to improve its predictive power by proposing new variables. The influential factors found in this study should be considered to improve patients’ use of ePHRs

Making it work for me: beliefs about making a personal health record relevant and useable.

BACKGROUND: A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their health information, e.g. data from their medical records and data collected by apps. However, engagement with their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and other services. We have explored the beliefs potential users have about a PHR, how it could be made personally relevant, and barriers to its use. METHODS: A qualitative design comprising eight focus groups, each with 6-8 participants. Groups included adults with long-term health conditions, young people, physically active adults, data experts, and members of the voluntary sector. Each group lasted 60-90 min, was audio recorded and transcribed verbatim. We analysed the data using thematic analysis to address the question "What are people's beliefs about making a Personal Health Record have relevance and impact?" RESULTS: We found four themes. Making it work for me is about how to encourage individuals to actively engage with their PHR. I control my information is about individuals deciding what to share and who to share it with. My concerns is about individuals' concerns about information security and if and how their information will be acted upon. Potential impact shows the potential benefits of a PHR such as increasing self-efficacy, uptake of health-protective behaviours, and professionals taking a more holistic approach to providing care and facilitating behaviour change. CONCLUSIONS: Our research shows the functionality that a PHR requires in order for people to engage with it. Interactive functions and integration with lifestyle and health apps are particularly important. A PHR could increase the effectiveness of behaviour change apps by specifying evidence-based behaviour change techniques that apps should incorporate. A PHR has the potential to increase health-protective behaviours and facilitate a more person-driven health and social care system. It could support patients to take responsibility for self-managing their health and treatment regimens, as well as helping patients to play a more active role when care transfers across boundaries of responsibility

The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990�2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Methods: We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95 uncertainty intervals (UI). Findings: In 2017, there were 6·8 million (95 UI 6·4�7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9�83·5) per 100 000 population in 1990 to 84·3 (79·2�89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55�0·69) per 100 000 population in 1990 to 0·51 (0·42�0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 398·7�446·1 per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 6·3�7·2 per 100 000 population). High Socio-demographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464·5 438·6�490·9 per 100 000 population), followed by the UK (449·6 420·6�481·6 per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1·8 0·8�3·2 per 100 000 population) and Singapore had the lowest (0·08 0·06�0·14 per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0·56 million (0·39�0·77) in 1990 to 1·02 million (0·71�1·38) in 2017. The age-standardised rate of DALYs decreased from 26·5 (21·0�33·0) per 100 000 population in 1990 to 23·2 (19·1�27·8) per 100 000 population in 2017. Interpretation: The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Development and implementation of clinical guidelines : an artificial intelligence perspective

Clinical practice guidelines in paper format are still the preferred form of delivery of medical knowledge and recommendations to healthcare professionals. Their current support and development process have well identified limitations to which the healthcare community has been continuously searching solutions. Artificial intelligence may create the conditions and provide the tools to address many, if not all, of these limitations.. This paper presents a comprehensive and up to date review of computer-interpretable guideline approaches, namely Arden Syntax, GLIF, PROforma, Asbru, GLARE and SAGE. It also provides an assessment of how well these approaches respond to the challenges posed by paper-based guidelines and addresses topics of Artificial intelligence that could provide a solution to the shortcomings of clinical guidelines. Among the topics addressed by this paper are expert systems, case-based reasoning, medical ontologies and reasoning under uncertainty, with a special focus on methodologies for assessing quality of information when managing incomplete information. Finally, an analysis is made of the fundamental requirements of a guideline model and the importance that standard terminologies and models for clinical data have in the semantic and syntactic interoperability between a guideline execution engine and the software tools used in clinical settings. It is also proposed a line of research that includes the development of an ontology for clinical practice guidelines and a decision model for a guideline-based expert system that manages non-compliance with clinical guidelines and uncertainty.This work is funded by national funds through the FCT – Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project PEst-OE/EEI/UI0752/2011"