JMIR mHealth and uHealth最新文献

{"title":"Selection of Behavior Change Techniques for Asthma Medication Adherence Apps: Evidence-Based Design Study.","authors":"Alison J Wright, Jeremy Holland, Iain Simpson, Samantha Walker, Naomi Bennett-Steele, John Weinman","doi":"10.2196/49348","DOIUrl":"10.2196/49348","url":null,"abstract":"<p><strong>Background: </strong>Poor medication adherence is a widespread issue that causes adverse patient outcomes and is expensive for all aspects of the health care system. Developing cost-effective and scalable interventions to promote medication adherence is a key goal. Mobile apps hold promise as a mode of delivery for adherence interventions, but app design rarely takes into account the behavioral influences on nonadherence with sufficient rigor. As a result, apps may not realize their full potential in enhancing adherence. Medication nonadherence is common among adults prescribed preventer inhalers for asthma and has a variety of influences, creating a need to identify what components behavior change technique (BCT) apps should include to effectively tackle each influence.</p><p><strong>Objective: </strong>This study aimed to identify the most acceptable and practicable BCTs to include in a medication adherence app targeting factors that influence preventer inhaler adherence in adults with asthma.</p><p><strong>Methods: </strong>Key influences on preventer inhaler adherence in adults with asthma were identified based on reviews of peer-reviewed and gray literature and domain expert knowledge. These influences were then mapped to a published set of 26 mechanisms of action (MoAs) of behavior change interventions. Next, candidate BCTs to change each MoA were identified using the Theory and Techniques tool, a web-based resource that reflects almost 100 expert behavioral scientists' consensus about which BCTs are most likely to change particular MoAs. Finally, candidate BCTs were filtered by considering their potential acceptability and practicability.</p><p><strong>Results: </strong>A total of 31 influences on preventer inhaler adherence were identified and coded to 15/26 of the influences on behavior listed by the Theory and Techniques tool. The initial mapping of influences on behavior to candidate BCTs to change those influences identified 41 candidate BCTs. After considering the potential acceptability and practicability of the candidate BCTs, the number of BCTs suggested for inclusion was reduced to 24.</p><p><strong>Conclusions: </strong>Using an evidence-based approach, this study identified 24 BCTs that may be particularly useful to include in apps promoting adherence to preventer inhalers in order to target particular influences on adherence. The list can be used by app developers to improve the quality of adherence behavior change support that their apps provide or by health care decision-makers to identify which apps contain elements addressing a range of adherence difficulties.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e49348"},"PeriodicalIF":6.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect and Safety of App-Based Interventions for Populations With Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"He Zhang, Hongchi Wang, Cheng Zhang, Ruili Zhao, Qian Lv, Luyao Zhang, Haoran Zhang, Shiyan Yan","doi":"10.2196/71193","DOIUrl":"10.2196/71193","url":null,"abstract":"<p><strong>Background: </strong>Interventions based on apps are becoming increasingly popular for the treatment of osteoarthritis (OA), but research on the potential moderators of treatment efficacy is lacking.</p><p><strong>Objective: </strong>The aim of this study was to examine the treatment efficacy, cost-effectiveness, and safety associated with app-based interventions for populations with OA and identify the potential factors associated with better treatment outcomes.</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, and the Cochrane Library were searched from their inception to September 19, 2024, for randomized controlled trials on app-based interventions for patients with OA that report efficacy or health economic outcomes. The quality of each included study was assessed using the revised Cochrane Risk of Bias Assessment Tool (ROB 2.0). The primary outcome measure is the change in pain intensity before and after treatment. Secondary outcomes included function, quality of life, adverse events, and self-management. If I2 was >50%, a random-effects model was applied. In addition to preplanned subgroup analyses based on OA type, intervention duration, risk of bias, age, and type of app-based intervention, exploratory post hoc subgroup analyses were conducted on variables related to the population, intervention characteristics, and study design features.</p><p><strong>Results: </strong>The review includes 14 studies, comprising 12 randomized controlled trials (RCTs) and 2 health economics studies. The RCTs involved a total of 1410 participants, whose mean age ranged from 54 to 67 years. Compared with controls, app-based interventions led to a reduction in pain and improvement in physical function (standardized mean difference [SMD]=-0.36; 95% CI: -0.58 to -0.14; P<.001; I2=72% and SMD 0.39; 95% CI 0.16 to 0.62; P<.001; I2=67%; respectively), but showed no significance for quality of life and adverse events (SMD 0.23; 95% CI -0.04 to 0.50; P=.10; I2=68% and odds ratio [OR]=1.33; 95% CI 0.84 to 2.12; P=.23; I2=7%; respectively). The cost of the intervention group was lower than that of the control group. Subgroup analysis revealed a significant difference between those aged 60 years and older and those younger than 60 years (SMD -0.29; 95% CI -0.51 to -0.06 and SMD -0.84; 95% CI -1.25 to -0.43). The study also reported a high level of satisfaction and compliance rate, with all scores of the System Usability Scale exceeding 70 points, and this score is considered acceptable.</p><p><strong>Conclusions: </strong>This study showed that app-based interventions were safe and effective for patients with OA, which might provide a cost-effective option, especially in resource-limited settings. Age is a critical factor for optimizing treatment benefits, especially when considering individual needs.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e71193"},"PeriodicalIF":6.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engagement With Conversational Agent-Enabled Interventions in Cardiometabolic Disease Self-Management: Systematic Review.","authors":"Nick Kashyap, Ann Tresa Sebastian, Chris Lynch, Paul Jansons, Ralph Maddison, Tilman Dingler, Brian Oldenburg","doi":"10.2196/67913","DOIUrl":"10.2196/67913","url":null,"abstract":"<p><strong>Background: </strong>Well-designed conversational agents can improve health care capacity to meet the dynamic and complex needs of people self-managing cardiometabolic diseases (CMD). However, a lack of empirical evidence on conversational agent-enabled intervention design features and their impact on engagement make it challenging to comprehensively evaluate effectiveness. This review synthesizes evidence on conversational agent-enabled intervention design features and how they impact on engagement to inform the development of more engaging conversational agent-enabled interventions that effectively help people with CMD to self-manage their condition.</p><p><strong>Objective: </strong>The aim of the study is to synthesize evidence pertaining to conversational agent-enabled intervention design features and their impact on engagement of people self-managing CMD.</p><p><strong>Methods: </strong>Searches were conducted in Ovid (MEDLINE), Web of Science, and Scopus databases. Inclusion criteria were primary research studies reporting on conversational agent-enabled interventions that included measures of engagement and included adults with CMD. Data extraction captured perspectives of people with CMD on various design features of conversational agent-enabled interventions.</p><p><strong>Results: </strong>Of 1366 studies identified for screening, 20 were included in the review. In total, 18 of these were qualitative or quasi-experimental evaluations of conversational agent-enabled intervention prototypes. Five domains of design features that impact user engagement with conversational agent-enabled interventions emerged: communication style, functionality, accessibility, visual appearance, and personality.</p><p><strong>Conclusions: </strong>Across all 5 domains, integrating redundancy and anthropomorphism were identified as effective strategies for improving engagement by increasing user autonomy and investment. Future research should adopt design strategies that are inclusive and adaptive to the diverse needs of users and aligned with the unique considerations relevant to conversational agent-enabled interventions.</p><p><strong>Trial registration: </strong>PROSPERO CRD42023431579; https://tinyurl.com/3srmzw8f.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.2196/52973.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e67913"},"PeriodicalIF":6.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Smartwatch Device on Adherence to Home-Based Cardiac Rehabilitation in Patients With Coronary Heart Disease: Randomized Controlled Trial.","authors":"Sisi Zhang, Yuehui Wang, Jiahui Wu, Changsheng Ma, Xiaoping Meng","doi":"10.2196/70848","DOIUrl":"10.2196/70848","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital technologies have the potential to overcome many of the limitations associated with traditional center-based cardiac rehabilitation (CBCR), such as limited accessibility, transportation barriers, and low adherence. In this context, home-based cardiac rehabilitation (HBCR) has emerged as a promising alternative. However, maintaining adherence and providing continuous supervision in remote settings remain a major challenge. Smartwatch-based interventions may offer a novel solution to support and monitor patients in HBCR programs, yet robust clinical evidence is still limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study was designed to investigate the effectiveness of a smartwatch-facilitated HCBR model in improving exercise adherence and health-related outcomes in patients with coronary heart disease (CHD), aiming to improve adherence and other outcomes related to the secondary prevention of cardiovascular disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective, single-center, randomized, parallel-controlled, non-blinded trial. Eligible participants were adults (≥18 years) with a confirmed diagnosis of CHD, recruited from a tertiary hospital in Jilin Province, China. Participants were randomly assigned in a 1:1 ratio to either the intervention group (smartwatch-facilitated HBCR) or the control group (standard HBCR) for a duration of 3 months. The intervention group received a comprehensive program delivered via a smartwatch, including real-time feedback, remote supervision, physical activity monitoring, and educational content. The control group received conventional HBCR without technological assistance. The primary outcome was adherence to the HBCR program, assessed using the Home-Based Cardiac Rehabilitation Exercise Adherence Scale. Secondary outcomes included cardiopulmonary function (peak VO₂ measured via cardiopulmonary exercise testing), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and health-related quality of life (36-Item Short Form Survey, SF-36), evaluated at baseline and at 3 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between January 1 and December 30, 2023, a total of 62 patients (mean [SD] age 59.93 [10.06] years; 40.4% women [25/62]) were enrolled and randomized to the intervention group (n=32) or control group (n=30). Baseline characteristics were well balanced between the groups. At 3 months, participants in the smartwatch group demonstrated significantly higher adherence scores compared to the control group (P&lt;.01). Additionally, the smartwatch group showed significant improvements in peak VO₂ (P&lt;.01), anxiety (GAD-7, P&lt;.01), depression (PHQ-9, P&lt;.01), and selected domains of SF-36 (P&lt;.05). No serious adverse events related to the intervention were reported, and user engagement with the smartwatch platform was high throughout the study period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates that a smartwatch-facilitated HBCR m","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e70848"},"PeriodicalIF":6.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: The Role of Environmental Factors in Technology-Assisted Physical Activity Intervention Studies Among Older Adults: Scoping Review.","authors":"Carl-Philipp Jansen, Désirée Nijland, Jean-Michel Oppert, Veysel Alcan, Kirsi E Keskinen, Emmi Matikainen-Tervola, Zada Pajalic, Merja Rantakokko, Signe Tomsone, Essi-Mari Tuomola, Erja Portegijs, Erik J Timmermans","doi":"10.2196/83822","DOIUrl":"10.2196/83822","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/59570.].</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e83822"},"PeriodicalIF":6.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating a Multimodal Digital Device for Continuous Perioperative Monitoring in Patients With Lung Cancer Undergoing Thoracic Surgery: Development and Usability Study.","authors":"Runchen Wang, Jianqi Zheng, Wenwei Guo, Haiqi Huang, Qixia Wang, Yihong Li, Manwan Lin, Linchong Huang, Qing Zhang, Kaishen Chen, Zhiming Ye, Hongsheng Deng, Yu Jiang, Yuechun Lin, Yi Feng, Ying Huang, Ying Chen, Jianxing He, Hengrui Liang","doi":"10.2196/69512","DOIUrl":"10.2196/69512","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive thoracic surgery has improved lung cancer outcomes but requires enhanced postoperative care. Traditionally, the episodic care model has limited timely and multidimensional monitoring of patients. Recent technological advances in multimodal digital devices, including wearable devices and electronic patient-reported outcomes (ePROs), offer a promising solution to these challenges. However, current studies focus on only a few parameters and limited application in thoracic surgery.</p><p><strong>Objective: </strong>This study aims to propose a self-controlled study to evaluate the feasibility and reliability of multimodal digital devices, including wearables and ePROs, for continuous perioperative monitoring to enhance recovery after thoracic surgery.</p><p><strong>Methods: </strong>We included 288 patients with non-small cell lung cancer from the Guangzhou Medical University cohort, which includes 2757 participants with various lung diseases. Digital data were collected during hospitalization using a commercial smartwatch combined with an ePROs questionnaire, while clinical data were obtained from electronic health records (EHRs). Agreement between the digital device and EHR was evaluated via Bland-Altman analysis. Time-series data were normalized for continuous outlier monitoring, and threshold analysis of ePROs scores were used to explore associations across different modules.</p><p><strong>Results: </strong>Throughout hospitalization, digital devices provided a subjective overview of the patients' recovery trajectories. Results of Bland-Altman analysis demonstrated a high level of agreement between the digital device and the EHR. For body temperature, the analysis revealed a minimal bias of 0.02 °C (95% CI -0.01 °C to 0.05 °C), the agreement for heart rate showed a bias of 0.26 beats per minute (bpm; 95% CI -0.49 bpm to 1.01 bpm), and the bias for oxygen saturation was -0.06% (95% CI -0.27% to 0.15%), indicating close alignment between the 2 measurement methods. Meanwhile, wearable devices demonstrate significant potential in outlier detection compared to the episodic care model, offering accurate and sensitive monitoring of outliers between traditional measurement intervals. Using a thresholding method, we found that wearable metrics were correlated with the severity of ePROs.</p><p><strong>Conclusions: </strong>These findings highlight the reliability and clinical potential of digital device-based multimodal systems within the enhanced recovery after surgery framework, offering a novel approach for continuous perioperative monitoring.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e69512"},"PeriodicalIF":6.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12485267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Digital Health Technologies in Tuberculosis Treatment: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Qinglin Cheng, Ping Chen, Ruoqi Dai, Qingjun Jia, Xuexin Bai, Qiancheng Cao, Qingchun Li, Yifei Wu, Yinyan Huang","doi":"10.2196/75424","DOIUrl":"10.2196/75424","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) treatment remains a critical global health challenge, as traditional standard of care (SoC) approaches face limitations in accessibility and efficacy. While digital health technologies (DHTs) offer promising solutions to address these gaps, limited evidence exists on their comparative effectiveness.</p><p><strong>Objective: </strong>This study systematically evaluates and compares the impact of diverse DHTs on improving TB treatment outcomes and adherence, aiming to identify optimal strategies across different patient populations.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, Cochrane Library, Embase, and Web of Science from database inception through February 28, 2025, with no language restrictions. Eligible studies included randomized controlled trials comparing DHTs with SoC for TB treatment. The primary outcome was treatment success, defined as completion or cure. A random-effects network meta-analysis was performed, calculating odds ratios (OR) and 95% credibility intervals (CrI) to assess treatment effects. Surface under the cumulative ranking curve (SUCRA) values were used to rank intervention effectiveness. This study is registered with PROSPERO (International Prospective Register of Systematic Reviews; CRD42025601199).</p><p><strong>Results: </strong>From 2420 screened studies, 27 randomized controlled trials involving 23,283 patients and eight DHT interventions were included. The network meta-analysis revealed that digital health platforms showed marginal improvements in treatment success (OR=3.44; 95% CrI 0.95-11.67; SUCRA=0.913; P=.05). Compared with SoC, video directly observed treatment (VDOT) significantly improved treatment success (OR=2.39; 95% CrI 1.18-4.75; SUCRA=0.848; P=.01). Medication event reminder monitors significantly enhanced treatment adherence (OR=3.13; 95% CrI 1.55-7.05; SUCRA=0.891; P=.003).</p><p><strong>Conclusions: </strong>Results underscore the significant potential of DHTs to improve TB treatment management. VDOT emerged as the most effective intervention for enhancing treatment success, while medication event reminder monitors demonstrated efficacy in sustaining adherence. Digital health platforms showed promise but require additional validation. Caution is warranted due to potential heterogeneity across studies, which may affect generalizability. This research offers actionable insights for stakeholders aiming to optimize TB management through strategic DHT integration.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e75424"},"PeriodicalIF":6.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large-Scale Analysis of Oura Ring Data During Pregnancy: Temporal Trajectories in Sleep, Temperature Trends, Cardiorespiratory, and Activity Metrics.","authors":"Rebecca Adaimi, Nina Thigpen, Alicia Clausel, Neta Gotlieb, Ketan Patel, Massimiliano de Zambotti","doi":"10.2196/80213","DOIUrl":"https://doi.org/10.2196/80213","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pregnancy and childbirth involve significant health challenges, including preventable maternal deaths, severe complications, and disparities tied to social determinants, emphasizing the need for improved maternal care. Pregnancy could benefit from a more comprehensive, continuous care model that captures dynamic changes and enhances maternal-fetal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This large-scale, real-world, high-density study uses wearable data to investigate maternal biobehavioral trajectories for pregnancies leading to loss, preterm, and term births, exploring how demographics factors like age and body mass index (BMI) affect these trajectories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective observational analysis of pregnancies from a sample of 10,318 18-51-year-old female Oura Ring users (324 preterm births, 5039 term births, 4955 pregnancies ending in loss before 20 weeks of gestation). Oura biobehavioral data were analyzed across a 64-week window encompassing 8 weeks pre-pregnancy, through pregnancy and postpartum, via Generalized Estimating Equation (GEE) statistical modeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Gestational age emerged as a significant factor across all domains among term pregnancies (P &lt; .001). During the first trimester, participants experienced marked sleep changes, peaking around week 9 and characterized by more time in bed (+30 min), asleep (+15 min), and awake (+15 min) compared to pre-pregnancy. Metrics declined and stabilized in the second trimester; by the third, time in bed returned to baseline, while sleep remained reduced and wakefulness elevated. At birth, time in bed and wakefulness peaked, and sleep duration reached its minimum, with nighttime wake exceeding 3 standard deviations above baseline. Temperature changes were more pronounced, sustained, and occurred earlier than sleep changes-becoming evident by week 4, peaking at +0.3 °C above baseline by week 9, and showing a steady decline until birth. A secondary, modest increase (+0.1 °C) was observed near birth, followed by a decline postpartum. Heart rate (HR) increased steadily, peaking at +10 bpm above baseline at week 32, while HR variability (HRV) declined by &gt;15 ms in a mirrored pattern. Respiratory rate peaked around week 9 and declined thereafter. Step count declined in the first trimester, with a ~2,000-step reduction at around week 8. After a slight rebound mid-pregnancy, activity declined again, reaching its lowest point near birth, with &gt;2,500 fewer steps than pre-pregnancy. Age and BMI showed significant but modest interaction effects (all P &lt;.01). In pregnancies ending in loss, deviations emerged up to two weeks prior. Time in bed decreased starting ~2 weeks before loss (P &lt;.001), followed by reductions in sleep duration (P &lt;.001), temperature trends (P &lt;.001), respiratory rate (P =.019), HR (P =.005), and awake time (P =.033).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These findings highlight the complex dynam","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":" ","pages":""},"PeriodicalIF":6.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Value of Continuous Plantar Temperature Monitoring for Diabetic Foot Health Management: Observational, Prospective Cohort Study.","authors":"Maryam Hajizadeh, Emily Matijevich, Emily Bray, Evan Minty, Brock Liden","doi":"10.2196/73187","DOIUrl":"10.2196/73187","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) are a life-changing complication of diabetes. There is increasing evidence that remote plantar temperature monitoring can reduce the recurrence of DFUs. Monitoring of foot temperature once a day is the current guideline for identifying early signs of foot inflammation. However, single readings of physiological signals can increase the risk of misdiagnosis when the signals fluctuate throughout the day.</p><p><strong>Objective: </strong>The aim of this study was to evaluate whether intraday temperature asymmetry signals were stable or varied as a function of time in individuals at risk of DFUs.</p><p><strong>Methods: </strong>In total, 64 participants with diabetes (mean age 68, SD 13.8 y) were provided with multimodal sensory insoles (Orpyx Sensory Insoles) to monitor continuous temperature data at a frequency of once per minute at 5 plantar locations in a 90-day study window. The augmented Dickey-Fuller test was used to determine whether the temperature asymmetry signals were stationary (ie, indicating constant mean and variance over time) or nonstationary (ie, indicating time-varying behaviors or trends in the signal).</p><p><strong>Results: </strong>The study included 43 participants, 1080 data days, and 5400 contralateral temperature asymmetry signals. Most (4428/5400, 82%) of the temperature asymmetry signals were nonstationary, with intraday fluctuations likely influenced by physiological and environmental factors. Of the nonstationary signals, nearly half (1948/4428, 44%) fluctuated above and below the concerning asymmetry threshold of 2.2 °C. The intraday variability underscores the potential for false-positive and false-negative hot spot detection with once-daily measurements. Substantial variability was observed in stationarity patterns both within and across participants. Notably, concerning asymmetries in nonstationary signals occurred at different time points across participants, measurement windows, and days.</p><p><strong>Conclusions: </strong>Our findings highlight the value of continuous plantar temperature monitoring for diabetic foot health management, relative to once-daily measurements. Several repeated measurements throughout the day increase confidence with regard to the accuracy of observed plantar physiology trends. Continuous monitoring may improve the accuracy of plantar temperature measurement, unlock new diagnostic capabilities, and support personalized care.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e73187"},"PeriodicalIF":6.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12431787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of a Multicomponent mHealth Intervention for Stroke Management in Rural China: Cluster-Randomized Trial With 6-Year Follow-Up.","authors":"Bolu Yang, Enying Gong, Xingxing Chen, Jie Tan, Nicholas Peoples, Yuhan Li, Jiayu Cai, Yan Li, Brian Oldenburg, Chen Chen, Dejin Dong, Xiaochen Zhang, Eric Finkelstein, Lei Si, Lijing L Yan","doi":"10.2196/75326","DOIUrl":"10.2196/75326","url":null,"abstract":"<p><strong>Background: </strong>To bridge the gap between clinical guidelines and suboptimal stroke management in rural settings, we conducted an implementation trial using evidence-based, mobile health-enabled strategies to empower primary care providers in rural China. The system-integrated and digital technology-enabled model of care (SINEMA) model was shown to significantly reduce blood pressure and mortality among people with stroke in rural China.</p><p><strong>Objective: </strong>This study aimed to evaluate the cost-effectiveness of the SINEMA intervention within both the active trial and the post-trial observational periods and its budget impact for potential nationwide scalability.</p><p><strong>Methods: </strong>In the cluster-randomized implementation trial (the SINEMA trial), 50 villages were randomized to either a 1-year intervention (2017-2018) or usual care, with 1299 patients with stroke followed up until 2022-2023-6 years after the trial baseline. The incremental cost-effectiveness ratios (ICER) for systolic blood pressure reduction and quality-adjusted life year gains were estimated from a health sector perspective. Both probabilistic and deterministic sensitivity analyses were conducted to assess the robustness of the findings. Additionally, a budget impact analysis was performed from a public payer perspective to estimate the per-capita and total costs of national scale-up under 2 scenarios: a standalone intervention and integration into the existing basic public health service system.</p><p><strong>Results: </strong>The ICER per 1 mmHg systolic blood pressure reduction was $8.4 for the within-trial estimation. The ICER per quality-adjusted life year gained was $837.9 within-trial and $727.9 post-trial, both highly cost-effective relative to any commonly adopted thresholds and robust in sensitivity analyses. The first-year budget impact ranged from $115.6 million to $197.7 million in the 2 scenarios, reducing to $46.6 million to $78.7 million by year 5, with a per-capita cost of $0.03-$0.06.</p><p><strong>Conclusions: </strong>Our findings demonstrate that the SINEMA intervention was cost-effective during the trial period and remained so throughout the 6-year sustainability observation period. These results highlight the potential of adopting similar health system-integrated, mobile health-enabled strategies to enhance the management of stroke and other chronic diseases in resource-limited settings.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT0318585, ClinicalTrials.gov NCT05792618; https://clinicaltrials.gov/study/NCT03185858 and https://clinicaltrials.gov/study/NCT05792618.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.3389/fneur.2023.1145562.</p>","PeriodicalId":14756,"journal":{"name":"JMIR mHealth and uHealth","volume":"13 ","pages":"e75326"},"PeriodicalIF":6.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}