Browsing by Subject "mHealth"

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  • ARIA Working Grp; Bousquet, J; Pfaar, O; Togias, A; Haahtela, T; Toppila-Salmi, S (2019)
    Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
  • Wallis, Lee; Hasselberg, Marie; Barkman, Catharina; Bogoch, Isaac; Broomhead, Sean; Dumont, Guy; Groenewald, Johann; Lundin, Johan; Bergendahl, Johan Norell; Nyasulu, Peter; Olofsson, Maud; Weinehall, Lars; Laflamme, Lucie (2017)
    Background: Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. Objectives: This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. Methods: A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. Results: There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. Conclusions: Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.
  • MASK Grp; Menditto, Enrica; Costa, Elisio; Midao, Luis; Haahtela, Tari; Toppila-Salmi, S.; Kuitunen, M.; Valovirta, E. (2019)
    Background: Mobile technology may help to better understand the adherence to treatment. MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12143 users were registered. A total of 6949 users reported at least one VAS data recording. Among them, 1887 users reported >= 7 VAS data. About 1195 subjects were included in the analysis of adherence. One hundred and thirty-six (11.28%) users were adherent (MPR >= 70% and PDC = 70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non-adherent to medications (MPR Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on-demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication-taking behaviour in a real-world setting.
  • Aulbach, Matthias Burkard; Knittle, Keegan; van Beurden, Samantha Barbara; Haukkala, Ari; Lawrence, Natalia S. (2021)
    Food Go/No-Go training aims to alter implicit food biases by creating associations between perceiving unhealthy foods and withholding a dominant response. Asking participants to repeatedly inhibit an impulse to approach unhealthy foods can decrease unhealthy food intake in laboratory settings. Less is known about how people engage with app-based Go/No-Go training in real-world settings and how this might relate to dietary outcomes. This pragmatic observational study investigated associations between the number of completed app-based food Go/No-Go training trials and changes in food intake (Food Frequency Questionnaire; FFQ) for different healthy and unhealthy food categories from baseline to one-month follow-up. In total, 1234 participants (m(BMI) = 29 kg/ m2, m(age) = 43years, 69% female) downloaded the FoodT app and completed food-Go/No-Go training at their own discretion (mean number of completed sessions = 10.7, sd = 10.3, range: 1-122). In pre-registered analyses, random-intercept linear models predicting intake of different foods, and controlled for baseline consumption, BMI, age, sex, smoking, metabolic syndrome, and dieting status, revealed small, significant associations between the number of completed training trials and reductions in unhealthy food intake (b = -0.0005, CI95 = [-0.0007;0.0003]) and increases in healthy food intake (b = 0.0003, CI95 = [0.0000; 0.0006]). These relationships varied by food category, and exploratory analyses suggest that more temporally spaced training was associated with greater changes in dietary intake. Taken together, these results imply a positive association between the amount of training completed and beneficial changes in food intake. However, the results of this pragmatic study should be interpreted cautiously, as self-selection biases, motivation and other engagement-related factors that could underlie these associations were not accounted for. Experimental research is needed to rule out these possible confounds and establish causal dose-response relationships between patterns of engagement with food Go/No-Go training and changes in dietary intake.
  • Bousquet, Jean; Anto, Josep M.; Haahtela, Tari; Jousilahti, Pekka; Erhola, Marina; Basagana, Xavier; Czarlewski, Wienczyslawa; Odemyr, Mikaela; Palkonen, Susanna; Sofiev, Mikael; Velasco, Cesar; Bedbrook, Anna; Delgado, Rodrigo; Kouznetsov, Rostislav; Mäkelä, Mika; Palamarchuk, Yuliia; Saarinen, Kimmo; Tommila, Erja; Valovirta, Erkka; Vasankari, Tuula; Zuberbier, Torsten; Annesi-Maesano, Isabella; Benveniste, Samuel; Mathieu-Dupas, Eve; Pepin, Jean-Louis; Picard, Robert; Zeng, Stephane; Ayache, Julia; Calves Venturos, Nuria; Micheli, Yann; Jullian-Desayes, Ingrid; Laune, Daniel (2020)
    In December 2019, a conference entitled "Europe That Protects: Safeguarding Our Planet, Safeguarding Our Health" was held in Helsinki. It was co-organized by the Finnish Institute for Health and Welfare, the Finnish Environment Institute and the European Commission, under the auspices of Finland's Presidency of the EU. As a side event, a symposium organized as the final POLLAR (Impact of air POLLution on Asthma and Rhinitis) meeting explored the digital transformation of health and care to sustain planetary health in airway diseases. The Finnish Allergy Programme collaborates with MASK (Mobile Airways Sentinel NetworK) and can be considered as a proof-of-concept to impact Planetary Health. The Good Practice of DG Sante (The Directorate-General for Health and Food Safety) on digitally-enabled, patient-centred care pathways is in line with the objectives of the Finnish Allergy Programme. The ARIACARE-Digital network has been deployed in 25 countries. It represents an example of the digital cross-border exchange of real-world data and experience with the aim to improve patient care. The integration of information technology tools for climate, weather, air pollution and aerobiology in mobile Health applications will enable the development of an alert system. Citizens will thus be informed about personal environmental threats, which may also be linked to indicators of Planetary Health and sustainability. The digital transformation of the public health policy was also proposed, following the experience of the Agency for Health Quality and Assessment of Catalonia (AQuAS).
  • Lahti, Mari (Helsingfors universitet, 2017)
    Introduction: The importance of good nutrition is not always recognized among athletes and their coaches. Young athletes need professional guidance, so they can learn how to execute dietary practices that support their athletic performance and overall well-being. The growing body of scientific evidence on performance enhancing nutrition and its practical applications challenges the Finnish field of competitive sports to invest in professional nutrition coaching among athletes. Aims of the study: The aim of this study was to examine, if eating habits of young endurance athletes can be influenced by a nutrition intervention carried out using a mobile application (MealLoggerTM) with an inbuilt nutrition program. We also examined, whether the motivation towards sports and nutrition and the perceived competence for following a certain diet are related to athletes’ adherence to the nutrition program and to the measured changes in food intake. Materials and methods: 17 young individual endurance athletes followed through a four-week nutrition intervention by keeping a photo food journal and logging their food servings with the smart phone application MealLoggerTM. A common application inbuilt nutrition program with servings goals for different food groups was designed in advance and implemented after a group education session on optimal sports nutrition. During the intervention period, the participants received real-time feedback from the mobile application on their adherence to the nutrition program. In addition, individualized meal photo comments were provided by a nutritionist three times a week. The athletes also received common weekly motivational messages through the application. Food intake was measured at baseline, after the intervention and 8-weeks after the intervention using food frequency questionnaire (FFQ). The motivation and perceived competence were assessed with Self-Determination theory (SDT) questionnaires. The adherence to the nutrition program was assessed by comparing the logged food servings to the defined nutrition goals. Results: Twelve participants (71%) completed the post-intervention questionnaires. No statistically significant changes in consumption of food groups included in the nutrition program were detected. The consumption of berries increased 2,36 times per week (SD 4,07 p=0,049). The consumption of skimmed milk decreased 3,00 times per week (SD 4,28, p=0,042) and the consumption of milk/alternatives in total decreased 3,67 times per week (SD 5,82, p=0,034). MealLoggerTM data was retrieved from 15 participants. Most of the participants (n=8) with high adherence (H) achieved at least 3 out of 4 goals on every week. Most participants (n=7) with low adherence (L) failed to achieve any of the nutrition goals on any of the four weeks. No statistically significant differences in motivation or perceived competence were found between the H and L. The overall engagement to the mobile application was lower in L compared to H. The participants in L were mostly female, significantly younger and more likely to be living with a guardian, responsible for the acquisition and preparation of food. Discussion: Despite detecting only small dietary improvements, the application showed good feasibility and acceptability among the high adherence participants. In the future, to provide more effective nutrition coaching an appropriate baseline assessment should be included. The goals of the nutrition program should be adjusted according to the athletes’ individual needs. More democratic coaching styles, with parental involvement should be explored in order to increase engagement and adherence of young athletes.
  • Nurmi, Johanna; Knittle, Keegan; Ginchev, Todor; Khattak, Fida; Helf, Christopher; Zwickl, Patrick; Castellano-Tejedor, Carmina; Lusilla-Palacios, Pilar; Costa-Requena, Jose; Ravaja, Niklas; Haukkala, Ari (2020)
    Background: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials. KEYWORDS health app; mHealth; human-computer interaction; prevention; service design; usability design; intrinsic motivation; reflective processes; spontaneous processes; engagement; self-determination theory; autonomous motivation; gamification; physical activity
  • Economides, Marcos; Lehrer, Paul; Ranta, Kristian; Nazander, Albert; Hilgert, Outi; Raevuori, Anu; Gevirtz, Richard; Khazan, Inna; Forman‑Hoffman, Valerie L. (2020)
    A rise in the prevalence of depression underscores the need for accessible and effective interventions. The objectives of this study were to determine if the addition of a treatment component showing promise in treating depression, heart rate variability-biofeedback (HRV-B), to our original smartphone-based, 8-week digital intervention was feasible and whether patients in the HRV-B ("enhanced") intervention were more likely to experience clinically significant improvements in depressive symptoms than patients in our original ("standard") intervention. We used a quasi-experimental, non-equivalent (matched) groups design to compare changes in symptoms of depression in the enhanced group (n = 48) to historical outcome data from the standard group (n = 48). Patients in the enhanced group completed a total average of 3.86 h of HRV-B practice across 25.8 sessions, and were more likely to report a clinically significant improvement in depressive symptom score post-intervention than participants in the standard group, even after adjusting for differences in demographics and engagement between groups (adjusted OR 3.44, 95% CI [1.28-9.26], P = .015). Our findings suggest that adding HRV-B to an app-based, smartphone-delivered, remote intervention for depression is feasible and may enhance treatment outcomes.
  • MASK Study Grp; Bousquet, J.; Bedbrook, A.; Czarlewski, W.; Haahtela, T.; Valovirta, E.; Vasankari, T.; Toppila-Salmi, S.; Salimäki, Johanna; Kuitunen, M.; Wallace, D. V. (2019)
    AimsMobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.MethodsMASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.StakeholdersInclude patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors.ResultsMASK is deployed in 23 countries and 17 languages. 26,000 users have registered.EU grants (2018)MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).Lessons learnt(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.
  • Bousquet, J.; Bedbrook, A.; Czarlewski, W.; Onorato, G. L; Arnavielhe, S.; Laune, D.; Mathieu-Dupas, E.; Fonseca, J.; Costa, E.; Lourenço, O.; Morais-Almeida, M.; Todo-Bom, A.; Illario, M.; Menditto, E.; Canonica, G. W; Cecchi, L.; Monti, R.; Napoli, L.; Ventura, M. T; De Feo, G.; Fokkens, W. J; Chavannes, N. H; Reitsma, S.; Cruz, A. A; da Silva, J.; Serpa, F. S; Larenas-Linnemann, D.; Fuentes Perez, J. M; Huerta-Villalobos, Y. R; Rivero-Yeverino, D.; Rodriguez-Zagal, E.; Valiulis, A.; Dubakiene, R.; Emuzyte, R.; Kvedariene, V.; Annesi-Maesano, I.; Blain, H.; Bonniaud, P.; Bosse, I.; Dauvilliers, Y.; Devillier, P.; Fontaine, J. F; Pépin, J. L; Pham-Thi, N.; Portejoie, F.; Picard, R.; Roche, N.; Rolland, C.; Schmidt-Grendelmeier, P.; Kuna, P.; Samolinski, B.; Anto, J. M; Cardona, V.; Mullol, J.; Pinnock, H.; Ryan, D.; Sheikh, A.; Walker, S.; Williams, S.; Becker, S.; Klimek, L.; Pfaar, O.; Bergmann, K. C; Mösges, R.; Zuberbier, T.; Roller-Wirnsberger, R. E; Tomazic, P. V; Haahtela, T.; Salimäki, J.; Toppila-Salmi, S.; Valovirta, E.; Vasankari, T.; Gemicioğlu, B.; Yorgancioglu, A.; Papadopoulos, N. G; Prokopakis, E. P; Tsiligianni, I. G; Bosnic-Anticevich, S.; O’Hehir, R.; Ivancevich, J. C; Neffen, H.; Zernotti, M. E; Kull, I.; Melén, E.; Wickman, M.; Bachert, C.; Hellings, P. W; Brusselle, G.; Palkonen, S.; Bindslev-Jensen, C.; Eller, E.; Waserman, S.; Boulet, L. P; Bouchard, J.; Chu, D. K; Schünemann, H. J; Sova, M.; De Vries, G.; van Eerd, M.; Agache, I.; Ansotegui, I. J; Bewick, M.; Casale, T.; Dykewick, M.; Ebisawa, M.; Murray, R.; Naclerio, R.; Okamoto, Y.; Wallace, D. V (BioMed Central, 2019)
    Abstract Aims Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. Methods MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. Stakeholders Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors. Results MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. EU grants (2018) MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). Lessons learnt (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.
  • MASK Study Grp (2018)
    mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over-the-counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self-management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self-medicate, are often non-adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.
  • Kulathinal, Sangita; Joseph, Bijoy; Säävälä, Minna (2019)
    Background: Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India. Objective: This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India. Methods: We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed. Results: The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents' mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline. Conclusions: A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India
  • Bousquet, Jean; Ansotegui, Ignacio J.; Anto, Josep M.; Arnavielhe, Sylvie; Bachert, Claus; Basagana, Xavier; Bedard, Annabelle; Bedbrook, Anna; Bonini, Matteo; Bosnic-Anticevich, Sinthia; Braido, Fulvio; Cardona, Vicky; Czarlewski, Wienczyslawa; Cruz, Alvaro A.; Demoly, Pascal; De Vries, Govert; Dramburg, Stephanie; Mathieu-Dupas, Eve; Erhola, Marina; Fokkens, Wytske J.; Fonseca, Joao A.; Haahtela, Tari; Hellings, Peter W.; Illario, Maddalena; Ivancevich, Juan Carlos; Jormanainen, Vesa; Klimek, Ludger; Kuna, Piotr; Kvedariene, Violeta; Laune, Daniel; Larenas-Linnemann, Desiree; Lourenco, Olga; Onorato, Gabrielle L.; Matricardi, Paolo M.; Melen, Erik; Mullol, Joaquim; Papadopoulos, Nikos G.; Pfaar, Oliver; Nhan Pham-Thi,; Sheikh, Aziz; Tan, Rachel; To, Teresa; Tomazic, Peter Valentin; Toppila-Salmi, Sanna; Tripodi, Salvadore; Wallace, Dana; Valiulis, Arunas; van Eerd, Michiel; Ventura, Maria Teresa; Yorgancioglu, Arzu; Zuberbier, Torsten (2019)
    Smart devices and Internet-based applications (apps) are largely used in allergic rhinitis and may help to address some unmet needs. However, these new tools need to first of all be tested for privacy rules, acceptability, usability, and cost-effectiveness. Second, they should be evaluated in the frame of the digital transformation of health, their impact on health care delivery, and health outcomes. This review (1) summarizes some existing mobile health apps for allergic rhinitis and reviews those in which testing has been published, (2) discusses apps that include risk factors of allergic rhinitis, (3) examines the impact of mobile health apps in phenotype discovery, (4) provides real-world evidence for care pathways, and finally (5) discusses mobile health tools enabling the digital transformation of health and care, empowering citizens, and building a healthier society. (C) 2019 American Academy of Allergy, Asthma & Immunology
  • Salmenius-Suominen, Heli (Helsingin yliopisto, 2017)
    Johdanto: Ruokavaliomuutoksilla voi ehkäistä useita lihavuuteen liittyviä kansantauteja, kuten tyypin 2 diabetesta. Ryhmissä tai yksilöohjauksena tapahtuva elintapaohjaus on ollut lihavuuden hoidon perusta. Painonpudotusinterventioissa sähköiset työkalut ovat osoittautuneet tehokkaiksi. Sosiaalisen tuen hyödyntäminen parantaa intervention vaikuttavuutta edelleen. Tutkimustietoa virtuaalisen tuen hyödyntämisestä elintapamuutokseen ja painonhallinnan edistämiseen on kuitenkin vähän. Tavoitteet: Tavoitteena oli selvittää, miten ohjauksen ja vertaistuen mahdollistava valokuvallinen ruokapäiväkirja oli yhteydessä elintapamuutoksen toteutumiseen ylipainoisilla työterveyshuollon asiakkailla ja avohoidossa olevilla henkilöillä. Lisäksi tarkoituksena oli selvittää uudenlaisen menetelmän (älypuhelinsovelluksen, mHealth) toteutettavuutta ja käytettävyyttä. Aineisto ja menetelmät: Tutkimukseen osallistui 26 ylipainoista (BMI>25 kg/m²) aikuista miestä ja naista, jotka rekrytoitiin työterveyshuollon asiakasyrityksestä sekä Pääkaupunkiseudun Diabetesyhdistys ry:n kautta. Osallistujat pitivät pienryhmissä neljä viikkoa visuaalista ruokapäiväkirjaa ottamalla valokuvia aterioistaan käyttämällä älypuhelinsovellusta ja saivat ohjausta ryhmien ohjaajalta. Ryhmäläiset näkivät toistensa ateriakuvat ja pystyivät ”tykkäämään” ja kommentoimaan toistensa kuvia. Ruoankäyttöä mitattiin tutkimuksen alussa, intervention päätyttyä ja neljä viikkoa intervention päättymisestä ruoankäyttökyselyn (FFQ, engl. food frequency questionnaire) avulla. FFQ sisälsi kahdeksan ruoka-ryhmää ja 48 elintarviketta. Kyselylomakkeilla selvitettiin myös tavoitteita, kokemusta sosiaalisesta tuesta ja ryhmän ilmapiiriä. Sosiaaliseksi tueksi määriteltiin myös sovelluksen kautta annetut ja saadut tykkäykset sekä kirjoitetut kommentit. Lisäksi mitattiin lähtötilanteessa ja intervention jälkeen pituus, paino ja vyötärönympärys sekä analysoitiin sovelluksen käyttöaktiivisuutta (ateriakuvat, tykkäykset, kirjautuminen sovellukseen ja kommentit). Tulokset: Kukaan osallistujista ei keskeyttänyt tutkimusta. Naisia oli mukana 74,1 % ja osallistujien keski-ikä oli 48,5 vuotta. Osallistujien painoindeksi oli lähtötilanteessa keskimäärin 32,4 (SD 3,9). Osallistujat määrittelivät tavoitteikseen muun muassa ateriakoon pienentämisen ja sokerittomien juomien käytön lisääntymisen. Kasviksia, hedelmiä ja marjoja käytettiin lähtötilanteessa keskimäärin 3,89 (SD 2,07) kertaa päivässä. Heti intervention jälkeen kasviksia käytettiin 6,04 (SD 2,31) kertaa päivässä. Kasvisten, hedelmien ja marjojen syönti oli kasvanut 2,15 (SD 2,64) kerralla päivässä ja muutos oli tilastollisesti merkitsevä (p<0,001). Kasviksia, hedelmiä ja marjoja syötiin neljä viikkoa intervention päättymisen jälkeen keskimäärin 5,26 (SD 2,41) kertaa päivässä. Verrattuna lähtötasoon kasvisten päivittäinen käyttö oli neljä viikkoa intervention päättymisestä edelleen runsaampaa (p=0,019). Muiden tarkasteltujen ruokamuuttujien muutokset eivät olleet tilastollisesti merkitseviä. Neljän viikon interventiojakson aikana osallistujien paino putosi keskimäärin 1,54 kg (SD 1,82; p=0,001), eli yhteensä laskua tapahtui 2,3 %. Vyötärönympärys kaventui keskimäärin 2,40 cm (SD 2,42; p=0,001). Älypuhelinsovellusta käytettiin aktiivisesti, mutta käytössä oli vaihtelua. Ateriakuvia ladattiin yhteensä intervention aikana sovellukseen 4114 kappaletta (ka 158,2; SD 62,6), eli keskimäärin 5,7 ateriakuvaa päivässä osallistujaa kohden. Tykkäyksiä annettiin yhteensä 7580, (ka 291,5; SD 368 osallistujaa kohden), eli keskimäärin 10,5 tykkäystä päivässä osallistujaa kohden. Sovellukseen kirjauduttiin yhteensä 6921 kertaa (ka 266,2; SD 123,6 osallistujaa kohden), mikä tarkoittaa 9,5 kertaa päivässä osallistujaa kohden. Sovelluksen käyttöaktiivisuus tai koettu sosiaalinen tuki ei ollut yhteydessä ruoankäytön tai painon muutoksiin. Osallistujista 84 % koki kuitenkin saaneensa tukea muilta ryhmän jäseniltä. Johtopäätökset: Mobiiliteknologian välityksellä tapahtuvan ohjauksen avulla voidaan saavuttaa muutoksia ruoankäytössä ja edistää painonpudotusta. Jatkossa painonpudotukseen ja elintapamuutoksiin tähtäävien interventioiden tulisi olla pidempikestoisia ja näyttöä tarvitaan mobiiliteknologian tehokkuudesta pitkäaikaisessa painonhallinnassa. Sosiaalinen tuki ei tässä tutkimuksessa ollut yhteydessä syömis- ja painomuutoksiin, mutta kontrolliryhmän avulla saataisiin lisätietoa siitä, minkälaisiin tuloksiin päästään sovelluksen avulla yksilöohjauksella, verrattuna ryhmäominaisuuden sisältävään ohjaukseen.
  • Asare, Kennedy Opoku; Terhorst, Yannik; Vega, Julio; Peltonen, Ella; Lagerspetz, Eemil; Ferreira, Denzil (2021)
    Background: Depression is a prevalent mental health challenge. Current depression assessment methods using self-reported and clinician-administered questionnaires have limitations. Instrumenting smartphones to passively and continuously collect moment-by-moment data sets to quantify human behaviors has the potential to augment current depression assessment methods for early diagnosis, scalable, and longitudinal monitoring of depression. Objective: The objective of this study was to investigate the feasibility of predicting depression with human behaviors quantified from smartphone data sets, and to identify behaviors that can influence depression. Methods: Smartphone data sets and self-reported 8-item Patient Health Questionnaire (PHQ-8) depression assessments were collected from 629 participants in an exploratory longitudinal study over an average of 22.1 days (SD 17.90; range 8-86). We quantified 22 regularity, entropy, and SD behavioral markers from the smartphone data. We explored the relationship between the behavioral features and depression using correlation and bivariate linear mixed models (LMMs). We leveraged 5 supervised machine learning (ML) algorithms with hyperparameter optimization, nested cross-validation, and imbalanced data handling to predict depression. Finally, with the permutation importance method, we identified influential behavioral markers in predicting depression. Results: Of the 629 participants from at least 56 countries, 69 (10.97%) were females, 546 (86.8%) were males, and 14 (2.2%) were nonbinary. Participants' age distribution is as follows: 73/629 (11.6%) were aged between 18 and 24, 204/629 (32.4%) were aged between 25 and 34, 156/629 (24.8%) were aged between 35 and 44, 166/629 (26.4%) were aged between 45 and 64, and 30/629 (4.8%) were aged 65 years and over. Of the 1374 PHQ-8 assessments, 1143 (83.19%) responses were nondepressed scores (PHQ-8 score = 10), as identified based on PHQ-8 cut-off. A significant positive Pearson correlation was found between screen status-normalized entropy and depression (r=0.14, P Conclusions: Our findings demonstrate that behavioral markers indicative of depression can be unobtrusively identified from smartphone sensors' data. Traditional assessment of depression can be augmented with behavioral markers from smartphones for depression diagnosis and monitoring.
  • Strömberg, Lisbeth (Helsingin yliopisto, 2020)
    Gestational diabetes mellitus (GDM) is a condition of glucose intolerance with onset or first recognition during pregnancy, and it poses multiple health risks for both the mother and the child. The prevalence of GDM is increasing globally and effective interventions are needed to reduce the associated risks. Mobile health (mHealth) solutions have a great potential in answering this need since they are cost-effective and able to reach large groups of people. mHealth solutions might be especially effective for management of chronic conditions that require patient behavior change. Investigating intervention acceptability has an important part in the process of developing successful interventions. The aim of this thesis is to investigate the prospective acceptability of an mHealth intervention for GDM from the perspective of its potential recipients. The thesis also seeks to find out whether there are any associations between technological experience and perceptions of intervention acceptability as well as ways in which the intervention acceptability could be improved. The thesis utilizes data collected in the first phase of the eMOM GDM study, a research project with the aim of developing an mHealth intervention to support the self-management of GDM. The application acceptability was studied with semi-structured interviews with 10 women currently diagnosed with GDM. Previous technological experience was self-reported by the participants in a background questionnaire. Theory-driven content analysis was used to analyze the interviews. The results show that the intervention has high prospective acceptability from the perspective of the potential participants. For most of the domains of acceptability there is still room for improvement, and several ideas for further improving the intervention’s acceptability are discussed. The results could also indicate a possible relationship between technological experience and mHealth intervention acceptability. This thesis contributes to the development of an intervention by providing insight on the factors influencing intervention acceptability and ideas on how to improve it. The results also provide valuable information for developing future mHealth solutions for GDM. The potential association between technological experience and intervention acceptability are interesting regarding all mHealth intervention development and should be studied further.
  • Gluschkoff, Tanja (Helsingin yliopisto, 2020)
    Digitalization is part of a cultural change that can change people’s attitudes towards food and eating habits. Over the past decade the use of various mobile applications has increased both in people’s daily lives and in scientific research. However, from the health promotion perspective the previous studies have found that health and nutrition related mobile applications are not being used or evaluated in a versatile manner. This study examines the experiences of people who participated in a nutrition intervention at the City of Helsinki's health centers. The study examines participants’ experiences of using a MealLogger-application, its significance for the participants' food relationship and the changes experienced in their own food relationship. MealLogger is a digital food diary. The duration of the intervention was three months. It included group counseling by a nutritionist, weekly challenges and three meetings with the group. During the intervention participants actively used a digital food diary and photographed all the meals and snacks they ate during the day. The study uses a qualitative research approach. The theoretical framework of the thesis is based on the food relationship approach, including the dimensions of thoughts, emotions, senses, behavior and values. The research material consists of twenty thematic interviews. The study material was analyzed using thematic analysis and typification. Participants perceived the use of a digital food diary as positive and as a useful tool. The study identified two types of user experiences relating to the use of phone application: social and independent usage. Changes in eating habits were described in terms of developing a regular meal rhythm, reduction in portion size and reduction or substitution of certain foods, such as junk food or candy. The types of food relationships identified were based on values, behavior, emotions or information. Participants described the changes in food relationship as relationship becoming more relaxed or coherent. Some participants described having a more positive attitude towards a healthy diet. Some participants described not experiencing any changes in their relationship with food after using the digital food diary.
  • Järvelä-Reijonen, Elina; Karhunen, Leila; Sairanen, Essi; Muotka, Joona; Lindroos, Sanni; Laitinen, Jaana; Puttonen, Sampsa; Peuhkuri, Katri; Hallikainen, Maarit; Pihlajamaki, Jussi; Korpela, Riitta; Ermes, Miikka; Lappalainen, Raimo; Kolehmainen, Marjukka (2018)
    Background: Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects. Methods: Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants' (n = 219, 85% females) mean body mass index was 31.3 kg/m(2) (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups. Results: Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT- based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures. Conclusions: ACT- based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted. (Continued on next page)
  • Järvelä-Reijonen, Elina; Karhunen, Leila; Sairanen, Essi; Muotka, Joona; Lindroos, Sanni; Laitinen, Jaana; Puttonen, Sampsa; Peuhkuri, Katri; Hallikainen, Maarit; Pihlajamäki, Jussi; Korpela, Riitta; Ermes, Miikka; Lappalainen, Raimo; Kolehmainen, Marjukka (BioMed Central, 2018)
    Abstract Background Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects. Methods Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants’ (n = 219, 85% females) mean body mass index was 31.3 kg/m2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups. Results Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures. Conclusions ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted. Trial registration ClinicalTrials.gov ( NCT01738256 ), registered 17 August, 2012.
  • Bousquet, J.; Devillier, P.; Arnavielhe, S.; Bedbrook, A.; Alexis-Alexandre, G.; van Eerd, M.; Murray, R.; Canonica, G. W.; Illario, M.; Menditto, E.; Passalacqua, G.; Stellato, C.; Triggiani, M.; Carreiro-Martins, P.; Fonseca, J.; Morais Almeida, M.; Nogueira-Silva, L.; Pereira, A. M.; Todo Bom, A.; Bosse, I.; Caimmi, D.; Demoly, P.; Fontaine, J. F.; Just, J.; Onorato, G. L.; Kowalski, M. L.; Kuna, P.; Samolinski, B.; Anto, J. M.; Mullol, J.; Valero, A.; Tomazic, P. V.; Bergmann, K. C.; Keil, T.; Klimek, L.; Moesges, R.; Shamai, S.; Zuberbier, T.; Murphy, E.; McDowall, P.; Price, D.; Ryan, D.; Sheikh, A.; Chavannes, N. H.; Fokkens, W. J.; Kvedariene, V.; Valiulis, A.; Bachert, C.; Hellings, P. W.; Kull, I.; Melen, E.; Wickman, M.; Bindslev-Jensen, C.; Eller, E.; Haahtela, T.; Papadopoulos, N. G.; Annesi-Maesano, I.; Bewick, M.; Bosnic-Anticevich, S.; Cruz, A. A.; De Vries, G.; Gemicioglu, B.; Larenas-Linnemann, D.; Laune, D.; Mathieu-Dupas, E.; O'Hehir, R. E.; Pfaar, O.; Portejoie, F.; Siroux, V.; Spranger, O.; Valovirta, E.; VandenPlas, O.; Yorgancioglu, A. (2018)
    BackgroundLarge observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect real-world everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology. MethodsA mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries. ResultsA total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control). ConclusionsThis study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses.