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Journal Description

i-JMR is a general medical journal with a focus on innovation in health, health care, and medicine - through new medical techniques and innovative ideas and/or research, including—but not limited to—technology, clinical informatics, sociotechnical and organizational health care innovations, or groundbreaking research.

Published by JMIR Publications, publisher of JMIR, the leading eHealth/mHealth journal (Impact Factor 2017: 4.671), i-JMR is a JMIR "sister journal" with a projected impact factor of about 2.03 (2016) which features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.

i-JMR is indexed in PubMed and archived in PubMed Central.

i-JMR is also indexed in Clarivate Analytics (formerly the IP and Science Division of Thomson Reuters) new Emerging Sources Citation Index (ESCI).


Recent Articles:

  • Online search for diet recommendations. Source: Flickr; Copyright:; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations


    Background: There is currently no scientific evidence supporting the use of specific diets in the management of multiple sclerosis (MS); the strongest dietary associations are observed with vitamin D and omega-3 fatty acid supplementation. Despite this, there are many websites that provide advice or suggestions about using various dietary approaches to control symptoms or disease progression. Objective: The objective of this study was to assess the dietary advice for the symptomatic management of MS available on the internet. Methods: This study was a systematic review of webpages that provided dietary advice for the management of MS. Webpages were selected from an internet search conducted in November 2016 using Google, Yahoo, and Bing search engines and the search term “MS diet.” The first two pages of results from each search engine were included for the initial assessment. Duplicates were removed. Data extracted from websites included specific advice relating to diet and its rationale and the citation of supporting scientific literature. Authorship and credential information were reviewed to assess webpage quality. Results: We included 32 webpages in the final assessment. The webpages made a wide variety of specific recommendations regarding dietary patterns and individual foods to help manage MS. The most common dietary pattern advised on these webpages was the low-fat, high-fiber balanced diet, followed by the low-saturated fat diet, near-vegetarian Swank diet, and the Paleo diet. The main categories of individual foods or nutrients suggested for addition to the diet were: supplements (especially omega-3 and vitamin D), fruits, vegetables, and lean protein. In contrast, the most commonly recommended for removal were saturated fats, dairy, gluten-containing grains, and refined sugar. These recommendations were often accompanied by rationale relating to how the particular food or nutrient may affect the development, prevalence and symptoms of MS; however, very little of this information is supported by the current scientific evidence between diet and MS. Only 9 webpages provided full authorship including credential information. Conclusions: There is a wide variety of Web-based dietary advice, which in some cases is contradictory. In most cases, this advice is the result of peoples’ individual experiences and has not been scientifically tested. How people living with MS use this information is not known. These findings highlight the important role health professionals can play in assisting people living with MS in their health information-seeking behaviors.

  • Source: Adobe Stock; Copyright: gumpapa; URL:; License: Licensed by the authors.

    A Platform to Record Patient Events During Physiological Monitoring With Wearable Sensors: Proof-of-Concept Study


    Background: Patient journals have been used as valuable resources in clinical studies. However, the full potential value of such journals can be undermined by inefficiencies and ambiguities associated with handwritten patient reports. The increasing number of mobile phones and mobile-based health care approaches presents an opportunity to improve communications from patients to clinicians and clinical researchers through the use of digital patient journals. Objective: The objective of this project was to develop a smartphone-based platform that would enable patients to record events and symptoms on the same timeline as clinical data collected by wearable sensors. Methods: This platform consists of two major components: a smartphone for patients to record their journals and wireless sensors for clinical data collection. The clinical data and patient records are then exported to a clinical researcher interface, and the data and journal are processed and combined into a single time-series graph for analysis. This paper gives a block diagram of the platform’s principal components and compares its features to those of other methods but does not explicitly discuss the process of design or development of the system. Results: As a proof of concept, body temperature data were obtained in a 4-hour span from a 22-year-old male, during which the subject simultaneously recorded relevant activities and events using the iPhone platform. After export to a clinical researcher’s desktop, the digital records and temperature data were processed and fused into a single time-series graph. The events were filtered based on specific keywords to facilitate data analysis. Conclusions: We have developed a user-friendly patient journal platform, based on widely available smartphone technology, that gives clinicians and researchers a simple method to track and analyze patient activities and record the activities on a shared timeline with clinical data from wearable devices.

  • Source: Pixabay; Copyright: edar; URL:; License: Public Domain (CC0).

    Views of People With Epilepsy About Web-Based Self-Presentation: A Qualitative Study


    Background: Web-based media, particularly social networking sites (SNSs), are a source of support for people with long-term conditions, like epilepsy. Living with epilepsy can reduce opportunities for accessing information and social support owing to transportation difficulties and stigma leading to self-isolation. However, some people with epilepsy (PWE) overcome these barriers using SNSs and other Web-based media. At present, little is known about Web-based identity and self-presentation of PWE; this study aims to address this gap. Objective: This study aims to describe how the use of digital technologies, such as SNSs, impacts sense of identity in PWE. Methods: We used qualitative research methods to examine Web-based media use and self-presentation in a group of 14 PWE (age range: 33-73 years; 7 men and 7 women). The median diagnosis duration was 25 years. Semistructured interviews ranged from 40 to 120 minutes, held at participants’ homes or in a public place of their choice, in the United Kingdom. QSR Nvivo 11 software was used to perform an inductive thematic analysis. Results: In this study, 9 participants used Web-based media to “silently” learn from other PWE by reading user posts on SNSs and epilepsy-related forums. When asked about self-presentation, 7 participants described feeling cautious about disclosing their epilepsy to others online. Six participants presented themselves in the same manner irrespective of the situation and described their identity as being presented in the same way both online and offline. Conclusions: PWE can deploy SNSs and Web-based media to manage aspects of their condition by learning from others and obtaining social support that may otherwise be difficult to access. Some PWE share openly, whereas others silently observe, without posting. Both benefit from the shared experiences of others. Privacy concerns and stigma can act as a barrier to sharing using Web-based media and SNSs. For some, Web-based media offers a chance to experiment with identity and change self-presentation, leading to gradually “coming out” and feeling more comfortable discussing epilepsy with others.

  • Health-related video on YouTube (montage). Source: YouTube / Placeit; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Investigating the Role of Communication for Information Seekers’ Trust-Related Evaluations of Health Videos on the Web: Content Analysis, Survey Data, and...


    Background: According to the language expectancy theory and the communication accommodation theory, health information seekers’ trust evaluations of Web-based videos are determined by interplays between content and seekers’ expectations on vloggers’ appropriate language use in specific contexts of Web-based communication. Objectives: Two investigations focused on differences both between vloggers’ language styles and between users’ general trust in specific Web-based platforms to investigate how the context of Web-based communication can be characterized (research question, RQ1). Thereafter, we investigated whether information uncertainty, vloggers’ language style, and context of Web-based communication affect seekers’ trust evaluations of videos (RQ2). Methods: With a content analysis of 36 health videos from YouTube and Vimeo, we examined the extent of trust-related linguistic characteristics (ie, first-person and second-person pronouns). Additionally, we surveyed participants (n=151) on their trust in YouTube and Moodle (academic Web-based platform; RQ1). In an experiment, further participants (n=124) watched a video about nutrition myths and were asked to evaluate the information credibility, vloggers’ trustworthiness, and accommodation of language by vloggers (RQ2). Following a 3 × 2 × 2 mixed design, vloggers’ explanations contained unambiguous (confirming or disconfirming) or ambiguous (neither confirming nor disconfirming) evidence on the myths (within factor). Furthermore, vloggers used YouTube-typical language (many first-person pronouns) or formal language (no first-person pronouns), and videos were presented on YouTube or Moodle (between factors). Results: The content analysis revealed that videos on YouTube contained more first-person pronouns than on Vimeo (F1,35=4.64; P=.04; ηp 2=0.12), but no more second-person pronouns (F1,35=1.23; P=.23). Furthermore, when asked about their trust in YouTube or Moodle, participants trusted YouTube more than Moodle (t150≤−9.63; all P≤.001). In the experiment, participants evaluated information to be more credible when information contained unambiguous rather than ambiguous evidence (F2,116=9.109; P<.001; ηp 2=0.14). Unexpectedly, information credibility did not depend on vloggers’ language style or the video platform (F1,117≤2.40; P≥.06). Likewise, video’s platform did not affect participants’ evaluations of vloggers’trustworthiness (F1,117<0.18; P>.34). However, participants judged vloggers who used a YouTube-typical language as being more benevolent, and their language use as being more appropriate in both video platforms (F1,117≥3.41; P≤.03; ηp 2≥0.028). Moreover, participants rated the YouTube-typical (vs formal) language as more appropriate for Moodle, but they did not rate one or the other language style as more appropriate for YouTube (F1,117=5.40; P=.01; ηp 2=0.04). Conclusions: This study shows that among specific Web-based contexts, users’ typical language use can differ, as can their trust-related evaluations. In addition, health information seekers seem to be affected by providers’ language styles in ways that depend on the Web-based communication context. Accordingly, further investigations that would identify concrete interplays between language style and communication context might help providers to understand whether additional information would help or hurt seekers’ ability to accurately evaluate information.

  • Source: Freepik; Copyright: Bearfotos; URL:; License: Licensed by JMIR.

    Body Mass Index Screening and Follow-Up: A Cross-Sectional Questionnaire Study of Pennsylvania School Nurses


    Background: Childhood overweight and obesity health concerns can affect a student’s academic performance, so it is important to identify resources for school nurses that would help to improve self-efficacy, knowledge, and confidence when approaching parents with sensitive weight-related information and influence overall obesity prevention efforts in the school setting. Objective: The purpose of this study was to conduct a Pennsylvania (PA) state-wide 29-item survey addressing school nursing barriers and practices, supplementing information already known in this area. Although the survey covered a range of topics, the focus was body mass index (BMI) screening and its related practice within the schools. Methods: We conducted a state-wide Web-based survey of school nurses in PA to understand current areas of care, find ways to address child health through school BMI screenings and follow up, and identify current educational gaps to assist school nurses with providing whole child care within the realm of weight management. Chi-square test of independence was conducted to determine the relationship between BMI screening follow up and interest in a BMI toolkit. Results: Nurse participants (N=210), with a 42% (210/500) response rate, represented 208 school districts across PA. Participants were asked about their current process for notifying parents of BMI screening results. The majority (116/210, 55.2%) send a letter home in the mail, while others (62/210, 29.5%) send a letter home with students. A small number (8/210, 3.8%) said they did not notify parents altogether, and some (39/210, 18.6%) notify parents electronically. More than one-third (75/210, 35.7%) of nurses reported receiving BMI screening inquiries from parents; however, under half (35/75, 46.7%) of those respondents indicated they follow up with parents whose child screens overweight or obese. Overall, the vast majority (182/210, 86.7%) do not follow up with parents whose child screens overweight or obese. The majority (150/210, 71.4%) of the nurses responded they would benefit from a toolkit with resources to assist with communication with parents and children about BMI screenings. A significant association between respondent follow up and interest in a BMI toolkit was observed (P=.01). Conclusions: Schools must start recognizing the role school nurses play to monitor and promote children’s health. This goal might include involving them in school-based preventive programs, empowering them to lead initiatives that support whole child health and ensuring opportunities for professional development of interest to them. Nonetheless, the first step in facilitating obesity prevention methods within schools is to provide school nurses with meaningful tools that help facilitate conversations with parents, guardians, and caregivers regarding their child’s weight status and health through a BMI screening toolkit.

  • Source: Flickr; Copyright: Dr Partha Sarathi Sahana; URL:; License: Creative Commons Attribution (CC-BY).

    Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility...


    Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID). Objective: We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality. Methods: We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care. Results: The baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service. Conclusions: With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion.

  • Source: Flickr; Copyright: Obra Shalom Campo Grande; URL:; License: Creative Commons Attribution + NoDerivatives (CC-BY-ND).

    Extrahepatic Autoimmune Diseases are Prevalent in Autoimmune Hepatitis Patients and Their First-Degree Relatives: Survey Study


    Background: Concurrent autoimmune illnesses contribute to increased medical burden and reduced quality of life in patients with autoimmune hepatitis (AIH). The frequency of coexisting autoimmune conditions among North American patients with AIH and their families remains incomplete. Challenges associated with disease capture in the electronic medical record, high study costs, and geographic spread of patients are formidable barriers to understanding the extent of concurrent autoimmune conditions in these groups. Objective: This objective of this study was to examine the frequency of extrahepatic autoimmune diseases (EHAD) among AIH cases and healthy controls as well as their first-degree relatives using social networking sites (SNS). Methods: We developed a 53-question survey detailing the history of autoimmune diseases. A survey link was posted at routine intervals within specific Web-based cohorts on SNS. Healthy controls, without self-reported autoimmune liver disease, were recruited from Amazon’s Mechanical Turk. Continuous variables were summarized using medians and P values obtained with the Wilcoxon rank-sum test. Categorical variables were compared using the chi-square test. Results: Compared with controls (n=1162), cases (n=306) were more likely to be older (median age: 49 vs 33 years), female (284/306, 92.81% vs 955/1162, 82.18%), and have an EHAD (128/306, 41.83% vs 218/1162, 18.76%; P=.001). The most frequent EHADs among cases were thyroid disease (49/306, 16.01% ), Sjögren syndrome (27/306, 8.82%), Raynaud phenomenon (23/306, 7.52%), and psoriasis (22/306, 7.19%). Overall, 55.88% (171/306) of cases and 35.71% (1601/4484) of controls reported at least 1 first-degree relative (FDR) with a history of EHAD (P=.001). Cases had a significantly higher risk of EHAD than controls after the adjustment for age, sex, race, and body mass index: odds ratio 2.46 (95% CI 1.8-3.3); P=.001. Conclusions: Patients with AIH report higher prevalence of coexistent EHAD than healthy controls, and their FDRs are also more likely to have autoimmune disorders.

  • Person performing CPR on a dummy. Source: Pexels; Copyright:; URL:; License: Licensed by JMIR.

    Basic Life Support Knowledge Among a Nonmedical Population in Jeddah, Saudi Arabia: Cross-Sectional Study


    Background: Providing basic life support (BLS) at the site of an accident is crucial to increase the survival rates of the injured people. It is especially relevant when health care is far away. Objective: The aim of our study is to assess the BLS knowledge level of the Saudi Arabian population and identify influencing factors associated with level of knowledge about BLS. Methods: Our study is a cross-sectional descriptive study, which was conducted using a self-administered online questionnaire derived from the BLS practice test. The Saudi population was the target population. The questionnaire was divided into two parts: one contained demographic data and the second part contained questions to test the population’s perception about how to perform BLS techniques properly. The data were collected between July and August 2017. Statistically significant differences were defined as those with a P value <.05, and a score of five or more was considered a passing score on the second part. We used SPSS version 21 for data analysis. Results: Our study included 301 participants. Our participants’ BLS online exam scores ranged from 0 to 10, with a mean of 4.1 (SD 1.7). Only 39.2% (118/301) of the participants passed the test. The percentage of bachelor’s degree or higher holders constituted 60.1% (181/301) of the study population. In addition, higher income was significantly associated with higher scores on the test (P=.04). Conclusions: This study demonstrated that the theoretical knowledge level of BLS among the general population in Jeddah was below average. There is a critical need to increase the public’s exposure to BLS education through raising awareness campaigns and government-funded training programs that aim to curb the incidence of out-of-hospital cardiac arrest mortalities in the Saudi community.

  • Source: Shutterstock; Copyright:; URL:; License: Licensed by the authors.

    Calorie Estimation From Pictures of Food: Crowdsourcing Study


    Background: Software designed to accurately estimate food calories from still images could help users and health professionals identify dietary patterns and food choices associated with health and health risks more effectively. However, calorie estimation from images is difficult, and no publicly available software can do so accurately while minimizing the burden associated with data collection and analysis. Objective: The aim of this study was to determine the accuracy of crowdsourced annotations of calorie content in food images and to identify and quantify sources of bias and noise as a function of respondent characteristics and food qualities (eg, energy density). Methods: We invited adult social media users to provide calorie estimates for 20 food images (for which ground truth calorie data were known) using a custom-built webpage that administers an online quiz. The images were selected to provide a range of food types and energy density. Participants optionally provided age range, gender, and their height and weight. In addition, 5 nutrition experts provided annotations for the same data to form a basis of comparison. We examined estimated accuracy on the basis of expertise, demographic data, and food qualities using linear mixed-effects models with participant and image index as random variables. We also analyzed the advantage of aggregating nonexpert estimates. Results: A total of 2028 respondents agreed to participate in the study (males: 770/2028, 37.97%, mean body mass index: 27.5 kg/m2). Average accuracy was 5 out of 20 correct guesses, where “correct” was defined as a number within 20% of the ground truth. Even a small crowd of 10 individuals achieved an accuracy of 7, exceeding the average individual and expert annotator’s accuracy of 5. Women were more accurate than men (P<.001), and younger people were more accurate than older people (P<.001). The calorie content of energy-dense foods was overestimated (P=.02). Participants performed worse when images contained reference objects, such as credit cards, for scale (P=.01). Conclusions: Our findings provide new information about how calories are estimated from food images, which can inform the design of related software and analyses.

  • Source: Radboud Annals of Medical Students; Copyright: Julia ten Elzen; URL:; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

    Importance and Presence of High-Quality Evidence for Clinical Decisions in Neurosurgery: International Survey of Neurosurgeons


    Background: The publication rate of neurosurgical guidelines has increased tremendously over the past decade; however, only a small proportion of clinical decisions appear to be based on high-quality evidence. Objective: The aim was to evaluate the evidence available within neurosurgery and its value within clinical practice according to neurosurgeons. Methods: A Web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. Results: The response rate to the survey was 6.78% (173/2552). According to 48.6% (84/173) of the respondents, neurosurgery clinical practices are based on less evidence than other medical specialties and not enough high-quality evidence is available; however, 84.4% (146/173) of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59.0% (102/173) considered the neurosurgical guidelines in their hospital to be based on high-quality evidence, most of whom considered their own treatments to be based on high-quality (level I and/or level II) data (84.3%, 86/102; significantly more than for the neurosurgeons who did not consider the hospital guidelines to be based on high-quality evidence: 55%, 12/22; P<.001). Also, more neurosurgeons with formal training believed they could understand, criticize, and interpret statistical outcomes presented in journals than those without formal training (93%, 56/60 and 68%, 57/84 respectively; P<.001). Conclusions: According to the respondents, neurosurgery is based on high-quality evidence less often than other medical specialties. The results of the survey indicate that formal training in evidence-based medicine would enable neurosurgeons to better understand, criticize, and interpret statistical outcomes presented in journals.

  • A person reading an article about yoga. Source: Wikimedia Commons /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    Characterizing Websites That Provide Information About Complementary and Integrative Health: Systematic Search and Evaluation of Five Domains


    Background: In recent years, there has been an increase in the utilization of complementary and integrative health (CIH) care, and an increase in information-seeking behavior focused on CIH. Thus, understanding the quality of CIH information that is available on the internet is imperative. Although there have been a limited number of studies evaluating the quality of websites providing information about specific CIH-related topics, a broad evaluation of CIH websites has not been conducted. Objective: This study was designed to fill that gap. We set out to assess website quality in 5 CIH domains: (1) acupuncture, (2) homeopathy, (3) massage, (4) reiki, and (5) yoga. This study aimed to 1) characterize the websites by type and quality; 2) evaluate website characteristics which may affect readers’ perceptions, specifically message content, structural features, and presentation style, and 3) investigate the extent to which harms, benefits and purposes of use are stated on websites. Methods: This study employed a systematic search strategy to identify websites in each of the target domains to be evaluated. The websites were then classified by type, and a set of checklists focusing on quality, message content, structural features, and presentation style was used to evaluate the websites. Lastly, we performed content analysis to identify harms, benefits, and perceived purposes of use. Results: There were similarities across domains regarding their overall quality and their message content. Across all domains, a high proportion of websites received strong scores in terms of ownership, currency, interactivity and navigability. Scores were more variable concerning authorship, balanced presentation of information and the use of sources of information. However, there were differences regarding their structural features and presentation style. Acupuncture and reiki sites tended to include more external links, and yoga, fewer. There was variation across domains in the extent to which the websites contained domain-specific terminology. Websites tended to provide an extensive list of potential benefits, while reporting of harms was scarce. Conclusions: This is the first study to perform a multidimensional assessment of websites in multiple CIH domains. This review showed that while there are similarities among websites of different CIH domains, there are also differences. The diverse distribution of website types suggests that, regardless of CIH domain, the public encounters information through many different types of media, and it would be useful to consider how the presentation of this content may differ depending on the medium. The characteristics for which variability exist are areas that warrant greater attention from researchers, policy makers, clinicians and patients. There is also a need to better understand how individuals may interact with CIH websites, and to develop tools to assist people to interpret the CIH-related information that they encounter.

  • Source: Image created by the Authors; Copyright: Karen Day; URL:; License: Licensed by the authors.

    Arthritis-Related Support in a Social Media Group for Quilting Hobbyists: Qualitative Study


    Background: People with arthritis are increasingly seeking support online, particularly for information about social role participation while experiencing symptoms of chronic arthritis. Social media enables peer-to-peer support on how serious leisure (eg, hobbies such as quilting) can be adapted to allow participation. Research is needed to understand what type of peer support is provided online and how this support occurs. Objective: The aim of our study was to explore what kind of support is offered by fellow hobbyists (with or without arthritis) in response to requests for advice in a social media group. Methods: Three vignettes were posted on a Facebook quilting group regarding arthritis-related symptoms or impairments that affect how people quilt. A Facebook Insights report was used to examine the groups’ demographics. Responses to the vignettes were thematically analyzed. Results: The members of the quilting Facebook group were mostly women (18,376/18,478, 99.45%), aged 55 to 64 years, and most were located in the United States. In response to the vignettes, the 22 participants predominantly offered emotional support and shared information. Participants shared their real-life experiences and creative means in adapting medical advice to their crafting. More than half (30/54, 56%) of the advice that was offered aligned with the OrthoInfo medical best practice guidelines relevant to the vignettes. Conclusions: Serious leisure social media groups can be useful forums for sharing information about arthritis-related issues. People do respond to requests for support and information, although there is a difference between quilting support (eg, “I need a new iron, what should I buy?”) and health support (eg, “I have arthritis, what scissors should I buy?”). People provide emotional support for life events on serious leisure social media platforms (eg, offering condolences when a person states that she is making a memory quilt), and this extends to health issues when group members reveal them.

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  • Perceived Treatment Satisfaction and Effectiveness Facilitators Among Patients With Chronic Health Conditions: A Self-Reported Survey

    Date Submitted: Dec 31, 2018

    Open Peer Review Period: Jan 1, 2019 - Feb 26, 2019

    Background: Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to better adherence. However, how patients pe...

    Background: Approximately 50% of patients are nonadherent to prescribed medications. Patient perception regarding medication effectiveness has been linked to better adherence. However, how patients perceive effectiveness is poorly understood. Objective: We aimed to elucidate factors associated with perceived treatment satisfaction and effectiveness among patients with chronic health conditions. Methods: We conducted an online survey of participants with migraine, multiple sclerosis (MS), or rheumatoid arthritis (RA). Descriptive statistics, correlations, and comparison tests were used to examine outcomes. Results: Data were collected from 1,820 patients: 567 with migraine, 717 with MS, and 536 with RA. The majority of participants were female (90.9%), >40 years old (79.9%), and diagnosed >5 years ago (65.2%). Treatment satisfaction and perceived medication effectiveness were highly correlated (r = 0.90, P < .0001). Three temporal factors were positively correlated with satisfaction and perceived effectiveness: time on current medication (satisfaction rs = 0.22, P < .0001; effectiveness rs = 0.25, P < .0001); time since diagnosis (satisfaction rs = 0.07, P = .004; effectiveness rs = 0.09, P =.0003); and time on treatment (effectiveness rs = 0.08, P = .002). Conclusions: Findings validated the strong relationship between treatment satisfaction and perceived effectiveness. Understanding the (1) positive relationship between “time” and treatment satisfaction and effectiveness and (2) factors associated with determining medication effectiveness can help clinicians better understand the mindset of patients in regard to treatment. Clinicians may be better prepared to elicit patient beliefs, which influence adherence to medication for people diagnosed with chronic health conditions.

  • The Use of Wireless, Smartphone Application-Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: A Pilot Randomized Controlled Trial

    Date Submitted: Dec 15, 2018

    Open Peer Review Period: Dec 18, 2018 - Feb 12, 2019

    Background: Reliable home blood pressure monitoring (HBPM) is essential to effective hypertension management, however manual recording is subject to under-reporting and inaccuracies. Mobile-health tec...

    Background: Reliable home blood pressure monitoring (HBPM) is essential to effective hypertension management, however manual recording is subject to under-reporting and inaccuracies. Mobile-health technologies hold great potential as HBPM tools, but fidelity of smartphone application (app) in HBPM has not been adequately assessed. Objective: The primary aim of the trial was to compare the fidelity of the smartphone app to that of a handwritten logbook in making HBPM data available to clinicians at follow-up visits. Fidelity was defined as the percentage of scheduled BP recordings over a 3-week period that were properly recorded and reported to the clinic. The secondary aims were to investigate patient factors associated with HBPM fidelity and to determine the effect of monitoring duration on fidelity. Methods: A two-arm, parallel, unblinded, randomized controlled pilot trial was conducted in a government polyclinic in Singapore. Hypertensive adults, ages 40-70 years who were on antihypertensive medication and owned a smartphone were recruited from clinic and randomized by a computer-generated randomization schedule to 3 weeks of HBPM using either a semi-automated process utilizing Bluetooth®-enabled BP monitor and a smartphone app or a fully-manual process utilizing a conventional handwritten logbook. The primary outcome was home BP recording fidelity. Results: Of the 80 patients randomized, 79 (Smartphone app, 38; Logbook, 41) were included in the final analysis. Although home BP recording fidelity was higher in the Smartphone app group, it did not differ significantly between study arms (Smartphone app, 66.7%; Logbook, 52.4%; P=.22). Chinese and Indian ethnicities were associated with higher fidelity (95% CI) by 35.6 (4.27, 66.9) and 45.0 (8.69, 81.3) points, respectively, in comparison to other ethnicities (P=.03); longer smartphone use increased fidelity on average 10.5 (0.83, 20.2) points per year of use (P=.03); number of apps on smartphone decreased fidelity at a rate of -0.32 (-0.58, -0.05) per app (P=.02); years of hypertension morbidity increased fidelity at a rate of 1.56 (0.03, 3.09) per year (P=.046); and the number of people working in the household decreased fidelity at a rate of -8.18 (-16.3, -0.08) points per additional working person (P=.048). The fidelity of the app was significantly higher in the first week (64.4%) compared to the second (55.1%, P=.001) and third (58.2%, P=.03) weeks of monitoring. Conclusions: Amidst the increasing integration of health technologies into clinical practice, our study demonstrates the feasibility of smartphone app-assisted HBPM in hypertensive adults in the multi-ethnic population of Singapore. Our pilot study found no significant difference in mean BP recording fidelity between a smartphone app and a conventional hand-written logbook. However, the small sample size precludes definitive conclusions and highlights the need for a larger, adequately powered trial. Clinical Trial: NCT03209024

  • Traumatic Retropharyngeal Abscess of Insidious Onset -a case report and literature review

    Date Submitted: Nov 25, 2018

    Open Peer Review Period: Dec 3, 2018 - Jan 28, 2019

    Retropharyngeal abscess is an abscess of the deep spaces in the neck which if not treated urgently can be life-threatening as a result of airway compromise. It is important to detect and treat very ea...

    Retropharyngeal abscess is an abscess of the deep spaces in the neck which if not treated urgently can be life-threatening as a result of airway compromise. It is important to detect and treat very early. It may arise in pediatrics from direct neck trauma which is not very common and fishbone impaction. Direct anterior neck trauma resulting in insidious retropharyngeal abscess has not been widely reported.