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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:

  • Source: Flickr; Copyright: Army Medicine; URL: https://www.flickr.com/photos/armymedicine/8616603578; License: Creative Commons Attribution (CC-BY).

    Orthopedic Surgeons’ Perspectives on the Decision-Making Process for the Use of Bioprinter Cartilage Grafts: Web-Based Survey

    Abstract:

    Background: Traumatic and degenerative lesions in the cartilage are one of the most difficult and frustrating types of injuries for orthopedic surgeons and patients. Future developments in medical science, regenerative medicine, and materials science may allow the repair of human body parts using 3D bioprinting techniques and serve as a basis for new therapies for tissue and organ regeneration. One future possibility is the treatment of joint cartilage defects with in vivo 3D printing from biological/biocompatible materials to produce a suitable cell attachment and proliferation environment in the damaged site and employ the natural recovery potential of the body. This study focuses on the perspectives of orthopedic surgeons regarding the key factors/determinants and perceived clinical value of a new therapeutic option. Objective: This study aimed to determine the knowledge and expectations of orthopedic surgeons regarding the clinical use of bioprinted cartilage. Methods: The survey, conducted anonymously and self-managed, was sent to orthopedic surgeons from the Catalan Society of Orthopedic and Traumatology Surgery. In accordance with the method devised by Eysenbach, the Checklist for Reporting Results of Internet E-Surveys was used to analyze the results. The following factors were taken into consideration: the type and origin of the information received; its relevance; the level of acceptance of new technologies; and how the technology is related to age, years, and place of experience in the field. Results: Of the 86 orthopedic surgeons included, 36 believed the age of the patient was a restriction, 53 believed the size of the lesion should be between 1 and 2 cm to be considered for this type of technology, and 51 believed that the graft should last more than 5 years. Surgeons over 50 years of age (38/86, 44%) gave more importance to clinical evidence as compared to surgeons from the other age groups. Conclusions: The perspective of orthopedic surgeons depends highly on the information they receive and whether it is specialized and consistent, as this will condition their acceptance and implementation of the bioprinted cartilage.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://www.i-jmr.org/2019/2/e12664/; License: Creative Commons Attribution (CC-BY).

    EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases

    Abstract:

    Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/attractive-young-woman-using-spray-treat-sore-throat_3590147.htm; License: Licensed by JMIR.

    Clinical Impact of a Digital Dose Counter Pressurized Metered-Dose Inhaler on Uncontrolled Asthma: Cross-Sectional, Observational, Surveillance Study

    Abstract:

    Background: In India, control of asthma with persistent symptoms remains a clinical enigma with likely incriminating factors including non- and pseudoadherence to the inhaled corticosteroids and long-acting beta2-agonists. The United States Food and Drug Administration guidance recommends the use of dose counter pressurized metered-dose inhalers (pMDIs) with further mechanisms to track adherence and pseudoadherence in real-world settings. Objective: Digital dose counter pMDIs (dpMDIs) offer simplified, reliable tracking of individual “actuated” dosages with “END” display at completion of the labelled therapeutic aerosol spray. The translational impact on symptom persistence with likely unwarranted exposure to the “Step up” strategy is often prevented if not treated, as in the cases of “pseudo” severe asthma. To further assess the real-world acceptance and clinical impact of dpMDIs in bronchial asthma including poorly controlled or uncontrolled bronchial asthma cases, a noninterventional observational study was performed. Methods: This cross-sectional, retrospective, case cohort, observational study—the Drug Utilization Surveillance—of dpMDIs in bronchial asthma was conducted in September 2016 in an outpatient setting in India. The retrospective analysis was initiated and conducted as per the International Conference on Harmonization Good Clinical Practice principles and Declaration of Helsinki, following approval from the local ethics committee and registration in the Clinical Trial Registry of India. Results: Consecutive cases of moderate-to-severe asthma with poor control (n=4575), diagnosed as per the Global Initiative for Asthma symptom scale at baseline and follow-up, were included. Patients under treatment using dpMDIs were enrolled from 500 centers across India and assessed by respiratory care specialists. Baseline asthma control was assessed as partly controlled (n=4575) or poorly controlled (n=2942). Per protocol analyses showed that asthma was well controlled with dpMDIs at 8 weeks in 92.7% of the cases (2727/2942, P<.001). Adverse events (n=106, 2%) of mild-to-moderate intensity were reported. Nebulization was required in two patients with episodic breathlessness who were discharged with no consequent sequelae. Post hoc analyses for patients with baseline poorly controlled asthma who “switched” exclusively to dpMDI monotherapy or a combination with xanthines or long-acting beta2-agonists showed a “well controlled” asthma status in 85.9% (500/582, P=.04), 95.4% (395/414, P=.048), and 80.3% (106/132, P=.28) of the cases, respectively. The patient acceptability criteria for an “empty” canister was well correlated with the clinical strategy to identify and avoid pseudoadherence in poorly controlled or difficult-to-treat asthma cases, especially in patients who “switched” exclusively to dpMDIs (n=582) and demonstrated responses of “Use till twenty dose display” (65/156, 41.6%), “Use till END display” (83/156, 53.2%), and “Use till LAST spray” (8/156, 5.1%). Conclusions: dpMDIs offer simple, accurate, and reliable tracking of non- and pseudoadherence while highlighting incremental asthma-control rates in severe and pseudosevere asthma cases before risk assessment for further “add-on” therapy Trial Registration: Clinical Trials Registry - India CTRI/2018/06/014595; http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php? trialid=24583

  • Source: Flickr; Copyright: UC Davis College of Engineering Follow; URL: https://www.flickr.com/photos/ucdaviscoe/43141312700/in/album-72157673882491418/; License: Creative Commons Attribution (CC-BY).

    Artificial Intelligence in Clinical Health Care Applications: Viewpoint

    Abstract:

    The idea of artificial intelligence (AI) has a long history. It turned out, however, that reaching intelligence at human levels is more complicated than originally anticipated. Currently, we are experiencing a renewed interest in AI, fueled by an enormous increase in computing power and an even larger increase in data, in combination with improved AI technologies like deep learning. Healthcare is considered the next domain to be revolutionized by artificial intelligence. While AI approaches are excellently suited to develop certain algorithms, for biomedical applications there are specific challenges. We propose six recommendations—the 6Rs—to improve AI projects in the biomedical space, especially clinical health care, and to facilitate communication between AI scientists and medical doctors: (1) Relevant and well-defined clinical question first; (2) Right data (ie, representative and of good quality); (3) Ratio between number of patients and their variables should fit the AI method; (4) Relationship between data and ground truth should be as direct and causal as possible; (5) Regulatory ready; enabling validation; and (6) Right AI method.

  • Source: Freepik; Copyright: katemangostar; URL: https://www.freepik.com/free-photo/happy-elderly-woman-her-daughter-browsing-tablet-computer_4166883.htm; License: Licensed by JMIR.

    Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical...

    Abstract:

    Background: Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective: The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods: Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results: In total, 95.1% (234/246) of the participants used their personal digital ID (NemID), 57.7% (142/246) were in contact with their GPs electronically, and 54.0% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control. The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions: Information about patients’ eHL may provide clinicians an understanding of patients’ reasons for not using digital health services, better than sociodemographic data or self-rated health.

  • Source: Flickr; Copyright: James Mutter; URL: https://www.flickr.com/photos/bestinplastics/4893012629/; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study

    Abstract:

    Background: Although plastic surgery has been gaining a lot of popularity recently, there seems to be limited perception and a poor understanding of this field by both medical professionals, including medical students, and the general public. This might alter referral patterns as well as medical students’ choice to pursue a career in plastic surgery. Objective: The purpose of this study was to assess knowledge and perception of plastic surgery among medical students and to explore the influencing factors underlying particular beliefs. Methods: Data for this cross-sectional study were collected between August 22 and December 22, 2017. The questionnaire was formulated on the basis of our own study objectives and from available questionnaires with similar objectives. It was composed of 14 questions divided into three main parts: demographics, the specialty of plastic surgery, and media involvement and its effect on plastic surgery. The study was conducted via an online questionnaire among medical students in all years at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20. Results: A total of 886 medical students participated in this study. We achieved a response rate of 56.79%. The mean age of the participants was 21.2 years. The mean awareness score was 9.7 (SD 4.2) for female students and 8.3 (SD 4.2) for male students (P<.001). The condition most commonly known to be treated by a plastic surgeon was burns (70.3% of responses). Conclusions: Medical students do not have adequate awareness of plastic surgery, and early exposure to this specialty may enhance their awareness.

  • Source: Freepik; Copyright: yanalya; URL: https://www.freepik.com/free-photo/girlfriends-using-electronic-gadgets-home_3938817.htm; License: Licensed by JMIR.

    Impact of Emotional Support, Informational Support, and Norms of Reciprocity on Trust Toward the Medical Aesthetic Community: The Moderating Effect of Core...

    Abstract:

    Background: The consumption of medical aesthetic services has become popular in recent years. Many people have purchased medical aesthetic services and treatments in pursuit of self-beauty. When members of online medical aesthetic communities actively participate in discussions and encourage and support one another, there is an increase in community commitment, trust toward each other, and trust toward the community, ultimately promoting social sharing in an environment of positive feedback. Objective: This study aimed to explore via the theory of social support—grounded in a deeper social capabilities framework developed by Khan following the Nobel laureate Amartya Sen’s groundbreaking work—whether emotional support, informational support, and norms of reciprocity in online communities impact group members in terms of creating trust toward other members. This enhances trust toward the community and generates a sense of community commitment, ultimately impacting social buying intention and social sharing intention. Methods: This study used IBM SPSS and AMOS to analyze data. Data were collected through online questionnaires in online medical aesthetic community forums, thereby producing samples that were both representative and accurate. To understand whether core self-evaluation (CSE) is a moderator in the relationship between social sharing intention and social buying intention, this study averaged the point of CSEs in the sample after statistical analysis, dividing the sample into 2 groups. Results: The results showed that emotional support and norms of reciprocity positively impact trust toward members, and trust toward members positively impact trust toward the community. This generates trust transfer, which positively impacts social buying intention and social sharing intention. At the same time, CSE is a moderator variable between trust toward the community and social buying intention, but CSE is not a moderator variable between trust toward the community and social sharing intention. Conclusions: This study revealed that when members of online medical aesthetic communities actively participate in discussions and encourage and support one another, community commitment, trust toward each other, and trust toward the community increases, ultimately promoting social sharing and buying intentions.

  • Source: Foter; Copyright: Foter; URL: https://foter.com/photo2/hospital-surgery-medical-health-medicine-doctor/; License: Public Domain (CC0).

    Awareness and Level of Knowledge About Surgical Site Infections and Risks of Wound Infection Among Medical Physicians in King Abdulaziz University Hospital:...

    Abstract:

    Background: Surgical site infections (SSIs) are one of the leading causes of death, and its prevention is a key element of applying the concept of patient safety and quality care. Objective: This study aimed to assess the level of knowledge about SSIs and risks of wound infection among medical physicians in King Abdulaziz University Hospital. Methods: All surgical and medical consultants, specialists, residents, and medical interns were invited to participate in the study. A 20-Item multiple-choice questionnaire was developed by reviewing the previous literature and with the help of a group of certified surgeons to assess the level of knowledge in all participants. Results: A total of 119 doctors were included in this study. Among all respondents, 92 (77.3%) were intern doctors, 16 (13.4%) were resident doctors, and 11 (9.2%) were specialist doctors. Moreover, 66 (55.5%) doctors knew the definition of SSI. Only one-quarter, that is, 30 (25.2%) doctors knew about the incidence of SSI. In addition, 8 doctors (6.7%) had good knowledge, 75 (63.0%) had fair knowledge, and 36 (30.2%) had poor knowledge regarding SSI according to this study. Conclusions: Level of knowledge about SSIs and risks of wound infections among medical physicians should be improved to ensure better wound care and quality care for the patients.

  • Source: Air Force Medical Service (Stacey Geiger); Copyright: US Air Force; URL: https://www.airforcemedicine.af.mil/News/Display/Article/1292471/gastroenterology-clinic-helps-prevent-colon-cancer-with-early-detection-screeni/; License: Public Domain (CC0).

    Evaluating Information Quality of Revised Patient Education Information on Colonoscopy: It Is New But Is It Improved?

    Abstract:

    Background: Previous research indicates that patients and their families have many questions about colonoscopy that are not fully answered by existing resources. We developed revised forms on colonoscopy bowel preparation and on the procedure itself. Objective: As the goal of the revised materials is to have improved information relative to currently available information, we were interested in how revised information compared with what is currently available in terms of information quality and patient preference. Methods: Participants were asked to review one at a time the Revised and Current versions of Colonoscopy bowel preparation instructions (study 1) and About Colonoscopy (study 2). The order of administration of the Revised and Current versions was randomly counterbalanced to assess order effects. Respondents rated each form along the following dimensions: amount, clarity, trustworthiness, readability and understandability, how new or familiar the information was, and reassurance. Participants were asked which form they preferred and 4 questions about why they preferred it. Open-ended questions asked participants to describe likes and dislikes of the forms and suggestions for improvement. Results: The study 1 and study 2 samples were similar. Overall, in study 1, 62.4% preferred the Revised form, 28.1% preferred the Current form, and 6.7% were not sure. Overall, in study 2, 50.5% preferred the Revised form, 31.1% preferred the Current form, and 18.4% were not sure. Almost 75% of those in study 1 who received the Revised form first, preferred it, compared with less than half of those who received it first in study 2. In study 1, 75% of those without previous colonoscopy experience preferred the Revised form, compared with more than half of those who had previously undergone a colonoscopy. The study 1 logistic regression analysis demonstrated that participants were more likely to prefer the Revised form if they had viewed it first and had no previous experience with colonoscopy. In study 2, none of the variables assessed were associated with a preference for the Revised form. In comparing the 2 forms head-to-head, participants who preferred the Revised form in study 1 rated it as clearer compared with those who preferred the Current form. Finally, many participants who preferred the Revised form indicated in the open-ended questions that they liked it because it had more information than the Current form and that it had good visual information. Conclusions: This study is one of the first to evaluate 2 different patient education resources in a head-to-head comparison using the same participants in a within-subjects design. This approach was useful in comparing revised educational information with current resources. Moving forward, this knowledge translation approach of a head-to-head comparison of 2 different information sources could be taken to develop and refine information sources on other health issues.

  • Source: Freepik; Copyright: Teerawut Masawat; URL: https://www.freepik.com/free-photo/laptop-communication-finger-one-life_1048564.htm#term=typing&page=3&position=32; License: Licensed by JMIR.

    Health Topics on Facebook Groups: Content Analysis of Posts in Multiple Sclerosis Communities

    Abstract:

    Background: Social network sites (SNSs) are being increasingly used to exchange health information between patients and practitioners, pharmaceutical companies, and research centers. Research contributions have explored the contents of such exchanges discussed online. They have categorized the topics discussed and explored the engagement levels of these discussions. Objective: This research aimed at investigating the potential role of SNSs in health care. Specifically it provides an information-clustering analysis of the health information available on SNSs and develops a research design that allows an investigation of this information in enhancing health care research and delivery. In addition, this research aims at testing whether SNSs are valid tools for sharing drug-related information by patients. Methods: This research is based on a specific chronic disease: multiple sclerosis. We searched Facebook to identify and research the social media groups related to this condition. The analysis was restricted to public groups for privacy concerns. We created a database by downloading posts from two main groups (in the English language). Subsequently, we performed a content analysis and statistical analysis; this allowed us to explore the differences between categories, their engagement levels, and the types of posts shared. The mean level of engagement for each topic was analyzed using a 1-way analysis of variance. Results: From a sample of 7029 posts, initial results showed that there were 8 information categories that resonated (percentage of times the topic appears in our sample) with those who post on Facebook: information and awareness (4923/7029, 70.04%), event advertising and petitions (365/7029, 5.19%), fundraising (354/7029, 5.04%), patient support (217/7029, 3.09%), drug discussion (144/7029, 2.05%), clinical trials and research studies (59/7029, 0.84%), product and drug advertising (48/7029, 0.68%), and other (919/7029, 13.07%). Initial analysis showed that comments and likes (as measures of engagement level) are the most frequent indicators and measures of level of engagement. Our results show a high engagement level (in terms of views, likes, comments, etc) for patient support and information and awareness. In addition, although drug discussion had a low resonance, it had an unexpected highly engagement level which we found worthy of further exploration. Conclusions: SNSs have become important tools for patients and health care practitioners to share or seek information. We identified the type of information shared and how the public reacted to it. Our research confirmed that the topics discussed in social media related to specific diseases such as multiple sclerosis are similar to the information categories observed by other researchers. We unexpectedly found other categories such as drug discussion. These and other results of our study enhance our understanding of how content is disseminated and perceived within a specific disease-based community. We concluded that this information has useful implications in the design of prevention campaigns, educational programs, and chronic disease management.

  • Source: PxHere; Copyright: Fox; URL: https://pxhere.com/en/photo/1552281; License: Public Domain (CC0).

    Internet Usage by Polish Patients With Multiple Sclerosis: A Multicenter Questionnaire Study

    Abstract:

    Background: The internet is a source of knowledge and medium widely used in services that facilitate access to information and networking. Multiple sclerosis (MS) patients find the possibility of acquiring information relating to their condition particularly rewarding. Objective: We aimed to identify Polish MS patients’ preferences by analyzing a percentage of internet users and determining the most common search subjects and patients’ approach to information on the internet. Disability connected with the condition, its duration, and other factors that influence patients’ internet use were examined along with instances of relations established through the internet and their durability. Methods: The study examined 1045 patients (731 women, 314 men) treated in 10 Polish MS centers, of whom 932 (89.19%) declared to be internet users. Their average age was 40.65 (SD 11.06) and average MS duration was 9.08 (SD 6.97) years. The study used a proprietary survey on information seeking, the range of searched subjects, and internet usage frequency. Results: The majority of the patients (494/932, 53.0%) used the internet 6-7 times per week and 4.3% (40/932) declared they spent minimum 2 hours per day. The most commonly searched subjects were world news (604/932, 72.9% of patients using the internet); 60.8% (504/932) searched for information on their condition, particularly for new treatment methods (562/932, 67.8%) and the course of illness (520/932, 62.7%). One’s sex had no impact on internet usage (female vs male, odds ratio [OR] 1.13, 95% CI 0.72-1.77), although a patient’s age might, at varying degrees. We found several significant associations using a .05 significance level: a patient with higher education used the internet 9 times more often than one with primary education (OR 8.64, 95% CI 3.31-22.57); lasting relationships increased chances of internet usage by 10-fold compared to widowers (OR 0.12, 95% CI 0.05-0.31); living in a city with a population over 100,000 increased chances by nearly 6 times compared with the countryside (OR 5.59, 95% CI 2.72-11.48); the relapsing-remitting MS type saw a 2-fold increase compared with the primary progressive MS type (OR 0.47, 95% CI 0.29-0.75); and those needing assistance were 2 times less likely to use the internet than patients who could move independently (OR 0.53, 95% CI 0.31-0.89). More than half of the patients (489/932, 52.5%) did not discuss the information found on the internet with their neurologists; 15.9% (148/932) believed that relationships established through the internet can be stable. Conclusions: The majority of Polish patients use the internet as a crucial information source on their condition and innovative treatment methods. The internet can be helpful in establishing new relationships, which are usually short-lived. Polish patients do not frequently discuss the information gathered on the internet with their doctors.

  • Online search for diet recommendations. Source: Flickr; Copyright: makemelocal.com; URL: https://www.flickr.com/photos/154076108@N02/26932391967; License: Creative Commons Attribution + Noncommercial + ShareAlike (CC-BY-NC-SA).

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

    Abstract:

    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.

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  • Awareness and experiences of cosmetic treatment providers with Body Dysmorphic Disorder in Saudi Arabia: A cross-sectional study

    Date Submitted: May 13, 2019

    Open Peer Review Period: May 16, 2019 - Jul 11, 2019

    Background: Body Dysmorphic Disorder (BDD) is defined as, constant obsession about one’s external appearance and flaws. Which is considered a psychological disorder, were people suffering from this...

    Background: Body Dysmorphic Disorder (BDD) is defined as, constant obsession about one’s external appearance and flaws. Which is considered a psychological disorder, were people suffering from this issue might seek help from cosmetic procedure providers. Such as dermatologists or plastic surgeons. Objective: Nowadays, there is a huge increase in cosmetic procedures done worldwide and in Saudi Arabia. Yet there are no enough studies conducted in our region to assess the awareness of BDD among physicians who provide any kind of cosmetic procedures and treatment. In regard to their attitude toward such cases, and how would they manage it. Methods: Our study is a quantitative (observational) cross sectional study, conducted among all cosmetic procedure providers, such as Dermatologist, Otorhinolaryngologists who Provide cosmetic treatments, and Plastic Surgeons. A four paged questionnaire has been distributed among physicians, in governmental hospitals and also among physicians working in cosmetic clinics. The questionnaire was a close-ended one, which had four different sections. Then data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Total number of participants was 155, majority were males, by a number of 113 (72.9%), while 42 (27.1%) were female. 52 (33.5%) reported being totally familiar with the clinical picture of BDD. More than half of physicians reported that they have familiar with the diagnostic criteria of BDD during their practice by a number of 82 (52.9%). A number of physicians 63 (40.6%), estimated the prevalence of BDD in cosmetic practice to range from (1%-5%). Physicians also reported BDD to be more common among females. 76 (49%) of physicians sometimes share the knowledge about BDD with their patients if they are suspecting them to have it Conclusions: Recently, cosmetic treatments are more available to everyone, which lead to an influx of undiagnosed BDD patients electing to perform unnecessary cosmetic treatments. Therefore, physicians should have the clinical knowledge about BDD, on how to diagnose and how to manage. To avoid unnecessary costly procedures.

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