https://www.i-jmr.org/issue/feedInteractive Journal of Medical Research2023-01-10T09:15:03-05:00JMIR Publicationseditor@jmir.orgOpen Journal Systems Unless stated otherwise, all articles are open-access distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work ("first published in the interactive Journal of Medical Research...") is properly cited with original URL and bibliographic citation information. The complete bibliographic information, a link to the original publication on http://www.i-jmr.org/, as well as this copyright and license information must be included. A new general medical journal for the 21st century, focusing on innovation in health and medical research. https://www.i-jmr.org/2024/1/e42849/ Evaluation of the Accuracy, Credibility, and Readability of Statin-Related Websites: Cross-Sectional Study2024-03-14T09:45:04-04:00Eunice LingDomenico de PieriEvenne LohKaren M ScottStephen C H LiHeather J Medbury<strong>Background:</strong> Cardiovascular disease (CVD) represents the greatest burden of mortality worldwide, and statins are the most commonly prescribed drug in its management. A wealth of information pertaining to statins and their side effects is on the internet; however, to date, no assessment of the accuracy, credibility, and readability of this information has been undertaken. <strong>Objective:</strong> This study aimed to evaluate the quality (accuracy, credibility, and readability) of websites likely to be visited by the general public undertaking a Google search of the side effects and use of statin medications. <strong>Methods:</strong> Following a Google web search, we reviewed the top 20 consumer-focused websites with statin information. Website accuracy, credibility, and readability were assessed based on website category (commercial, not-for-profit, and media), website rank, and the presence or absence of the Health on the Net Code of Conduct (HONcode) seal. Accuracy and credibility were assessed following the development of checklists (with 20 and 13 items, respectively). Readability was assessed using the Simple Measure of Gobbledegook scores. <strong>Results:</strong> Overall, the accuracy score was low (mean 14.35 out of 20). While side effects were comprehensively covered by 18 websites, there was little information about statin use in primary and secondary prevention. None of the websites met all criteria on the credibility checklist (mean 7.8 out of 13). The median Simple Measure of Gobbledegook score was 9.65 (IQR 8.825-10.85), with none of the websites meeting the recommended reading grade of 6, even the media websites. A website bearing the HONcode seal did not mean that the website was more comprehensive or readable. <strong>Conclusions:</strong> The quality of statin-related websites tended to be poor. Although the information contained was accurate, it was not comprehensive and was presented at a reading level that was too difficult for an average reader to fully comprehend. As such, consumers risk being uninformed about this pharmacotherapy. <strong>Trial Registration:</strong> 2024-03-14T09:45:04-04:00 https://www.i-jmr.org/2024/1/e45987/ A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study2024-03-13T09:30:04-04:00Sharon EagerHelen KillaspyJoanna CGillian MezeyPeter McPhersonMegan DowneyGeorgina ThompsonBrynmor Lloyd-Evans<strong>Background:</strong> Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. <strong>Objective:</strong> This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. <strong>Methods:</strong> This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through “think-aloud” testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. <strong>Results:</strong> Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals’ priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users’ inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. <strong>Conclusions:</strong> The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. 2024-03-13T09:30:04-04:00 https://www.i-jmr.org/2024/1/e52296/ Improvements in Neoplasm Classification in the International Classification of Diseases, Eleventh Revision: Systematic Comparative Study With the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision2024-03-08T09:00:04-05:00Yicong XuJingya ZhouHongxia LiDong CaiHuanbing ZhuShengdong Pan<strong>Background:</strong> The International Classification of Diseases, Eleventh Revision (ICD-11) improved neoplasm classification. <strong>Objective:</strong> We aimed to study the alterations in the ICD-11 compared to the Chinese Clinical Modification of the International Classification of Diseases, Tenth Revision (ICD-10-CCM) for neoplasm classification and to provide evidence supporting the transition to the ICD-11. <strong>Methods:</strong> We downloaded public data files from the World Health Organization and the National Health Commission of the People’s Republic of China. The ICD-10-CCM neoplasm codes were manually recoded with the ICD-11 coding tool, and an ICD-10-CCM/ICD-11 mapping table was generated. The existing files and the ICD-10-CCM/ICD-11 mapping table were used to compare the coding, classification, and expression features of neoplasms between the ICD-10-CCM and ICD-11. <strong>Results:</strong> The ICD-11 coding structure for neoplasms has dramatically changed. It provides advantages in coding granularity, coding capacity, and expression flexibility. In total, 27.4% (207/755) of ICD-10 codes and 38% (1359/3576) of ICD-10-CCM codes underwent grouping changes, which was a significantly different change (<i>χ</i><sup>2</sup><sub>1</sub>=30.3; <i>P</i><.001). Notably, 67.8% (2424/3576) of ICD-10-CCM codes could be fully represented by ICD-11 codes. Another 7% (252/3576) could be fully described by uniform resource identifiers. The ICD-11 had a significant difference in expression ability among the 4 ICD-10-CCM groups (<i>χ</i><sup>2</sup><sub>3</sub>=93.7; <i>P</i><.001), as well as a considerable difference between the changed and unchanged groups (<i>χ</i><sup>2</sup><sub>1</sub>=74.7; <i>P</i><.001). Expression ability negatively correlated with grouping changes (<i>r</i>=–.144; <i>P</i><.001). In the ICD-10-CCM/ICD-11 mapping table, 60.5% (2164/3576) of codes were postcoordinated. The top 3 postcoordinated results were specific anatomy (1907/3576, 53.3%), histopathology (201/3576, 5.6%), and alternative severity 2 (70/3576, 2%). The expression ability of postcoordination was not fully reflected. <strong>Conclusions:</strong> The ICD-11 includes many improvements in neoplasm classification, especially the new coding system, improved expression ability, and good semantic interoperability. The transition to the ICD-11 will inevitably bring challenges for clinicians, coders, policy makers and IT technicians, and many preparations will be necessary. 2024-03-08T09:00:04-05:00 https://www.i-jmr.org/2024/1/e52590/ The Effect of Body Temperature Changes on the Course of Treatment in Patients With Pneumonia and Sepsis: Results of an Observational Study2024-03-01T09:30:04-05:00Domen GuzeljAnže GrubelnikNina GreifPetra Povalej BržanJure FluherŽiga KalamarAndrej Markota<strong>Background:</strong> Traditionally, patients who are critically ill with infection and fever have been treated with antipyretics or even physically cooled. Presumed benefits of the reduction of body temperature are mostly based on decreased metabolic demands. However, it has been shown that decreasing body temperature in patients who are critically ill is not associated with improvement in treatment outcomes. Additionally, there is some data to support the use of temperature modulation (therapeutic hyperthermia) as an adjuvant treatment strategy in patients with infection. <strong>Objective:</strong> This study aims to determine the effect of body temperature on the course of intensive care unit (ICU) treatment of patients who are mechanically ventilated with pneumonia, sepsis, and positive tracheal aspirates on admission. <strong>Methods:</strong> We performed a single-center retrospective study. Core body temperature was measured in all patients. We analyzed associations between average temperatures in the first 48 hours after admission to ICU and ICU treatment parameters. Additionally, patients were divided into three groups: patients with negative tracheal aspirates 1 week after ICU admission (P-N group), patients with a different pathogen in tracheal aspirates 1 week after ICU admission (P-HAP group), and patients with a persisting pathogen in tracheal aspirates 1 week after ICU admission (P-P group). Differences in body temperature and interventions aimed at temperature modulation were determined. <strong>Results:</strong> We observed a significantly higher average temperature in the first 48 hours after admission to ICU in patients who survived to hospital discharge compared to nonsurvivors (mean 37.2 °C, SD 1 °C vs mean 36.9 °C, SD 1.6 °C; <i>P</i>=.04). We observed no associations between average temperatures in the first 48 hours after ICU admission and days of mechanical ventilation in the first 7 days of treatment (ρ=–0.090; <i>P</i>=.30), the average maximum daily requirement for noradrenaline in the first 7 days of treatment (ρ=–0.029; <i>P</i>=.80), average maximum FiO<sub>2</sub> in the first 7 days of ICU treatment (ρ=0.040; <i>P</i>=.70), and requirement for renal replacement therapy in the first 7 days of ICU treatment (mean 37.3 °C, SD 1.4 °C vs mean 37.0 °C, SD 1.3 °C; <i>P</i>=.23). In an additional analysis, we observed a significantly greater use of paracetamol in the P-N group (mean 1.0, SD 1.1 g vs mean 0.4, SD 0.7 g vs mean 0.4, SD 0.8 g; <i>P</i>=.009), a trend toward greater use of active cooling in the first 24 hours after ICU admission in the P-N group (n=11, 44% vs n=14, 33.3% vs n=16, 32%; <i>P</i>=.57), and no other significant differences in parameters of ICU treatment between patient groups. <strong>Conclusions:</strong> We observed better survival in patients who developed higher body temperatures in the first 48 hours after admission to the ICU; however, we observed no changes in other treatment parameters. Similarly, we observed greater use of paracetamol in patients with negative tracheal aspirates 1 week after ICU admission. Our results support the strategy of temperature tolerance in patients who are intubated with pneumonia and sepsis. 2024-03-01T09:30:04-05:00 https://www.i-jmr.org/2024/1/e47817/ Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings2024-02-26T09:00:04-05:00Sohail AghaIfeanyi NsoforDrew BernardSarah FrancisNandan Rao<strong>Background:</strong> To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. <strong>Objective:</strong> This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. <strong>Methods:</strong> We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents’ vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. <strong>Results:</strong> About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents’ perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. <strong>Conclusions:</strong> These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians’ fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies. 2024-02-26T09:00:04-05:00 https://www.i-jmr.org/2024/1/e50064/ Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study2024-02-15T09:45:40-05:00Ali AbdulHusseinZahid Ahmad ButtStanko DimitrovBrian Cozzarin<strong>Background:</strong> Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. <strong>Objective:</strong> In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. <strong>Methods:</strong> We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). <strong>Results:</strong> Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; <i>P</i>=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; <i>P</i><.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; <i>P</i><.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; <i>P</i><.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; <i>P</i><.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; <i>P</i><.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; <i>P</i><.001), 1.51 (95% CI 1.17-1.96; <i>P</i><.001), and 1.41 (95% CI 1.05-1.92; <i>P</i>=.02) than those who always had access to the same PPE, respectively. <strong>Conclusions:</strong> Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention. <strong>Trial Registration:</strong> 2024-02-15T09:45:40-05:00 https://www.i-jmr.org/2024/1/e54704/ A Preliminary Checklist (METRICS) to Standardize the Design and Reporting of Studies on Generative Artificial Intelligence–Based Models in Health Care Education and Practice: Development Study Involving a Literature Review2024-02-15T09:30:25-05:00Malik SallamMuna BarakatMohammed Sallam<strong>Background:</strong> Adherence to evidence-based practice is indispensable in health care. Recently, the utility of generative artificial intelligence (AI) models in health care has been evaluated extensively. However, the lack of consensus guidelines on the design and reporting of findings of these studies poses a challenge for the interpretation and synthesis of evidence. <strong>Objective:</strong> This study aimed to develop a preliminary checklist to standardize the reporting of generative AI-based studies in health care education and practice. <strong>Methods:</strong> A literature review was conducted in Scopus, PubMed, and Google Scholar. Published records with “ChatGPT,” “Bing,” or “Bard” in the title were retrieved. Careful examination of the methodologies employed in the included records was conducted to identify the common pertinent themes and the possible gaps in reporting. A panel discussion was held to establish a unified and thorough checklist for the reporting of AI studies in health care. The finalized checklist was used to evaluate the included records by 2 independent raters. Cohen κ was used as the method to evaluate the interrater reliability. <strong>Results:</strong> The final data set that formed the basis for pertinent theme identification and analysis comprised a total of 34 records. The finalized checklist included 9 pertinent themes collectively referred to as METRICS (Model, Evaluation, Timing, Range/Randomization, Individual factors, Count, and Specificity of prompts and language). Their details are as follows: (1) Model used and its exact settings; (2) Evaluation approach for the generated content; (3) Timing of testing the model; (4) Transparency of the data source; (5) Range of tested topics; (6) Randomization of selecting the queries; (7) Individual factors in selecting the queries and interrater reliability; (8) Count of queries executed to test the model; and (9) Specificity of the prompts and language used. The overall mean METRICS score was 3.0 (SD 0.58). The tested METRICS score was acceptable, with the range of Cohen κ of 0.558 to 0.962 (<i>P</i><.001 for the 9 tested items). With classification per item, the highest average METRICS score was recorded for the “Model” item, followed by the “Specificity” item, while the lowest scores were recorded for the “Randomization” item (classified as suboptimal) and “Individual factors” item (classified as satisfactory). <strong>Conclusions:</strong> The METRICS checklist can facilitate the design of studies guiding researchers toward best practices in reporting results. The findings highlight the need for standardized reporting algorithms for generative AI-based studies in health care, considering the variability observed in methodologies and reporting. The proposed METRICS checklist could be a preliminary helpful base to establish a universally accepted approach to standardize the design and reporting of generative AI-based studies in health care, which is a swiftly evolving research topic. 2024-02-15T09:30:25-05:00 https://www.i-jmr.org/2024/1/e48929/ Digital Methods for the Spiritual and Mental Health of Generation Z: Scoping Review2024-02-06T09:15:26-05:00Susanna Y ParkBridgette DoJacqlyn YourellJanice HermerJennifer Huberty<strong>Background:</strong> Generation Z (Gen Z) includes individuals born between 1995 and 2012. These individuals experience high rates of anxiety and depression. Most Gen Z individuals identify with being spiritual, and aspects from religion and spirituality can be integrated into mental health treatment and care as both are related to lower levels of depression. However, research on the spiritual and mental health of Gen Z is sparse. To date, there are no systematic or scoping reviews on digital methods to address the spiritual and mental health of Gen Z. <strong>Objective:</strong> This scoping review aimed to describe the current state of digital methods to address spiritual and mental health among Gen Z, identify the knowledge gaps, and make suggestions for how to leverage digital spiritual and mental health interventions for Gen Z. <strong>Methods:</strong> A comprehensive literature search was conducted in PubMed, Scopus, PsycInfo, CINAHL, Education Full Text, Google Scholar, SocIndex, and Sociological Abstracts. The inclusion criteria were as follows: (1) study population born between 1995 and 2012 (ie, Gen Z); (2) reporting on spiritual health or well-being, spirituality or religion, and mental health or well-being; (3) reporting on using digital methods; (4) publication in 1996 or beyond; (5) human subject research; (6) full text availability in English; (7) primary research study design; and (8) peer-reviewed article. Two authors screened articles and subsequently extracted data from the included articles to describe the available evidence. <strong>Results:</strong> A total of 413 articles were screened at the title and abstract levels, of which 27 were further assessed with full text for eligibility. Five studies met the inclusion criteria, and data were extracted to summarize study characteristics and findings. The studies were performed across 4 different countries. There were 2 mixed-methods studies (South Africa and Canada), 2 cross-sectional studies (China and United States), and 1 randomized controlled trial (United States). Of these studies, only 2 discussed digital interventions (a text messaging–based intervention to improve spiritual and mental health, and a feasibility study for a mental health app). Other studies had a digital component with minor or unclear spiritual and mental health measures. Overall, there was a lack of consistency in how spiritual and mental health were measured. <strong>Conclusions:</strong> Few studies have focused on assessing the spiritual and mental health of Gen Z in the digital context, and no research to date has examined a digital spiritual and mental health application among Gen Z. Research is needed to inform the development and evaluation of approaches to address the spiritual and mental health of Gen Z via digital means (eg, mobile apps). 2024-02-06T09:15:26-05:00 https://www.i-jmr.org/2024/1/e48587/ Strategies to Alleviate the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Low- and Middle-Income Countries: Scoping Review2024-01-18T09:15:04-05:00Olindah SilauleDaleen CasteleijnFasloen AdamsNokuthula Gloria Nkosi<strong>Background:</strong> There is considerable evidence of the burden of care encountered by informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Previous studies have highlighted the need to support these informal caregivers as key players in the care of these patients. To date, limited evidence exists on the extent and types of strategies for supporting these informal caregivers in low- and middle-income countries. <strong>Objective:</strong> This scoping review aims to identify and describe the extent and type of evidence on the existing strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. <strong>Methods:</strong> A systematic literature search was completed following the Joanna Briggs Institute methodology for scoping reviews. The participants, concept, and context framework was used to guide the search for literature sources across 5 databases: PubMed, MEDLINE, CINAHL, and PsycINFO for published literature and ProQuest for unpublished literature. This review included studies that reported on strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions, with a focus on studies that evaluated or recommended caregiver interventions and support strategies in low- and middle-income countries. The search was limited to studies conducted between 2001 and 2021, and only papers written in English were considered for inclusion. Using the Covidence software (Veritas Health Innovation), 2 reviewers independently screened the papers, applied the inclusion and exclusion criteria, and met biweekly to discuss and resolve conflicts. The relevant studies and reported outcomes were summarized, organized, and analyzed descriptively using numeric summary analysis and deductive content analysis. <strong>Results:</strong> Of the 18,342 studies identified, 44 (0.24%) met the inclusion criteria. The included studies were from 16 low- and middle-income countries in Asia, Africa, Europe, and South and North America. Most studies (21/44, 48%) were randomized controlled trials conducted in Asian countries. The identified strategies were grouped into 2 categories: implemented and recommended intervention strategies. Identified strategies included community-based interventions, psychoeducation interventions, support groups, cognitive behavioral therapy, spirituality-based interventions, and smartphone-based interventions. In addition, mindfulness and empowerment, collaborative interventions, standard care, financial and social support, counseling, occupation-based interventions, policy and legislature, and access to mental health care were identified. Psychoeducation and support group interventions were identified as common strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions. <strong>Conclusions:</strong> This review provides evidence on the types of implemented and recommended strategies for alleviating the burden of care among informal caregivers in low- and middle-income countries. Although psychoeducational interventions were the most preferred strategy for alleviating burden, their benefits were short-lived when compared with peer-led support groups. 2024-01-18T09:15:04-05:00 https://www.i-jmr.org/2023/1/e44606/ Evaluating the Effectiveness of School Closure in COVID-19–Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study2023-12-15T09:15:05-05:00Ping-Chen ChungKevin J ChenHui-Mei ChangTa-Chien Chan<strong>Background:</strong> During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. <strong>Objective:</strong> This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19–related syndromes in an outpatient syndromic surveillance system. <strong>Methods:</strong> We calculated the incidence of COVID-19–related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19–related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. <strong>Results:</strong> School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19–related syndromes in 2021 for 2 weeks after the intervention (coefficient −1.24, 95% CI −2.40 to −0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. <strong>Conclusions:</strong> Overall, school closure effectively suppresses COVID-19–related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. 2023-12-15T09:15:05-05:00