Sensitivity and specificity of automated blood pressure devices to detect atrial fibrillation: A systematic review and meta-analysis of diagnostic accuracy.

Background: Atrial fibrillation (AF) is a prevalent and preventable cause of stroke and mortality. Aim: This systematic review and meta-analysis aimed to investigate the sensitivity and specificity of office and out-of-office automated blood pressure (BP) devices to detect AF. Methods: Diagnostic studies, extracted from databases such as Ovid Medline and Embase, on AF detection by BP device(s), electrocardiography, and reported sensitivity and specificity, were included. Screening of abstracts and full texts, data extraction, and quality assessment were conducted independently by two investigators using Covidence software. The sensitivity and specificity of the BP devices were pooled using a random-effects model. Results: Sixteen studies including 10,158 participants were included. Only a few studies were conducted in primary care (n = 3) or with a low risk of bias (n = 5). Office BP devices, which utilised different algorithms to detect AF, had a sensitivity and specificity of 96.2 and 94%, respectively. Specificity was reduced when only one positive result was considered among consecutive BP measurements. Only a few studies (n = 3) investigated out-of-office BP. Only one study (n = 100) suggested the use of ≥79 and ≥26% of positive readings on 24-h ambulatory BP measurements to detect AF and paroxysmal AF, respectively. Conclusions: Office BP devices can be used clinically to screen for AF in high-risk populations. Clinical trials are needed to determine the effect of AF screening using office BP devices in reducing stroke risk and mortality. Further studies are also required to guide out-of-office use of BP devices for detecting paroxysmal AF or AF. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022319541, PROSPERO CRD42022319541.

The Relationship Between Technology Use and Problem Technology Use and Potential Psychosocial Mechanisms: Population-Based Telephone Survey in Community Adults During COVID-19.

Background: Although digital technology enables people to stay connected during COVID-19, protracted periods of isolation, crisis-induced stress, and technology-based activity may intensify problem technology use (PTU), such as social media addiction (SMA) and Internet gaming disorder (IGD). Objective: This study aimed to characterize the patterns and levels of SMA and IGD during COVID-19 in the general population of Hong Kong. We also tested the associations between prolonged use of social media/Internet games and SMA/IGD and the mediation effects of psychosocial statuses (i.e., loneliness, boredom, and post-traumatic stress) on these associations. Methods: A population-based random telephone survey was conducted in community adults in May 2020; 658 social media users and 177 Internet gamers were identified. A structured questionnaire, including the Bergen Social Media Addiction Scale, the diagnostic and statistical manual of mental disorder IGD Symptoms Checklist, the Post-Traumatic Stress Disorder Scale, Multidimensional State Boredom Scale, and the De Jong Gierveld Loneliness Scale, was used. Time spent on social media and Internet games during and before COVID-19 was also asked. Results: There were 66.2-81.8% increases in time use of social media or Internet games during COVID-19 compared to pre-COVID-19 self-reported information of the participants. The estimated IGD prevalence rate in the gamers based on the sample weighted to the age distribution and gender ratio of the Hong Kong population was 9.7%, higher than that of pre-COVID-19 research. Age, marital status, education levels, time use of social media, COVID-19-related post-traumatic stress, boredom, and emotional loneliness were significantly associated with SMA, while time spent on Internet games, boredom, and emotional loneliness was significantly associated with IGD. Boredom positively mediated the associations between time spent on social media/Internet games and SMA/IGD, whereas social loneliness negatively mediated the association between time spent on social media and SMA. Conclusion: These findings highlight the concern of prolonged use of digital platforms during COVID-19 and its role as a "double-edged sword" for psychosocial wellbeing and behavioral health during COVID-19. It also highlights a need to monitor and prevent PTU in the general public. The observed psychosocial mechanisms are modifiable and can inform the design of evidence-based prevention programs for PTU.

The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study.

BACKGROUND: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. OBJECTIVE: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. METHODS: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. RESULTS: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (ß=-.07; P=.04) but not among younger people (ß=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (ß=.09; P=.02) and older people (ß=.10; P=.01). The indirect effect via social loneliness was significant among older people (ß=-.01; P=.04) but not among younger people (ß=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (ß=.02; P=.04) and older people (ß=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). CONCLUSIONS: Social media may be a "double-edged sword" for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic.