[Psychological interventions on the Internet and digital therapeutics in the field of mental health: are we ready?] / Interventi psicologici su Internet e terapie digitali nell'ambito della salute mentale: siamo pronti?

In the last years, Information and Communication Technology has increasingly offered solutions in the field of psychology and mental health. Internet-based psychological interventions, apps, solutions based on social media have been suggested as tools to be used with the usual psychotherapy interventions, or in some cases, in substitution to them. Many of these are based on cognitive behavioral therapy (which by its nature is easily transferable into digital format) and fall into the category of digital therapeutics. On the other hand, tele-psychiatry, an area in strong expansion (also justified by the need to continue providing care to patients in this period of covid-19 which has prevented, or severely limited, face-to-face meetings), seems to improve the access to specialized mental health care, reduce delays in care, reduce stigma and promote greater patient attention. There is evidence that comes from randomized clinical trials, systematic reviews and meta-analysis and that demonstrates the efficacy of these tools in managing and preventing episodes of depression, anxiety and addictions. For other mental health disorders further confirmation is needed. In this context, it is therefore necessary to make greater use of randomized clinical trials with an adequate number of patients recruited, with a sufficient observation period and with easily measurable endpoints.

A Proposal For COVID-19 Applications Enabling Extensive Epidemiological Studies.

During the next phase of COVID-19 outbreak, mobile applications could be the most used and proposed technical solution for monitoring and tracking, by acquiring data from subgroups of the population. A possible problem could be data fragmentation, which could lead to three harmful effects: i) data could not cover the minimum percentage of the people for monitoring efficacy, ii) it could be heavily biased due to different data collection policies, and iii) the app could not monitor subjects moving across different zones or countries. A common approach could solve these problems, defining requirements for the selection of observed data and technical specifications for the complete interoperability between different solutions. This work aims to integrate the international framework of requirements in order to mitigate the known issues and to suggest a method for clinical data collection that ensures to researchers and public health institution significant and reliable data. First, we propose to identify which data is relevant for COVID-19 monitoring through literature and guidelines review. Then we analysed how the currently available guidelines for COVID-19 monitoring applications drafted by European Union and World Health Organization face the issues listed before. Eventually we proposed the first draft of integration of current guidelines.

[Information technology and digital health to support health in the time of CoViD-19.] / Information technology e digital health a supporto della salute ai tempi della CoViD-19.

The CoViD-19 pandemic has provided the opportunity for the health care's digital revolution with the unprecedented accelerated expansion of telehealth, telemedicine and other digital health tools. Several tools have been developed and launched at national and international level to face the emergency, including tools to perform online triage, symptoms checking, video visits and remote monitoring, and to conduct local and national epidemiological surveillance studies. Artificial intelligence-based tools have also been developed to diagnose cases of CoViD-19 or to identify patients at risk. Most of these technologies have been endorsed by medical societies such as the American Medical Association and the American Academy of Family Physicians which launched specific guidelines about their use. The growth in telemedicine services and in digital health technologies could not have occurred without important telehealth regulatory changes that have occurred in some countries aimed at promoting their use to face the CoViD-19 emergency, such as the deregulation of the use of video conferencing and video chat systems to carry out video visits, and the payment parity between telehealth and in clinic care. In order to decide whether to continue using these tools even after the pandemic is over, it could be useful to perform validation and efficacy studies of these tools to study their implications on the doctor-patient relationship, to understand if the new features can be integrated with the other technological tools already in use, and if they can improve clinical practice and quality of care.