Cost Analysis of a Digital Multimodal Cancer Prehabilitation.

INTRODUCTION: There is growing evidence that prehabilitation programmes effectively improve the physical and psychological conditions of cancer patients awaiting treatment. During the pandemic, people with cancer were classed as vulnerable. To reduce risk to this population Kent and Medway Prehabilitation service transformed into a TeleHealth format. The aim of this study is to assess the impact on health-related quality of life (HRQoL) and the costs of a digital multimodal prehabilitation programme. METHODS: HRQoL was measured with the EQ-5D and quality-adjusted life years (QALYs) were calculated. Costs of the prehabilitation service and inpatient care were calculated. Comparisons were made between different levels of prehabilitation received. RESULTS: A sample of 192 individuals was included in the study Mean HRQoL improved from 69.53 at baseline to 85.71 post-rehabilitation, a 23% increase. For each additional week of prehabilitation care in cancer patients, the model predicts that the total QALYS increase by 0.02, when baseline utility is held constant. CONCLUSIONS: Prehabilitation is associated with improved HRQoL and QALYs. Our model of a multimodal digital prehabilitation program can be beneficial for patients and reduce costs for healthcare facilities even when the patients attend only a few sessions.

"You know what, I'm in the trend as well" - Understanding the inter-play between digital and real-life social influences on the food and activity choices of young adults.

OBJECTIVE: To understand young adults' perceptions of online and real-life social influences on their food and activity choices. DESIGN: A qualitative study involving seven focus groups. Thematic analyses using both deductive and inductive techniques were performed. SETTING: A polytechnic and a university in Singapore. PARTICIPANTS: A total of 46 full-time students, 19-24 years of age. RESULTS: Participants revealed that social media meets multiple needs, contributing to its ubiquitous use and facilitating content spread between social networks. Food-related content shared on social media were mostly commercial posts, marketing foods and eateries showcasing price-promotions, emphasizing sensory properties of foods, or creating narratives that activated trends. Subsequently, real-life social activities frequently revolve around marketed foods that were not necessarily healthy. In contrast, physical activity posts were rarely being followed up in real life. Portrayals describing a toxic gym culture could contribute to negative perceptions of peers' physical activity posts and a disinclination towards sharing such posts. Participants expressed that close, supportive social networks in real-life strongly influenced initiating and maintaining healthy lifestyles. However, in a society that highly values academic achievements, participants prioritized studying and socializing over healthy eating and physical activity. CONCLUSIONS: Overall, our findings reveal that virtual and real-life social influences have complex interactions affecting Asian young adults' behavioral choices and should be considered when designing interventions for this group. Regulations related to the digital marketing of unhealthy food, and improving the availability, accessibility, and affordability of healthier food options, particularly in the foodservice sector, would be of value to consider.

Young People's Attitudes and Motivations Toward Social Media and Mobile Apps for Weight Control: Mixed Methods Study.

BACKGROUND: Effective prevention at a young enough age is critical to halt the obesity epidemic. Mobile health (mHealth) apps would potentially reach large numbers at low-cost. While there is already a profusion of lifestyle apps, they are mostly non-evidence-based and evidently ineffective against rising obesity prevalence. OBJECTIVE: The aim of this study was to explore preferences and usage of lifestyle apps among young people in 6 countries. METHODS: A mixed methods study was conducted among young people aged 13 to 24 years residing in the United Kingdom, Belgium, Finland, Greece, Singapore, and New Zealand. Participants were recruited from Web advertisements on Facebook, asking for volunteers interested in mobile apps in general, not specific to lifestyle or health, to complete a short survey comprising 18 questions on demographics, weight gain, and mobile app preferences and then to join English-language online focus groups, which were held during 2017, in password-protected Web rooms, moderated by an experienced researcher. Descriptive statistics were carried out for the survey, and thematic analysis was applied to transcripts. RESULTS: A total of 2285 young people (610 adolescents aged 13-17 years and 1675 young adults aged 18-24 years) responded and completed the survey, with 72.0% (1645) reported being concerned about weight gain for themselves or friends. Later, 807 young people (376 adolescents and 431 young adults) were selected based on age and country to participate in 12 online focus groups, with 719 young people completing. Analysis revealed 4 main themes: (1) feelings toward personal weight; (2) perception of lifestyle apps and desired content for weight gain prevention; (3) social media apps, lifestyle apps, and motivation for downloading and retaining; and (4) data safety and data usage and confidentiality. Young people are interested in evidence-based advice in programs incorporating their preferences. CONCLUSIONS: Young people are commonly, and consistently across 6 countries, concerned about weight gain and obesity and would welcome evidence-based mHealth programs, provided the views of young people themselves are incorporated in the program content.

Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration.

BACKGROUND: There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of health professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy making, we need to determine the effectiveness of mLearning. OBJECTIVE: The primary objective of this review was to evaluate the effectiveness of mLearning interventions for delivering health professions education in terms of learners' knowledge, skills, attitudes, and satisfaction. METHODS: We performed a systematic review of the effectiveness of mLearning in health professions education using standard Cochrane methodology. We searched 7 major bibliographic databases from January 1990 to August 2017 and included randomized controlled trials (RCTs) or cluster RCTs. RESULTS: A total of 29 studies, including 3175 learners, met the inclusion criteria. A total of 25 studies were RCTs and 4 were cluster RCTs. Interventions comprised tablet or smartphone apps, personal digital assistants, basic mobile phones, iPods, and Moving Picture Experts Group-1 audio layer 3 player devices to deliver learning content. A total of 20 studies assessed knowledge (n=2469) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning over traditional learning for knowledge (standardized mean difference [SMD]=0.43, 95% CI 0.05-0.80, N=11 studies, low-quality evidence). There was no difference between blended learning and traditional learning for knowledge (SMD=0.20, 95% CI -0.47 to 0.86, N=6 studies, low-quality evidence). A total of 14 studies assessed skills (n=1097) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning (SMD=1.12, 95% CI 0.56-1.69, N=5 studies, moderate quality evidence) and blended learning (SMD=1.06, 95% CI 0.09-2.03, N=7 studies, low-quality evidence) over traditional learning for skills. A total of 5 and 4 studies assessed attitudes (n=440) and satisfaction (n=327), respectively, with inconclusive findings reported for each outcome. The risk of bias was judged as high in 16 studies. CONCLUSIONS: The evidence base suggests that mLearning is as effective as traditional learning or possibly more so. Although acknowledging the heterogeneity among the studies, this synthesis provides encouraging early evidence to strengthen efforts aimed at expanding health professions education using mobile devices in order to help tackle the global shortage of health professionals.

Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration.

BACKGROUND: Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. OBJECTIVE: The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction. METHODS: We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence. RESULTS: A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I2=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I2=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals' cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I2=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I2=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency. CONCLUSIONS: We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.

Accuracy of on-line self-reported weights and heights by young adults.

Background: e-epidemiology, a convenient and low-cost research method, is becoming increasingly popular. This study seeks to validate on-line self-reported heights and weights against objectively measured data in young adults. Methods: Young adults self-reported heights and weights in an on-line lifestyle survey. These were validated using two methods: (i) measurements by staff at the primary-care clinic and (ii) measurements by a researcher within two weeks of distribution of the survey. Analyses were conducted to determine differences between the self-reported and measured heights and weights and to identify characteristics associated with under- or over-reporting of these. Results: From a total of 23 010 young adults invited to the survey, 24% provided on-line data, mean age = 19.2 (SD 3.2) years, 43% male, 91% EU citizens. Both self-reported and measured data were available for 1446 individuals (547 men, 896 women and mean age 19.2 (SD2.6) years); 1278 validated using medical records, 168 by researcher measurements. Intra-class correlations between self-reported and measured parameters were weight (r = 0.99), height (r = 0.98), with acceptable levels of agreement between measured and self-reported weight, height and BMI using Bland & Altman analyses. Self-reported weight was underestimated uniformly across BMI categories, gender and ethnicity, by a mean -0.4 (SD 0.4) kg (P < 0.001). Height was accurately reported overall across BMI and gender: both self-reported and measured heights =1.72 (SD 0.01) m, P = 0.783. Discrepancies between methods caused misclassification of BMI category for 17 (1.8%) of participants. Conclusions: Engagement of young adults with on-line research is encouraging. On-line self-reporting provides acceptably reliable anthropometric data for young adults, with under-reporting of weight by just 0.4 kg.

Nutritional adequacy of meals from an independent catering facility versus chain restaurants for young adults.

BACKGROUND: Eating out of home has been associated with the increasing prevalence of obesity. While some chain restaurants provide nutritional information for their products, smaller independent catering facilities may not provide such information. The aim of this study was to assess the nutritional adequacy of meals provided to young adults at an independent catering facility and compare them with meals provided by chain restaurants. METHODS: Meals were analysed in 2014 in the UK in relation of nutrient provision to targets for macro- and micro-nutrients. One-way ANOVA was performed to compare menus between the restaurants included in the analyses. RESULTS: 2056 meal combinations were analysed, 210 from the student accommodation and 1,846 from five largest national chain restaurants. Mean (SD) nutritional content was: student accommodation: 1193(269)kcal, fat 52.0(22)g, saturated fat 24.5(14.5)g, protein 42.4(28.5)g, carbohydrate 117.0(30)g; chain restaurants: 922(160)kcal, fat 40.0(9.7)g, saturated fat 14.5(5.8)g, protein 31.2(6.5)g, carbohydrate 104.2(16.6)g. Meals from the student accommodation presented significantly more calories than the meals in all five chain restaurants ( p = 0.0015). CONCLUSIONS: Meal provision in the student accommodation was in excess of energy requirements and higher than the meals offered in chain restaurants. Regulating or setting nutritional standards for all places that provide food is essential as current food provision may favour unwanted weight gain and diet-related diseases.

Elearning approaches to prevent weight gain in young adults: A randomized controlled study.

OBJECTIVE: Preventing obesity among young adults should be a preferred public health approach given the limited efficacy of treatment interventions. This study examined whether weight gain can be prevented by online approaches using two different behavioral models, one overtly directed at obesity and the other covertly. METHODS: A three-group parallel randomized controlled intervention was conducted in 2012-2013; 20,975 young adults were allocated a priori to one control and two "treatment" groups. Two treatment groups were offered online courses over 19 weeks on (1) personal weight control ("Not the Ice Cream Van," NTICV) and, (2) political, environmental, and social issues around food ("Goddess Demetra," "GD"). Control group received no contact. The primary outcome was weight change over 40 weeks. RESULTS: Within-group 40-week weight changes were different between groups (P < 0.001): Control (n = 2,134): +2.0 kg (95% CI = 1.5, 2.3 kg); NTICV (n = 1,810): -1.0 kg (95% CI = -1.3, -0.5); and GD (n = 2,057): -1.35 kg (95% CI = -1.4 to -0.7). Relative risks for weight gain vs. CONTROL: NTICV = 0.13 kg (95% CI = 0.10, 0.15), P < 0.0001; GD = 0.07 kg (95% CI = 0.05, 0.10), P < 0.0001. CONCLUSIONS: Both interventions were associated with prevention of the weight gain observed among control subjects. This low-cost intervention could be widely transferable as one tool against the obesity epidemic. Outside the randomized controlled trial setting, it could be enhanced using supporting advertising and social media.

Preventing weight gain with calorie-labeling.

OBJECTIVE: Calorie-labeling has been suggested as an anti-obesity measure but there is no evidence for its effect, to date. Early adulthood is a critical life-cycle period for unwanted weight gain and obesity development. This study examined whether providing calorie information would help young adults to avoid weight gain. METHODS: Using a pragmatic interrupted time-series study design, weight changes over 36 weeks were reported among two year-groups, each of 120 young adults, similar in age, gender, and ethnicity, living in fully-catered accommodation. Year 1: subjects were observed without calorie-labeling, apart from a 5-week pilot. Year 2: calorie-labeling was present prominently and consistently at main meals for 30 of the 36 weeks. RESULTS: Mean weight changes over 36 weeks, per protocol, were +3.5 kg (95% CI = 2.8-4.1 kg) (n = 64) in Year 1 and -0.15 kg (95% CI = -0.7-0.3 kg) (n = 87) in Year 2. Weight changes were significantly different between years, for males and females (both P < 0.001). Intention-to-treat analysis showed similar results. Relative Risk for weight gain in Year 2, compared to Year 1, was 0.5 (P < 0·0001). CONCLUSIONS: Calorie-labeling was associated with a 3.5 kg less weight gain, representing a low-cost "nudging" approach to combat the rapid weight gain seen in young adults.

Serial fecal calprotectin changes in children with Crohn's disease on treatment with exclusive enteral nutrition: associations with disease activity, treatment response, and prediction of a clinical relapse.

BACKGROUND: Exclusive enteral nutrition (EEN) induces clinical remission in pediatric Crohn's disease (CD). GOALS: This study explored changes in fecal calprotectin concentration during treatment with EEN. STUDY: Fecal calprotectin was measured in 4 serial stool samples from CD children during EEN. The Pediatric Crohn's Disease Activity Index (PCDAI) and systemic markers of disease activity were measured at the beginning and end of treatment. RESULTS: Fifteen CD children (7 girls; 11.6±2.3 y) participated. PCDAI decreased in 14 children and 7 children achieved clinical remission (PCDAI ≤10). Fecal calprotectin concentration decreased (30 d, P=0.014; 60 d, P<0.0001) only in those children who entered clinical remission (PCDAI ≤10). In the whole group mean calprotectin concentration at baseline (2158±642 mg/kg) was reduced by 975 mg/kg (95% confidence interval -1783; -167) after 30 days and 1700 mg/kg (95% confidence interval -2508; -892) on EEN completion. Only one child reached normal levels by the end of EEN. Decrease of pretreatment calprotectin levels by more than 18% after 30 days on EEN predicted clinical response at the end of EEN. Calprotectin levels at the end of EEN treatment did not predict the length of time lapsed to a future relapse. CONCLUSIONS: In this pilot study calprotectin decreased in patients who achieved clinical remission and may be useful to predict response to treatment.