Clinical named entity recognition and relation extraction using natural language processing of medical free text: A systematic review.

BACKGROUND: Natural Language Processing (NLP) applications have developed over the past years in various fields including its application to clinical free text for named entity recognition and relation extraction. However, there has been rapid developments the last few years that there's currently no overview of it. Moreover, it is unclear how these models and tools have been translated into clinical practice. We aim to synthesize and review these developments. METHODS: We reviewed literature from 2010 to date, searching PubMed, Scopus, the Association of Computational Linguistics (ACL), and Association of Computer Machinery (ACM) libraries for studies of NLP systems performing general-purpose (i.e., not disease- or treatment-specific) information extraction and relation extraction tasks in unstructured clinical text (e.g., discharge summaries). RESULTS: We included in the review 94 studies with 30 studies published in the last three years. Machine learning methods were used in 68 studies, rule-based in 5 studies, and both in 22 studies. 63 studies focused on Named Entity Recognition, 13 on Relation Extraction and 18 performed both. The most frequently extracted entities were "problem", "test" and "treatment". 72 studies used public datasets and 22 studies used proprietary datasets alone. Only 14 studies defined clearly a clinical or information task to be addressed by the system and just three studies reported its use outside the experimental setting. Only 7 studies shared a pre-trained model and only 8 an available software tool. DISCUSSION: Machine learning-based methods have dominated the NLP field on information extraction tasks. More recently, Transformer-based language models are taking the lead and showing the strongest performance. However, these developments are mostly based on a few datasets and generic annotations, with very few real-world use cases. This may raise questions about the generalizability of findings, translation into practice and highlights the need for robust clinical evaluation.

Detecting acute respiratory diseases in the pediatric population using cough sound features and machine learning: A systematic review.

BACKGROUND: Acute respiratory diseases are a leading cause of morbidity and mortality in children. Cough is a common symptom of acute respiratory diseases and the sound of cough can be indicative of the respiratory disease. However, cough sound assessment in routine clinical practice is limited to human perception and the skills of the clinician. Objective cough sound evaluation has the potential to aid clinicians in acute respiratory disease diagnosis. In this systematic review, we assess and summarize the predictive ability of machine learning algorithms in analyzing cough sounds of acute respiratory diseases in the pediatric population. METHOD: Our systematic search of the Scopus, Medline, and Embase databases on 25 January 2023 identified six articles meeting the inclusion criteria. Quality assessment of the included studies was performed using the checklist for the assessment of medical artificial intelligence. RESULTS: Our analysis shows variability in the input to the machine learning algorithms, such as the use of various cough sound features and combining cough sound features with clinical features. The use of the machine learning algorithms also varies from conventional algorithms, such as logistic regression and support vector machine, to deep learning techniques, such as convolutional neural networks. The classification accuracy for the detection of bronchiolitis, croup, pertussis, and pneumonia across five articles is in the range of 82-96%. However, a significant drop is observed in the detection accuracy for bronchiolitis and pneumonia in the remaining article. CONCLUSION: The number of articles is limited but, in general, the predictive ability of cough sound classification algorithms in childhood acute respiratory diseases shows promise.

Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review.

Nature prescriptions are gaining popularity as a form of social prescribing in support of sustainable health care. This systematic review and meta-analysis aims to synthesise evidence on the effectiveness of nature prescriptions and determine the factors important for their success. We searched five databases from inception up to July 25, 2021. Randomised and non-randomised controlled studies featuring a nature prescription (ie, a referral or an organised programme, by a health or social professional, to encourage spending time in nature) were included. Two reviewers independently conducted all steps of study selection; one reviewer collected summary data from published reports and conducted the risk of bias assessment. Random-effect DerSimonian-Laird meta-analyses were conducted for five key outcomes. We identified 92 unique studies (122 reports), of which 28 studies contributed data to meta-analyses. Compared with control conditions, nature prescription programmes resulted in a greater reduction in systolic blood pressure (mean difference -4·82 mm Hg [-8·92 to -0·72]) and diastolic blood pressure (mean difference -3·82 mm Hg [-6·47 to -1·16). Nature prescriptions also had a moderate to large effect on depression scores (post-intervention standardised mean difference -0·50 [-0·84 to -0·16]; change from baseline standardised mean difference -0·42 [-0·82 to -0·03]) and anxiety scores (post-intervention standardised mean difference -0·57 [-1·12 to -0·03]; change from baseline standardised mean difference -1·27 [-2·20 to -0·33]). Nature prescriptions resulted in a greater increase in daily step counts than control conditions (mean difference 900 steps [790 to 1010]) but did not improve weekly time of moderate physical activity (mean difference 25·90 min [-10·26 to 62·06]). A subgroup analysis restricted to studies featuring a referring institution showed stronger effects on depression scores, daily step counts, and weekly time of moderate physical activity than the general analysis. Beneficial effects on anxiety and depression scores were mainly provided by interventions involving social professionals whereas beneficial effects on blood pressures and daily step counts were provided mainly by interventions involving health professionals. Most studies have a moderate to high risk of bias. Nature prescription programmes showed evidence of cardiometabolic and mental health benefits and increases in walking. Effective nature prescription programmes can involve a range of natural settings and activities and can be implemented via social and community channels, in addition to health professionals.

The effects of dietary supplements and natural products targeting glucose levels: an overview.

Identifying effective dietary supplements and medicinal herbs has attracted the attention of clinicians and researchers to complement the standard treatment in controlling diabetes mellitus. In the present overview, we aimed to collect studies with the highest level of evidence to shed light on detecting the most effective dietary supplements and medicinal herbs for controlling glycemic status. For the current overview, four electronic databases, including PubMed, Scopus, Web of Science, and Cochrane Library, were systematically searched from inception to 31 December 2020 and then updated until 1 October 2021 to obtain eligible meta-analyses on either dietary supplements or medicinal herbs and their effects on glycemic status. Fasting blood sugar (FBS) and Hemoglobin A1C (HbA1C) were considered as primary outcomes. Finally, ninety-one meta-analyses on dietary supplements (n = 55) and herbs (n = 36) were included. Evidence showed positive effects of chromium, zinc, propolis, aloe vera, milk thistle, fenugreek, cinnamon, ginger, and nettle on FBS and/or HbA1C. However, mostly the heterogeneity (I2) was high. Other supplements and herbs also showed no reduction in glucose levels or their effects were small. Although some dietary supplements and medicinal herbs showed a significant reduction in FBS and/or HbA1C, mostly their effects from the clinical point of view were not remarkable. In addition, due to high heterogeneity, publication bias, and a limited number of included studies in most cases further clinical trials are needed for making decision on anti-diabetic supplement efficacy.

Have Deaths of Despair Risen during the COVID-19 Pandemic? A Systematic Review.

This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates COVID-19-related disruption may not have influenced suicide rates so far, but there have been reports of increased drug-related and liver disease mortality. Minority groups and women were more vulnerable, indicating the need for stronger equity focus on pandemic recovery and resilience strategies. Further high-quality studies with longer-term follow-up, especially from low-income countries, will inform these strategies.

Digital health for climate change mitigation and response: a scoping review.

OBJECTIVE: Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change. MATERIALS AND METHODS: We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant. RESULTS: The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas. DISCUSSION: While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation. CONCLUSION: Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.

Patterns of discretionary food intake among Australian children and their association with socio-demographic, lifestyle, and adiposity measures.

AIM: Australian children consume 35% of energy from discretionary food and beverages which increases their risk of non-communicable diseases like type 2 diabetes. Despite this concerning statistic, broad analysis of the profile of discretionary food intake has not been fully undertaken. This study asks: what is the discretionary food and beverage intake profile, contribution to nutrient intakes, and associations with demographic and health characteristics? METHODS: Cross-sectional data from the 2011-12 National Nutrition and Physical Activity Survey (n = 2812, 2-18 years) were used to profile discretionary food consumption. Dietary intake was assessed by 24-h recall. General linear models tested the difference in respondent characteristics by age group, sex, and quartiles of discretionary food energy contribution. RESULTS: Ninety-nine percent of respondents consumed discretionary foods, 74% exceeded the maximum discretionary food recommended serves. Among 10 eating occasions available to select: snack, dinner, lunch and morning tea appeared to contribute 76% of discretionary food energy, with snack and dinner contributing 24% each. Age and frequency of discretionary food consumption were positively associated with energy intake from discretionary foods (p < 0.001); while sex, socio-economic status, physical activity and body composition had no association. High discretionary food consumers chose specific discretionary food items in a large quantity (1.0-3.5-serves/discretionary food) compared to low discretionary food consumers (0.4-1.4-serves/discretionary food). CONCLUSIONS: Nearly all Australian children and adolescents consumed discretionary food daily. No demographic or anthropometric characteristics beyond increasing age were associated with higher discretionary food. Targeted public health policy and community interventions are required to focus on addressing the largest contributors to discretionary food intake in terms of equivalent serve sizes, popularity, and eating occasion.

Green Space Quality and Health: A Systematic Review.

(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing. Both objectively and subjectively measured qualities demonstrated associations with health outcomes. (4) Conclusion: Experimental studies and longitudinal cohort studies will strengthen current evidence. Evidence was lacking for needs-specific or culturally-appropriate amenities and soundscape characteristics. Qualities that need more in-depth investigation include indices that account for forms, patterns, and networks of objectively and subjectively measured green space qualities.

Exploring adults' motives for food choice of sustainable diet components: a qualitative study in Tehran Metropolis.

BACKGROUND: Todays, due to the impact of human food choices on increasing greenhouse gas emissions, water consumption and environmental degradation, there is a new approach about changing the pattern of food production and consumption, including sustainable food and nutrition system related to consumption. This study aimed to explore the components of a sustainable diet among the factors that affect people's food choices. METHODS: This qualitative study was carried out using an in-depth interview with 33 individuals aged 30-64 years old living in different areas of Tehran. Data collection, data analysis and theoretical conceptualization were performed simultaneously. MAXQDA 10 software was used for managing and organizing the data. RESULTS: In this paper, the findings are categorized according to the key components of a sustainable diet in five themes: "Health and Nutrition", "Food and Agriculture Security", "Environment and Ecosystems", "Markets, food trade and production chains", "social, cultural, and policy factors" were categorized. Meanwhile, the components of the "Health and Nutrition" domain had the highest contribution and the components of the two domains "food and agriculture" and "environment and ecosystems" had the lowest role based on the participants' perception in this study. CONCLUSION: Considering to the low importance of the components of a sustainable diet in food choices of the community, promoting the individual awareness of sustainable diet components, clarifying the importance of food choices in creating environmental impacts and leading the national macro policies in the field food and nutrition toward sustainable diet goals are essential.

Green Space and Health in Mainland China: A Systematic Review.

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China's rapid urbanization and economic growth.

Online training in evidence-based medicine and research methods for GP registrars: a mixed-methods evaluation of engagement and impact.

BACKGROUND: Evidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients' care. Online EBM education could improve clinicians' skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods). METHODS: Mixed-method data collection was conducted after individual registrars' completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016-2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews. RESULTS: The data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen's d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt; some were work-place related such as time, the influence of supervisors, access to resources; and one was related to patient preferences. CONCLUSIONS: This study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor's role on GP registrars' ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.

Choosing and following a very low calorie diet program in Australia: A quasi-mixed methods study to understand experiences, barriers, and facilitators in a self-initiated environment.

AIM: In Australian adults, this study seeks to describe the experiences and factors associated with the perceived outcomes of using a very low calorie diet (VLCD) program for ≥4 weeks. METHODS: A mixed method study using the method perspective was conducted to analyse individual semi-structured interviews conducted via videoconference and cross-sectional survey data. Australians 18 to 65 years were eligible if they were currently consuming at least one VLCD product daily for ≥4 weeks or had ceased consumption within 4 weeks. Interviews were thematically analysed. RESULTS: Weight loss (19 kg [SD: 18 kg]) and duration (5 months [SD: 5 months]) of VLCD product use of the 31 participants (female: 97%, 44 [SD: 11] years, body mass index >30 kg/m2 : 84%) were strongly correlated (r = 0.73, P < .001). Participants' experiences were influenced by a journey of learning from their previous weight loss attempts, discerned the VLCD program as credible, and chose to commence the VLCD due to a convergence of internal motivators. Early health-related outcomes were a reinforcing stimulus and participants developed new health behaviours but felt dependent on the VLCD long term. Throughout these experiences the participants identified various individual, program structure, and environment related factors which either facilitated their VLCD program use or created barriers to achieving their goals. Health care professionals were minimally engaged. CONCLUSIONS: A model of care to support facilitators and overcome barriers would mean more meaningful engagement of health care professionals to ultimately improve the experience and adherence of the VLCD program users in Australia.

Efficacy and acceptability of a pilot dietary intervention focusing on self-compassion, goal-setting and self-monitoring.

OBJECTIVE: Overweight and obesity are universal health challenges. Recent evidence emphasises the potential benefits of addressing psychological factors associated with obesity in dietary programmes. This pilot study investigated the efficacy and acceptability of a combined online and face-to-face dietary intervention that used self-compassion, goal-setting and self-monitoring to improve dietary behaviour, as well as psychological factors associated with dietary behaviour. DESIGN: Embedded mixed methods including a 4-week before-after trial and a one-on-one interview. Quantitative outcomes of the study were the levels of self-compassion; eating pathology; depression, anxiety and stress; and dietary intake. Qualitative outcomes were participants' perceptions about the acceptability of the intervention. SETTING: UNSW Kensington campus. PARTICIPANTS: Fourteen participants with overweight and obesity aged between 18 and 55 years old. RESULTS: Results showed that the intervention significantly improved self-compassion and some aspects of dietary intake (e.g. decrease in energy intake) at Week Four compared with Week Zero. Some aspects of eating pathology also significantly decreased (e.g. Eating Concern). However, changes in self-compassion over the 4 weeks did not significantly predict Week Four study outcomes, except for level of stress. Most participants found self-compassion, goal-setting and self-monitoring to be essential for dietary behaviour change. However, participants also indicated that an online programme needed to be efficient, simple and interactive. CONCLUSIONS: In conclusion, the current study provides preliminary but promising findings of an effective and acceptable combined online and face-to-face intervention that used self-compassion, goal-setting and self-monitoring to improve dietary habits. However, the results need to be examined in future long-term randomised controlled trials.