TY - JOUR AU - Mandel, L. Hannah AU - Shah, N. Shruti AU - Bailey, Charles L. AU - Carton, Thomas AU - Chen, Yu AU - Esquenazi-Karonika, Shari AU - Haendel, Melissa AU - Hornig, Mady AU - Kaushal, Rainu AU - Oliveira, R. Carlos AU - Perlowski, A. Alice AU - Pfaff, Emily AU - Rao, Suchitra AU - Razzaghi, Hanieh AU - Seibert, Elle AU - Thomas, L. Gelise AU - Weiner, G. Mark AU - Thorpe, E. Lorna AU - Divers, Jasmin AU - PY - 2025/3/5 TI - Opportunities and Challenges in Using Electronic Health Record Systems to Study Postacute Sequelae of SARS-CoV-2 Infection: Insights From the NIH RECOVER Initiative JO - J Med Internet Res SP - e59217 VL - 27 KW - COVID-19 KW - SARS-CoV-2 KW - Long COVID, post-acute COVID-19 syndrome KW - electronic health records KW - machine learning KW - public health surveillance KW - post-infection syndrome KW - medical informatics KW - electronic medical record KW - electronic health record network KW - electronic health record data KW - clinical research network KW - clinical data research network KW - common data model KW - digital health KW - infection KW - respiratory KW - infectious KW - epidemiological KW - pandemic UR - https://www.jmir.org/2025/1/e59217 UR - http://dx.doi.org/10.2196/59217 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053748 ID - info:doi/10.2196/59217 ER - TY - JOUR AU - Iera, Jessica AU - Isonne, Claudia AU - Seghieri, Chiara AU - Tavoschi, Lara AU - Ceparano, Mariateresa AU - Sciurti, Antonio AU - D'Alisera, Alessia AU - Sane Schepisi, Monica AU - Migliara, Giuseppe AU - Marzuillo, Carolina AU - Villari, Paolo AU - D'Ancona, Fortunato AU - Baccolini, Valentina PY - 2025/1/15 TI - Availability and Key Characteristics of National Early Warning Systems for Emerging Profiles of Antimicrobial Resistance in High-Income Countries: Systematic Review JO - JMIR Public Health Surveill SP - e57457 VL - 11 KW - early warning system KW - surveillance KW - emerging AMR KW - high-income countries KW - antimicrobial resistance N2 - Background: The World Health Organization (WHO) recently advocated an urgent need for implementing national surveillance systems for the timely detection and reporting of emerging antimicrobial resistance (AMR). However, public information on the existing national early warning systems (EWSs) is often incomplete, and a comprehensive overview on this topic is currently lacking. Objective: This review aimed to map the availability of EWSs for emerging AMR in high-income countries and describe their main characteristics. Methods: A systematic review was performed on bibliographic databases, and a targeted search was conducted on national websites. Any article, report, or web page describing national EWSs in high-income countries was eligible for inclusion. EWSs were identified considering the emerging AMR-reporting WHO framework. Results: We identified 7 national EWSs from 72 high-income countries: 2 in the East Asia and Pacific Region (Australia and Japan), 3 in Europe and Central Asia (France, Sweden, and the United Kingdom), and 2 in North America (the United States and Canada). The systems were established quite recently; in most cases, they covered both community and hospital settings, but their main characteristics varied widely across countries in terms of the organization and microorganisms under surveillance, with also different definitions of emerging AMR and alert functioning. A formal system assessment was available only in Australia. Conclusions: A broader implementation and investment of national surveillance systems for the early detection of emerging AMR are still needed to establish EWSs in countries and regions lacking such capabilities. More standardized data collection and reporting are also advisable to improve cooperation on a global scale. Further research is required to provide an in-depth analysis of EWSs, as this study is limited to publicly available data in high-income countries. UR - https://publichealth.jmir.org/2025/1/e57457 UR - http://dx.doi.org/10.2196/57457 ID - info:doi/10.2196/57457 ER - TY - JOUR AU - Rohrer, Rebecca AU - Wilson, Allegra AU - Baumgartner, Jennifer AU - Burton, Nicole AU - Ortiz, R. Ray AU - Dorsinville, Alan AU - Jones, E. Lucretia AU - Greene, K. Sharon PY - 2025/1/14 TI - Nowcasting to Monitor Real-Time Mpox Trends During the 2022 Outbreak in New York City: Evaluation Using Reportable Disease Data Stratified by Race or Ethnicity JO - Online J Public Health Inform SP - e56495 VL - 17 KW - data quality KW - epidemiology KW - forecasting KW - infectious disease KW - morbidity and mortality trends KW - mpox KW - nowcasting KW - public health practice KW - surveillance N2 - Background: Applying nowcasting methods to partially accrued reportable disease data can help policymakers interpret recent epidemic trends despite data lags and quickly identify and remediate health inequities. During the 2022 mpox outbreak in New York City, we applied Nowcasting by Bayesian Smoothing (NobBS) to estimate recent cases, citywide and stratified by race or ethnicity (Black or African American, Hispanic or Latino, and White). However, in real time, it was unclear if the estimates were accurate. Objective: We evaluated the accuracy of estimated mpox case counts across a range of NobBS implementation options. Methods: We evaluated NobBS performance for New York City residents with a confirmed or probable mpox diagnosis or illness onset from July 8 through September 30, 2022, as compared with fully accrued cases. We used the exponentiated average log score (average score) to compare moving window lengths, stratifying or not by race or ethnicity, diagnosis and onset dates, and daily and weekly aggregation. Results: During the study period, 3305 New York City residents were diagnosed with mpox (median 4, IQR 3-5 days from diagnosis to diagnosis report). Of these, 812 (25%) had missing onset dates, and of these, 230 (28%) had unknown race or ethnicity. The median lag in days from onset to onset report was 10 (IQR 7-14). For daily hindcasts by diagnosis date, the average score was 0.27 for the 14-day moving window used in real time. Average scores improved (increased) with longer moving windows (maximum: 0.47 for 49-day window). Stratifying by race or ethnicity improved performance, with an overall average score of 0.38 for the 14-day moving window (maximum: 0.57 for 49 day-window). Hindcasts for White patients performed best, with average scores of 0.45 for the 14-day window and 0.75 for the 49-day window. For unstratified, daily hindcasts by onset date, the average score ranged from 0.16 for the 42-day window to 0.30 for the 14-day window. Performance was not improved by weekly aggregation. Hindcasts underestimated diagnoses in early August after the epidemic peaked, then overestimated diagnoses in late August as the epidemic waned. Estimates were most accurate during September when cases were low and stable. Conclusions: Performance was better when hindcasting by diagnosis date than by onset date, consistent with shorter lags and higher completeness for diagnoses. For daily hindcasts by diagnosis date, longer moving windows performed better, but direct comparisons are limited because longer windows could only be assessed after case counts in this outbreak had stabilized. Stratification by race or ethnicity improved performance and identified differences in epidemic trends across patient groups. Contributors to differences in performance across strata might include differences in case volume, epidemic trends, delay distributions, and interview success rates. Health departments need reliable nowcasting and rapid evaluation tools, particularly to promote health equity by ensuring accurate estimates within all strata. UR - https://ojphi.jmir.org/2025/1/e56495 UR - http://dx.doi.org/10.2196/56495 ID - info:doi/10.2196/56495 ER - TY - JOUR AU - Atchison, J. Christina AU - Gilby, Nicholas AU - Pantelidou, Galini AU - Clemens, Sam AU - Pickering, Kevin AU - Chadeau-Hyam, Marc AU - Ashby, Deborah AU - Barclay, S. Wendy AU - Cooke, S. Graham AU - Darzi, Ara AU - Riley, Steven AU - Donnelly, A. Christl AU - Ward, Helen AU - Elliott, Paul PY - 2025/1/9 TI - Strategies to Increase Response Rate and Reduce Nonresponse Bias in Population Health Research: Analysis of a Series of Randomized Controlled Experiments during a Large COVID-19 Study JO - JMIR Public Health Surveill SP - e60022 VL - 11 KW - study recruitment KW - response rate KW - population-based research KW - COVID-19 KW - SARS-CoV-2 KW - web-based questionnaires N2 - Background: High response rates are needed in population-based studies, as nonresponse reduces effective sample size and bias affects accuracy and decreases the generalizability of the study findings. Objective: We tested different strategies to improve response rate and reduce nonresponse bias in a national population?based COVID-19 surveillance program in England, United Kingdom. Methods: Over 19 rounds, a random sample of individuals aged 5 years and older from the general population in England were invited by mail to complete a web-based questionnaire and return a swab for SARS-CoV-2 testing. We carried out several nested randomized controlled experiments to measure the impact on response rates of different interventions, including (1) variations in invitation and reminder letters and SMS text messages and (2) the offer of a conditional monetary incentive to return a swab, reporting absolute changes in response and relative response rate (95% CIs). Results: Monetary incentives increased the response rate (completed swabs returned as a proportion of the number of individuals invited) across all age groups, sex at birth, and area deprivation with the biggest increase among the lowest responders, namely teenagers and young adults and those living in more deprived areas. With no monetary incentive, the response rate was 3.4% in participants aged 18?22 years, increasing to 8.1% with a £10 (US $12.5) incentive, 11.9% with £20 (US $25.0), and 18.2% with £30 (US $37.5) (relative response rate 2.4 [95% CI 2.0-2.9], 3.5 [95% CI 3.0-4.2], and 5.4 [95% CI 4.4-6.7], respectively). Nonmonetary strategies had a modest, if any, impact on response rate. The largest effect was observed for sending an additional swab reminder (SMS text message or email). For example, those receiving an additional SMS text message were more likely to return a completed swab compared to those receiving the standard email-SMS approach, 73.3% versus 70.2%: percentage difference 3.1% (95% CI 2.2%-4.0%). Conclusions: Conditional monetary incentives improved response rates to a web-based survey, which required the return of a swab test, particularly for younger age groups. Used in a selective way, incentives may be an effective strategy for improving sample response and representativeness in population-based studies. UR - https://publichealth.jmir.org/2025/1/e60022 UR - http://dx.doi.org/10.2196/60022 ID - info:doi/10.2196/60022 ER - TY - JOUR AU - Swets, C. Maaike AU - Kerr, R. Steven AU - MacKenna, Brian AU - Fisher, Louis AU - van Wijnen, Merel AU - Brandwagt, Diederik AU - Schenk, W. Paul AU - Fraaij, Pieter AU - Visser, G. Leonardus AU - Bacon, Sebastian AU - Mehrkar, Amir AU - Nichol, Alistair AU - Twomey, Patrick AU - Matthews, C. Philippa AU - AU - Semple, G. Malcolm AU - Groeneveld, H. Geert AU - Goldacre, Ben AU - Jones, Iain AU - Baillie, Kenneth J. PY - 2024/12/23 TI - Using Laboratory Test Results for Surveillance During a New Outbreak of Acute Hepatitis in 3-Week- to 5-Year-Old Children in the United Kingdom, the Netherlands, Ireland, and Curaçao: Observational Cohort Study JO - JMIR Public Health Surveill SP - e55376 VL - 10 KW - pediatric hepatitis KW - disease surveillance KW - outbreak detection KW - pandemic preparedness KW - acute hepatitis KW - children KW - data analytics KW - hospital KW - laboratory KW - all age groups KW - pre-pandemic KW - United Kingdom KW - Netherlands KW - Ireland Curacao KW - single center KW - federated analytics KW - pandemic surveillance KW - outbreaks KW - public health N2 - Background: In March 2022, a concerning rise in cases of unexplained pediatric hepatitis was reported in multiple countries. Cases were defined as acute hepatitis with serum transaminases >500 U/L (aspartate transaminase [AST] or alanine transaminase [ALT]) in children aged 16 years or younger. We explored a simple federated data analytics method to search for evidence of unreported cases using routinely held data. We conducted a pragmatic survey to analyze changes in the proportion of hospitalized children with elevated AST or ALT over time. In addition, we studied the feasibility of using routinely collected clinical laboratory results to detect or follow-up the outbreak of an infectious disease. Objective: We explored a simple federated data analytics method to search for evidence of unreported cases using routinely held data. Methods: We provided hospitals with a simple computational tool to enable laboratories to share nondisclosive summary-level data. Summary statistics for AST and ALT measurements were collected from the last 10 years across all age groups. Measurements were considered elevated if ALT or AST was >200 U/L. The rate of elevated AST or ALT test for 3-week- to 5-year-olds was compared between a period of interest in which cases of hepatitis were reported (December 1, 2021, to August 31, 2022) and a prepandemic baseline period (January 1, 2012, to December 31, 2019). We calculated a z score, which measures the extent to which the rate for elevated ALT or AST was higher or lower in the period of interest compared to a baseline period, for the 3-week- to 5-year-olds. Results: Our approach of sharing a simple software tool for local use enabled rapid, federated data analysis. A total of 34 hospitals in the United Kingdom, the Netherlands, Ireland, and Curaçao were asked to contribute summary data, and 30 (88%) submitted their data. For all locations combined, the rate of elevated AST or ALT measurements in the period of interest was not elevated (z score=?0.46; P=.64). Results from individual regions were discordant, with a higher rate of elevated AST or ALT values in the Netherlands (z score=4.48; P<.001), driven by results from a single center in Utrecht. We did not observe any clear indication of changes in primary care activity or test results in the same period. Conclusions: Hospital laboratories collect large amounts of data on a daily basis that can potentially be of use for disease surveillance, but these are currently not optimally used. Federated analytics using nondisclosive, summary-level laboratory data sharing was successful, safe, and efficient. The approach holds potential as a tool for pandemic surveillance in future outbreaks. Our findings do not indicate the presence of a broader outbreak of mild hepatitis cases among young children, although there was an increase in elevated AST or ALT values locally in the Netherlands. UR - https://publichealth.jmir.org/2024/1/e55376 UR - http://dx.doi.org/10.2196/55376 ID - info:doi/10.2196/55376 ER - TY - JOUR AU - Poncet, Rémy AU - Gargominy, Olivier PY - 2024/12/9 TI - In the Shadow of Medicine: The Glaring Absence of Occurrence Records of Human-Hosted Biodiversity JO - Online J Public Health Inform SP - e60140 VL - 16 KW - human microbiome KW - bacterial occurrence data KW - public health KW - one health KW - biodiversity data gap KW - medical data integration KW - medical data KW - microbiome KW - bacterial KW - bacteria KW - biodiversity KW - disease prevention KW - pathogens KW - user-friendly KW - bacterial pathogens UR - https://ojphi.jmir.org/2024/1/e60140 UR - http://dx.doi.org/10.2196/60140 ID - info:doi/10.2196/60140 ER - TY - JOUR AU - Torán-Monserrat, Pere AU - Lamonja-Vicente, Noemí AU - Costa-Garrido, Anna AU - Carrasco-Ribelles, A. Lucía AU - Quirant, Bibiana AU - Boigues, Marc AU - Molina, Xaviera AU - Chacón, Carla AU - Dacosta-Aguayo, Rosalia AU - Arméstar, Fernando AU - Martínez Cáceres, María Eva AU - Prado, G. Julia AU - Violán, Concepción AU - PY - 2024/11/22 TI - SARS-CoV-2 Infection Risk by Vaccine Doses and Prior Infections Over 24 Months: ProHEpiC-19 Longitudinal Study JO - JMIR Public Health Surveill SP - e56926 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - health care workers KW - cohort KW - extended Cox models KW - coronavirus KW - epidemiology KW - epidemiological KW - risks KW - infectious KW - respiratory KW - longitudinal KW - vaccines KW - vaccination KW - vaccinated N2 - Background: As the vaccination campaign against COVID-19 progresses, it becomes crucial to comprehend the lasting effects of vaccination on safeguarding against new infections or reinfections. Objective: This study aimed to assess the risk of new SARS-CoV-2 infections based on the number of vaccine doses, prior infections, and other clinical characteristics. Methods: We defined a cohort of 800 health care workers in a 24-month study (March 2020 to December 2022) in northern Barcelona to determine new infections by SARS-CoV-2. We used extended Cox models, specifically Andersen-Gill (AG) and Prentice-Williams-Peterson, and we examined the risk of new infections. The AG model incorporated variables such as sex, age, job title, number of chronic conditions, vaccine doses, and prior infections. Additionally, 2 Prentice-Williams-Peterson models were adjusted, one for those individuals with no or 1 infection and another for those with 2 or 3 infections, both with the same covariates as the AG model. Results: The 800 participants (n=605, 75.6% women) received 1, 2, 3, and 4 doses of the vaccine. Compared to those who were unvaccinated, the number of vaccine doses significantly reduced (P<.001) the risk of infection by 66%, 81%, 89%, and 99%, respectively. Unit increase in the number of prior infections reduced the risk of infection by 75% (P<.001). When separating individuals by number of previous infections, risk was significantly reduced for those with no or 1 infection by 61% (P=.02), and by 88%, 93%, and 99% (P<.001) with 1, 2, 3, or 4 doses, respectively. In contrast, for those with 2 or 3 previous infections, the reduction was only significant with the fourth dose, at 98% (P<.001). The number of chronic diseases only increased the risk by 28%?31% (P<.001) for individuals with 0?1 previous infections. Conclusions: The study suggests that both prior infections and vaccination status significantly contribute to SARS-CoV-2 immunity, supporting vaccine effectiveness in reducing risk of reinfection for up to 24 months after follow-up from the onset of the pandemic. These insights contribute to our understanding of long-term immunity dynamics and inform strategies for mitigating the impact of COVID-19. Trial Registration: ClinicalTrials.gov NCT04885478; http://clinicaltrials.gov/ct2/show/NCT04885478 UR - https://publichealth.jmir.org/2024/1/e56926 UR - http://dx.doi.org/10.2196/56926 ID - info:doi/10.2196/56926 ER - TY - JOUR AU - Gutiérrez-Salmeán, Gabriela AU - Miranda-Alatriste, Vanessa Paola AU - Benítez-Alday, Patricio AU - Orozco-Rivera, Enrique Luis AU - Islas-Vargas, Nurit AU - Espinosa-Cuevas, Ángeles AU - Correa-Rotter, Ricardo AU - Colin-Ramirez, Eloisa PY - 2024/11/18 TI - Knowledge, Attitudes, and Behaviors Toward Salt Consumption and Its Association With 24-Hour Urinary Sodium and Potassium Excretion in Adults Living in Mexico City: Cross-Sectional Study JO - Interact J Med Res SP - e57265 VL - 13 KW - beliefs KW - attitudes KW - hypertension KW - knowledge KW - salt consumption KW - sodium intake KW - potassium intake KW - Mexico N2 - Background: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated. Objective: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion. Methods: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the ?idák correction applied for multiple comparisons. Results: Overall, 232 participants were recruited (women, n=184, 79.3%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25%, vs 15/184, 8.2%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25%, vs 10/48, 20.8%, P=.02). Additionally, more than half of men (30/48, 62.5%) reported never or rarely reading food labels, compared with women (96/184, 52.1%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95% CI 2384.9-2783.7 mg/day, P=.01). Conclusions: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods. UR - https://www.i-jmr.org/2024/1/e57265 UR - http://dx.doi.org/10.2196/57265 UR - http://www.ncbi.nlm.nih.gov/pubmed/39556832 ID - info:doi/10.2196/57265 ER - TY - JOUR AU - Zhang, Pengfei AU - Kamitaki, K. Brad AU - Do, Phu Thien PY - 2024/11/8 TI - Crowdsourcing Adverse Events Associated With Monoclonal Antibodies Targeting Calcitonin Gene?Related Peptide Signaling for Migraine Prevention: Natural Language Processing Analysis of Social Media JO - JMIR Form Res SP - e58176 VL - 8 KW - internet KW - patient reported outcome KW - headache KW - health information KW - Reddit KW - registry KW - monoclonal antibody KW - crowdsourcing KW - postmarketing KW - safety KW - surveillance KW - migraine KW - preventives KW - prevention KW - self-reported KW - calcitonin gene?related peptide KW - calcitonin KW - therapeutics KW - social media KW - medication-related KW - posts KW - propranolol KW - topiramate KW - erenumab KW - fremanezumab KW - cross-sectional KW - surveys N2 - Background: Clinical trials demonstrate the efficacy and tolerability of medications targeting calcitonin gene?related peptide (CGRP) signaling for migraine prevention. However, these trials may not accurately reflect the real-world experiences of more diverse and heterogeneous patient populations, who often have higher disease burden and more comorbidities. Therefore, postmarketing safety surveillance is warranted. Regulatory organizations encourage marketing authorization holders to screen digital media for suspected adverse reactions, applying the same requirements as for spontaneous reports. Real-world data from social media platforms constitute a potential venue to capture diverse patient experiences and help detect treatment-related adverse events. However, while social media holds promise for this purpose, its use in pharmacovigilance is still in its early stages. Computational linguistics, which involves the automatic manipulation and quantitative analysis of oral or written language, offers a potential method for exploring this content. Objective: This study aims to characterize adverse events related to monoclonal antibodies targeting CGRP signaling on Reddit, a large online social media forum, by using computational linguistics. Methods: We examined differences in word frequencies from medication-related posts on the Reddit subforum r/Migraine over a 10-year period (2010-2020) using computational linguistics. The study had 2 phases: a validation phase and an application phase. In the validation phase, we compared posts about propranolol and topiramate, as well as posts about each medication against randomly selected posts, to identify known and expected adverse events. In the application phase, we analyzed posts discussing 2 monoclonal antibodies targeting CGRP signaling?erenumab and fremanezumab?to identify potential adverse events for these medications. Results: From 22,467 Reddit r/Migraine posts, we extracted 402 (2%) propranolol posts, 1423 (6.33%) topiramate posts, 468 (2.08%) erenumab posts, and 73 (0.32%) fremanezumab posts. Comparing topiramate against propranolol identified several expected adverse events, for example, ?appetite,? ?weight,? ?taste,? ?foggy,? ?forgetful,? and ?dizziness.? Comparing erenumab against a random selection of terms identified ?constipation? as a recurring keyword. Comparing erenumab against fremanezumab identified ?constipation,? ?depression,? ?vomiting,? and ?muscle? as keywords. No adverse events were identified for fremanezumab. Conclusions: The validation phase of our study accurately identified common adverse events for oral migraine preventive medications. For example, typical adverse events such as ?appetite? and ?dizziness? were mentioned in posts about topiramate. When we applied this methodology to monoclonal antibodies targeting CGRP or its receptor?fremanezumab and erenumab, respectively?we found no definite adverse events for fremanezumab. However, notable flagged words for erenumab included ?constipation,? ?depression,? and ?vomiting.? In conclusion, computational linguistics applied to social media may help identify potential adverse events for novel therapeutics. While social media data show promise for pharmacovigilance, further work is needed to improve its reliability and usability. UR - https://formative.jmir.org/2024/1/e58176 UR - http://dx.doi.org/10.2196/58176 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58176 ER - TY - JOUR AU - Nguyen, Minh Hieu AU - Anderson, William AU - Chou, Shih-Hsiung AU - McWilliams, Andrew AU - Zhao, Jing AU - Pajewski, Nicholas AU - Taylor, Yhenneko PY - 2024/10/28 TI - Predictive Models for Sustained, Uncontrolled Hypertension and Hypertensive Crisis Based on Electronic Health Record Data: Algorithm Development and Validation JO - JMIR Med Inform SP - e58732 VL - 12 KW - machine learning KW - risk prediction KW - predictive model KW - decision support KW - blood pressure KW - cardiovascular KW - electronic health record N2 - Background: Assessing disease progression among patients with uncontrolled hypertension is important for identifying opportunities for intervention. Objective: We aim to develop and validate 2 models, one to predict sustained, uncontrolled hypertension (?2 blood pressure [BP] readings ?140/90 mm Hg or ?1 BP reading ?180/120 mm Hg) and one to predict hypertensive crisis (?1 BP reading ?180/120 mm Hg) within 1 year of an index visit (outpatient or ambulatory encounter in which an uncontrolled BP reading was recorded). Methods: Data from 142,897 patients with uncontrolled hypertension within Atrium Health Greater Charlotte in 2018 were used. Electronic health record?based predictors were based on the 1-year period before a patient?s index visit. The dataset was randomly split (80:20) into a training set and a validation set. In total, 4 machine learning frameworks were considered: L2-regularized logistic regression, multilayer perceptron, gradient boosting machines, and random forest. Model selection was performed with 10-fold cross-validation. The final models were assessed on discrimination (C-statistic), calibration (eg, integrated calibration index), and net benefit (with decision curve analysis). Additionally, internal-external cross-validation was performed at the county level to assess performance with new populations and summarized using random-effect meta-analyses. Results: In internal validation, the C-statistic and integrated calibration index were 0.72 (95% CI 0.71?0.72) and 0.015 (95% CI 0.012?0.020) for the sustained, uncontrolled hypertension model, and 0.81 (95% CI 0.79?0.82) and 0.009 (95% CI 0.007?0.011) for the hypertensive crisis model. The models had higher net benefit than the default policies (ie, treat-all and treat-none) across different decision thresholds. In internal-external cross-validation, the pooled performance was consistent with internal validation results; in particular, the pooled C-statistics were 0.70 (95% CI 0.69?0.71) and 0.79 (95% CI 0.78?0.81) for the sustained, uncontrolled hypertension model and hypertensive crisis model, respectively. Conclusions: An electronic health record?based model predicted hypertensive crisis reasonably well in internal and internal-external validations. The model can potentially be used to support population health surveillance and hypertension management. Further studies are needed to improve the ability to predict sustained, uncontrolled hypertension. UR - https://medinform.jmir.org/2024/1/e58732 UR - http://dx.doi.org/10.2196/58732 ID - info:doi/10.2196/58732 ER - TY - JOUR AU - Lim, Sachiko AU - Johannesson, Paul PY - 2024/9/26 TI - An Ontology to Bridge the Clinical Management of Patients and Public Health Responses for Strengthening Infectious Disease Surveillance: Design Science Study JO - JMIR Form Res SP - e53711 VL - 8 KW - infectious disease KW - ontology KW - IoT KW - infectious disease surveillance KW - patient monitoring KW - infectious disease management KW - risk analysis KW - early warning KW - data integration KW - semantic interoperability KW - public health N2 - Background: Novel surveillance approaches using digital technologies, including the Internet of Things (IoT), have evolved, enhancing traditional infectious disease surveillance systems by enabling real-time detection of outbreaks and reaching a wider population. However, disparate, heterogenous infectious disease surveillance systems often operate in silos due to a lack of interoperability. As a life-changing clinical use case, the COVID-19 pandemic has manifested that a lack of interoperability can severely inhibit public health responses to emerging infectious diseases. Interoperability is thus critical for building a robust ecosystem of infectious disease surveillance and enhancing preparedness for future outbreaks. The primary enabler for semantic interoperability is ontology. Objective: This study aims to design the IoT-based management of infectious disease ontology (IoT-MIDO) to enhance data sharing and integration of data collected from IoT-driven patient health monitoring, clinical management of individual patients, and disparate heterogeneous infectious disease surveillance. Methods: The ontology modeling approach was chosen for its semantic richness in knowledge representation, flexibility, ease of extensibility, and capability for knowledge inference and reasoning. The IoT-MIDO was developed using the basic formal ontology (BFO) as the top-level ontology. We reused the classes from existing BFO-based ontologies as much as possible to maximize the interoperability with other BFO-based ontologies and databases that rely on them. We formulated the competency questions as requirements for the ontology to achieve the intended goals. Results: We designed an ontology to integrate data from heterogeneous sources, including IoT-driven patient monitoring, clinical management of individual patients, and infectious disease surveillance systems. This integration aims to facilitate the collaboration between clinical care and public health domains. We also demonstrate five use cases using the simplified ontological models to show the potential applications of IoT-MIDO: (1) IoT-driven patient monitoring, risk assessment, early warning, and risk management; (2) clinical management of patients with infectious diseases; (3) epidemic risk analysis for timely response at the public health level; (4) infectious disease surveillance; and (5) transforming patient information into surveillance information. Conclusions: The development of the IoT-MIDO was driven by competency questions. Being able to answer all the formulated competency questions, we successfully demonstrated that our ontology has the potential to facilitate data sharing and integration for orchestrating IoT-driven patient health monitoring in the context of an infectious disease epidemic, clinical patient management, infectious disease surveillance, and epidemic risk analysis. The novelty and uniqueness of the ontology lie in building a bridge to link IoT-based individual patient monitoring and early warning based on patient risk assessment to infectious disease epidemic surveillance at the public health level. The ontology can also serve as a starting point to enable potential decision support systems, providing actionable insights to support public health organizations and practitioners in making informed decisions in a timely manner. UR - https://formative.jmir.org/2024/1/e53711 UR - http://dx.doi.org/10.2196/53711 UR - http://www.ncbi.nlm.nih.gov/pubmed/39325530 ID - info:doi/10.2196/53711 ER - TY - JOUR AU - Cabrera Alvargonzalez, J. Jorge AU - Larrañaga, Ana AU - Martinez, Javier AU - Pérez Castro, Sonia AU - Rey Cao, Sonia AU - Daviña Nuñez, Carlos AU - Del Campo Pérez, Víctor AU - Duran Parrondo, Carmen AU - Suarez Luque, Silvia AU - González Alonso, Elena AU - Silva Tojo, José Alfredo AU - Porteiro, Jacobo AU - Regueiro, Benito PY - 2024/9/24 TI - Assessment of the Effective Sensitivity of SARS-CoV-2 Sample Pooling Based on a Large-Scale Screening Experience: Retrospective Analysis JO - JMIR Public Health Surveill SP - e54503 VL - 10 KW - pooling KW - sensitivity KW - SARS-CoV-2 KW - PCR KW - saliva KW - screening KW - surveillance KW - COVID-19 KW - nonsymptomatic KW - transmission control N2 - Background: The development of new large-scale saliva pooling detection strategies can significantly enhance testing capacity and frequency for asymptomatic individuals, which is crucial for containing SARS-CoV-2. Objective: This study aims to implement and scale-up a SARS-CoV-2 screening method using pooled saliva samples to control the virus in critical areas and assess its effectiveness in detecting asymptomatic infections. Methods: Between August 2020 and February 2022, our laboratory received a total of 928,357 samples. Participants collected at least 1 mL of saliva using a self-sampling kit and registered their samples via a smartphone app. All samples were directly processed using AutoMate 2550 for preanalytical steps and then transferred to Microlab STAR, managed with the HAMILTON Pooling software for pooling. The standard pool preset size was 20 samples but was adjusted to 5 when the prevalence exceeded 2% in any group. Real-time polymerase chain reaction (RT-PCR) was conducted using the Allplex SARS-CoV-2 Assay until July 2021, followed by the Allplex SARS-CoV-2 FluA/FluB/RSV assay for the remainder of the study period. Results: Of the 928,357 samples received, 887,926 (95.64%) were fully processed into 56,126 pools. Of these pools, 4863 tested positive, detecting 5720 asymptomatic infections. This allowed for a comprehensive analysis of pooling?s impact on RT-PCR sensitivity and false-negative rate (FNR), including data on positive samples per pool (PPP). We defined Ctref as the minimum cycle threshold (Ct) of each data set from a sample or pool and compared these Ctref results from pooled samples with those of the individual tests (?CtP). We then examined their deviation from the expected offset due to dilution [??CtP = ?CtP ? log2]. In this work, the ?CtP and ??CtP were 2.23 versus 3.33 and ?0.89 versus 0.23, respectively, comparing global results with results for pools with 1 positive sample per pool. Therefore, depending on the number of genes used in the test and the size of the pool, we can evaluate the FNR and effective sensitivity (1 ? FNR) of the test configuration. In our scenario, with a maximum of 20 samples per pool and 3 target genes, statistical observations indicated an effective sensitivity exceeding 99%. From an economic perspective, the focus is on pooling efficiency, measured by the effective number of persons that can be tested with 1 test, referred to as persons per test (PPT). In this study, the global PPT was 8.66, reflecting savings of over 20 million euros (US $22 million) based on our reagent prices. Conclusions: Our results demonstrate that, as expected, pooling reduces the sensitivity of RT-PCR. However, with the appropriate pool size and the use of multiple target genes, effective sensitivity can remain above 99%. Saliva pooling may be a valuable tool for screening and surveillance in asymptomatic individuals and can aid in controlling SARS-CoV-2 transmission. Further studies are needed to assess the effectiveness of these strategies for SARS-CoV-2 and their application to other microorganisms or biomarkers detected by PCR. UR - https://publichealth.jmir.org/2024/1/e54503 UR - http://dx.doi.org/10.2196/54503 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316785 ID - info:doi/10.2196/54503 ER - TY - JOUR AU - Jones, S. Brie AU - DeWitt, E. Michael AU - Wenner, J. Jennifer AU - Sanders, W. John PY - 2024/9/12 TI - Lyme Disease Under-Ascertainment During the COVID-19 Pandemic in the United States: Retrospective Study JO - JMIR Public Health Surveill SP - e56571 VL - 10 KW - surveillance KW - ascertainment KW - Lyme diseases KW - vector-borne diseases KW - vector-borne disease KW - vector-borne pathogens KW - public health KW - Lyme disease KW - United States KW - North Carolina KW - COVID-19 KW - pandemic KW - hospital KW - hospitals KW - clinic-based KW - surveillance program KW - geospatial model KW - spatiotemporal N2 - Background: The COVID-19 pandemic resulted in a massive disruption in access to care and thus passive, hospital- and clinic-based surveillance programs. In 2020, the reported cases of Lyme disease were the lowest both across the United States and North Carolina in recent years. During this period, human contact patterns began to shift with higher rates of greenspace utilization and outdoor activities, putting more people into contact with potential vectors and associated vector-borne diseases. Lyme disease reporting relies on passive surveillance systems, which were likely disrupted by changes in health care?seeking behavior during the pandemic. Objective: This study aimed to quantify the likely under-ascertainment of cases of Lyme disease during the COVID-19 pandemic in the United States and North Carolina. Methods: We fitted publicly available, reported Lyme disease cases for both the United States and North Carolina prior to the year 2020 to predict the number of anticipated Lyme disease cases in the absence of the pandemic using a Bayesian modeling approach. We then compared the ratio of reported cases divided by the predicted cases to quantify the number of likely under-ascertained cases. We then fitted geospatial models to further quantify the spatial distribution of the likely under-ascertained cases and characterize spatial dynamics at local scales. Results: Reported cases of Lyme Disease were lower in 2020 in both the United States and North Carolina than prior years. Our findings suggest that roughly 14,200 cases may have gone undetected given historical trends prior to the pandemic. Furthermore, we estimate that only 40% to 80% of Lyme diseases cases were detected in North Carolina between August 2020 and February 2021, the peak months of the COVID-19 pandemic in both the United States and North Carolina, with prior ascertainment rates returning to normal levels after this period. Our models suggest both strong temporal effects with higher numbers of cases reported in the summer months as well as strong geographic effects. Conclusions: Ascertainment rates of Lyme disease were highly variable during the pandemic period both at national and subnational scales. Our findings suggest that there may have been a substantial number of unreported Lyme disease cases despite an apparent increase in greenspace utilization. The use of counterfactual modeling using spatial and historical trends can provide insight into the likely numbers of missed cases. Variable ascertainment of cases has implications for passive surveillance programs, especially in the trending of disease morbidity and outbreak detection, suggesting that other methods may be appropriate for outbreak detection during disturbances to these passive surveillance systems. UR - https://publichealth.jmir.org/2024/1/e56571 UR - http://dx.doi.org/10.2196/56571 ID - info:doi/10.2196/56571 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9730 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9730 ID - info:doi/10.5210/ojphi.v11i1.9730 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9735 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9735 ID - info:doi/10.5210/ojphi.v11i1.9735 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9736 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9736 ID - info:doi/10.5210/ojphi.v11i1.9736 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9737 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9737 ID - info:doi/10.5210/ojphi.v11i1.9737 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9738 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9738 ID - info:doi/10.5210/ojphi.v11i1.9738 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9739 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9739 ID - info:doi/10.5210/ojphi.v11i1.9739 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9740 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9740 ID - info:doi/10.5210/ojphi.v11i1.9740 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9741 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9741 ID - info:doi/10.5210/ojphi.v11i1.9741 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9742 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9742 ID - info:doi/10.5210/ojphi.v11i1.9742 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9743 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9743 ID - info:doi/10.5210/ojphi.v11i1.9743 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9744 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9744 ID - info:doi/10.5210/ojphi.v11i1.9744 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9745 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9745 ID - info:doi/10.5210/ojphi.v11i1.9745 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9746 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9746 ID - info:doi/10.5210/ojphi.v11i1.9746 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9747 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9747 ID - info:doi/10.5210/ojphi.v11i1.9747 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9748 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9748 ID - info:doi/10.5210/ojphi.v11i1.9748 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9749 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9749 ID - info:doi/10.5210/ojphi.v11i1.9749 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9750 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9750 ID - info:doi/10.5210/ojphi.v11i1.9750 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9751 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9751 ID - info:doi/10.5210/ojphi.v11i1.9751 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9752 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9752 ID - info:doi/10.5210/ojphi.v11i1.9752 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9753 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9753 ID - info:doi/10.5210/ojphi.v11i1.9753 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9754 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9754 ID - info:doi/10.5210/ojphi.v11i1.9754 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9756 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9756 ID - info:doi/10.5210/ojphi.v11i1.9756 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9757 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9757 ID - info:doi/10.5210/ojphi.v11i1.9757 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9758 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9758 ID - info:doi/10.5210/ojphi.v11i1.9758 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9759 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9759 ID - info:doi/10.5210/ojphi.v11i1.9759 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9760 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9760 ID - info:doi/10.5210/ojphi.v11i1.9760 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9761 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9761 ID - info:doi/10.5210/ojphi.v11i1.9761 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9762 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9762 ID - info:doi/10.5210/ojphi.v11i1.9762 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9763 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9763 ID - info:doi/10.5210/ojphi.v11i1.9763 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9764 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9764 ID - info:doi/10.5210/ojphi.v11i1.9764 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9765 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9765 ID - info:doi/10.5210/ojphi.v11i1.9765 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9766 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9766 ID - info:doi/10.5210/ojphi.v11i1.9766 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9767 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9767 ID - info:doi/10.5210/ojphi.v11i1.9767 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9768 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9768 ID - info:doi/10.5210/ojphi.v11i1.9768 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9769 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9769 ID - info:doi/10.5210/ojphi.v11i1.9769 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9770 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9770 ID - info:doi/10.5210/ojphi.v11i1.9770 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9771 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9771 ID - info:doi/10.5210/ojphi.v11i1.9771 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9772 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9772 ID - info:doi/10.5210/ojphi.v11i1.9772 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9773 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9773 ID - info:doi/10.5210/ojphi.v11i1.9773 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9774 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9774 ID - info:doi/10.5210/ojphi.v11i1.9774 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9776 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9776 ID - info:doi/10.5210/ojphi.v11i1.9776 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9779 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9779 ID - info:doi/10.5210/ojphi.v11i1.9779 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9780 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9780 ID - info:doi/10.5210/ojphi.v11i1.9780 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9789 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9789 ID - info:doi/10.5210/ojphi.v11i1.9789 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9817 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9817 ID - info:doi/10.5210/ojphi.v11i1.9817 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9942 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9942 ID - info:doi/10.5210/ojphi.v11i1.9942 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9943 VL - 11 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i1.9943 ID - info:doi/10.5210/ojphi.v11i1.9943 ER - TY - JOUR PY - 2018// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e8299 VL - 10 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v10i1.8299 ID - info:doi/10.5210/ojphi.v10i1.8299 ER - TY - JOUR PY - 2018// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e8302 VL - 10 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v10i1.8302 ID - info:doi/10.5210/ojphi.v10i1.8302 ER - TY - JOUR PY - 2018// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e8319 VL - 10 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v10i1.8319 ID - info:doi/10.5210/ojphi.v10i1.8319 ER - TY - JOUR PY - 2018// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e8321 VL - 10 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v10i1.8321 ID - info:doi/10.5210/ojphi.v10i1.8321 ER - TY - JOUR PY - 2018// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e8322 VL - 10 IS - 1 UR - UR - http://dx.doi.org/10.5210/ojphi.v10i1.8322 ID - info:doi/10.5210/ojphi.v10i1.8322 ER - TY - JOUR PY - 2018// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e8323 VL - 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