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Muse ED, Topol EJ. Transforming the cardiometabolic disease landscape: Multimodal AI-powered approaches in prevention and management. Cell Metab 2024; 36:670-683. [PMID: 38428435 PMCID: PMC10990799 DOI: 10.1016/j.cmet.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
The rise of artificial intelligence (AI) has revolutionized various scientific fields, particularly in medicine, where it has enabled the modeling of complex relationships from massive datasets. Initially, AI algorithms focused on improved interpretation of diagnostic studies such as chest X-rays and electrocardiograms in addition to predicting patient outcomes and future disease onset. However, AI has evolved with the introduction of transformer models, allowing analysis of the diverse, multimodal data sources existing in medicine today. Multimodal AI holds great promise in more accurate disease risk assessment and stratification as well as optimizing the key driving factors in cardiometabolic disease: blood pressure, sleep, stress, glucose control, weight, nutrition, and physical activity. In this article we outline the current state of medical AI in cardiometabolic disease, highlighting the potential of multimodal AI to augment personalized prevention and treatment strategies in cardiometabolic disease.
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Affiliation(s)
- Evan D Muse
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA 92037, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA 92037, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA 92037, USA.
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Clements MA, Kaufman N, Mel E. Using Digital Health Technology to Prevent and Treat Diabetes. Diabetes Technol Ther 2024; 26:S90-S107. [PMID: 38441446 DOI: 10.1089/dia.2024.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Mark A Clements
- Children's Mercy Hospital, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | - Neal Kaufman
- Fielding School of Public Health, Geffen School of Medicine, University of California, Los Angeles, CA
- Canary Health Inc., Los Angeles, CA
| | - Eran Mel
- Jesse Z. and Sara Lea Shaffer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Hui M, Zhang D, Ye L, Lv J, Yang L. Digital Health Interventions for Quality Improvements in Chronic Kidney Disease Primary Care: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:364. [PMID: 38256498 PMCID: PMC10816029 DOI: 10.3390/jcm13020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a significant public health issue globally. The importance of its timely identification and early intervention is paramount. However, a systematic approach for early CKD management in the primary care setting is currently lacking, receiving less attention compared to upstream risk factors such as diabetes and hypertension. This oversight may lead to a failure in meeting quality-of-care indicators. Digital health interventions (DHIs), which leverage digital tools to enhance healthcare delivery, have shown effectiveness in managing chronic diseases and improving the quality, safety, and efficiency of primary care. Our research aimed to evaluate the effectiveness of DHIs in the care process, focusing on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov for randomized controlled trials (RCTs) assessing DHIs' effectiveness in CKD patient care among adults in primary care settings. The search, conducted on 30 June 2023, included studies published in English from 1 January 2009. Screening was conducted using Covidence, adhering to Cochrane's guidelines for data extraction. We primarily evaluated changes in care processes (testing, documentation, medication use, etc.) and the use of renin-angiotensin-aldosterone system inhibitors (RAASi), referrals, among others. Multilevel meta-analysis was employed to address within-study clustering, and meta-regression analyzed the impact of study characteristics on heterogeneity in effect sizes. Clinical endpoints were recorded where available. Bias risk was assessed using the Cochrane Risk of Bias 2 tool. Data on reach, uptake, and feasibility were narratively summarized. The study is registered with PROSPERO (CRD42023449098). RESULTS From 679 records, 12 RCTs were included in the narrative synthesis, and 6 studies (encompassing 7 trials) in the meta-analysis. The trials indicated a -0.85% change (95%CI, -5.82% to 4.11%) in the proportion of patients receiving desired care. This result showed considerable heterogeneity (I2 = 91.9%). One study characteristic (co-intervention, education) correlated with larger effects. Although including co-intervention in multivariable meta-regression was significant, it did not diminish heterogeneity. The reported reach varied and was not high, while the uptake was relatively high. Most studies did not explicitly address feasibility, though some statements implied its evaluation. CONCLUSIONS The current literature on the impact of DHIs in community-based CKD care is limited. The studies suggest a non-significant effect of DHIs on enhancing CKD management in community settings, marked by significant heterogeneity. Future research should focus on rigorous, methodologically sound implementations to better assess the effectiveness of DHIs in the primary care management of CKD.
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Affiliation(s)
- Miao Hui
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
| | - Duoduo Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
| | - Lili Ye
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
| | - Jicheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
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Glock H, Borgström Bolmsjö B, Milos Nymberg V, Wolff M, Calling S. 'In the end, I'm the one who has to do the job': Participant experience of a lifestyle intervention for patients with hypertension. Scand J Prim Health Care 2023; 41:457-468. [PMID: 37882343 PMCID: PMC11001362 DOI: 10.1080/02813432.2023.2271042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE Cardiovascular disease can be prevented through lifestyle changes, but such changes are often hard to attain. Text message interventions with lifestyle advice have shown small but promising effects. Our objective was to explore participant experience of a text message lifestyle intervention for patients with hypertension, and implications for future lifestyle interventions. DESIGN AND SUBJECTS Fourteen participants were purposefully selected for telephone interviews after completion of a text message lifestyle intervention. A semi-structured interview guide with open-ended questions was used. Interviews were recorded and transcribed verbatim. The material was analyzed through systematic text condensation as described by Malterud, a data-driven analysis style that includes deductive elements. SETTING Primary care in three regions in southern Sweden. RESULTS The analysis resulted in three themes. 'Blood pressure and lifestyle, how seriously to take it?' revealed a remaining need for knowledge regarding to what extent lifestyle affects risk for cardiovascular disease. 'The text messages - a useful reminder in need of tailoring' described that the design of the intervention was satisfactory, but suggested improvements through increased individualization. Finally, 'Water off a duck's back or a kick in the pants - when does behavior change?' showed how some participants responded to the push to change while others did not, supplying material for further analysis in a framework of behavioral change theory. CONCLUSION A key to adoption was advice that was applicable in daily life. Timing in relation to a diagnosis of hypertension or other motivational factors, and tailoring to prior knowledge, habits, and limitations could increase effectiveness.
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Affiliation(s)
- Hanna Glock
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Beata Borgström Bolmsjö
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Moa Wolff
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Thomas SA, Browning CJ, Charchar FJ, Klein B, Ory MG, Bowden-Jones H, Chamberlain SR. Transforming global approaches to chronic disease prevention and management across the lifespan: integrating genomics, behavior change, and digital health solutions. Front Public Health 2023; 11:1248254. [PMID: 37905238 PMCID: PMC10613497 DOI: 10.3389/fpubh.2023.1248254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the "tsunami of chronic diseases." In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration.
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Affiliation(s)
- Shane A Thomas
- Vice Chancellor’s Office, Federation University, Ballarat, VIC, Australia
| | - Colette J Browning
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Fadi J Charchar
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Britt Klein
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Marcia G. Ory
- Center for Community Health and Aging, Texas A&M University, School of Public Health, College Station, TX, United States
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, London, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southern Gambling Service, and Southern Health NHS Foundation Trust, Southampton, United Kingdom
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Willems R, Annemans L, Siopis G, Moschonis G, Vedanthan R, Jung J, Kwasnicka D, Oldenburg B, d'Antonio C, Girolami S, Agapidaki E, Manios Y, Verhaeghe N. Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension. NPJ Digit Med 2023; 6:150. [PMID: 37596488 PMCID: PMC10439143 DOI: 10.1038/s41746-023-00876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/07/2023] [Indexed: 08/20/2023] Open
Abstract
Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold.Registration: PROSPERO (CRD42021247845).
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Affiliation(s)
- Ruben Willems
- Interuniversity Center of Health Economic Research (ICHER), department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Lieven Annemans
- Interuniversity Center of Health Economic Research (ICHER), department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - George Siopis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, Australia
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Brian Oldenburg
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Nick Verhaeghe
- Interuniversity Center of Health Economic Research (ICHER), department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Siopis G, Moschonis G, Eweka E, Jung J, Kwasnicka D, Asare BYA, Kodithuwakku V, Willems R, Verhaeghe N, Annemans L, Vedanthan R, Oldenburg B, Manios Y. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with hypertension: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health 2023; 5:e144-e159. [PMID: 36828607 DOI: 10.1016/s2589-7500(23)00002-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. FINDINGS Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a -3·62 mm Hg (95% CI -5·22 to -2·02) greater reduction in systolic blood pressure, and a -2·45 mm Hg (-3·83 to -1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (-2·45 mm Hg [-4·15 to -0·74]); however, there were no statistically significant reductions for SMS interventions (-1·80 mm Hg [-4·60 to 1·00]) or website interventions (-3·43 mm Hg [-7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. INTERPRETATION SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility. FUNDING European Union's Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- George Siopis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Evette Eweka
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Vimarsha Kodithuwakku
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium; Research Institute for Work and Society, HIVA KU Leuven, Leuven, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC, Australia; NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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