1
|
Siette J, Guion J, Ijaz K, Strutt P, Porte M, Savage G, Richards D. Development of a new computer simulated environment to screen cognition: assessing the feasibility and acceptability of Leaf Café in younger and older adults. BMC Med Inform Decis Mak 2024; 24:79. [PMID: 38504250 PMCID: PMC10949698 DOI: 10.1186/s12911-024-02478-3] [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] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Existing traditional cognitive screening tools for dementia have various limitations, including overreliance on tests assessing verbal memory and, to a lesser extent, on some aspects of executive functioning. Comprehensive neuropsychological assessment is sensitive to impairment but time-intensive and expensive. Virtual reality may provide a dynamic and unique understanding of cognitive performance and increase the ecological validity of cognitive assessment. The use of virtual reality in screening for cognitive function in older persons is promising, but evidence for its use remains sparse. OBJECTIVE Our primary aim was to examine the feasibility and acceptability of a newly developed, virtual reality assessment module, 'Leaf Café', a computer-based program that assesses cognition in an engaging, efficient, and ecologically relevant way. The secondary aim was to assess the ability of the module to discriminate between performances of younger and older adults. METHODS A cross-sectional study was carried out in Sydney, Australia, targeting adults aged 18 years and above. Participants completed a traditional cognitive screening tool (Telephone Interview for Cognitive Status-Modified, TICS-M) and Leaf Café, a low-immersive virtual reality module designed to evaluate learning and memory, perceptual-motor function, and executive functioning. The total performance score for each participant, ranging from 0 to 180, was correlated with their cognitive performance assessed by TICS-M, using Pearson's correlation coefficient. Following module completion, participants were presented with an open and closed-question survey to capture their perceptions, attitudes, and feedback on the module, encompassing practicality, acceptability, and enjoyment. Both descriptive and content analyses were employed to interpret the obtained data. RESULTS A sample of 131 participants (mean age 54.9 years, SD = 20.8, range 20-85) took part. The majority were female (71.8%) and born in an English-speaking country (75.8%). The mean amount of time spent in the module was 32.8 min (SD = 13.3) with a mean module score of 107.6 (SD = 38.7). Most participants completed the highest level (5; 80.5%). There was a significant correlation between Leaf Café total scores with TICS-M cognitive scores overall, and for both younger (aged 18-64 years) and older adult (aged 65 + years) groups. No significant difference was found on performance between age groups on TICS-M performance, however, younger adults had significantly better performance on the Leaf Café module than older adults (M = 124.1 vs 95.9; p < .001). Participants had similar response proportions regarding user experience with most agreeing that the module was easy to use (84%) and to navigate (85%). Compared with younger adults, older adults had lower rates of agreement on the module's design (36.8% vs 64.3%; p = .020) and support experienced (20.5% vs 53.6%; p = .007). Participants highlighted the significance of practicality and the cognitive challenges presented by the module, in terms of memory strain and user interface concerns. Feedback encompassed different opinions on the usefulness of music, with suggestions for improvements centred around clearer instructions, varied game dynamics, and considerations for diverse user needs. CONCLUSIONS Leaf Café is a feasible and acceptable tool to be used for screening for cognitive impairment in older adults and has real-world assessment value. Further verification on the game's utility in detecting cognitive impairment is required.
Collapse
Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia.
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - Jonathan Guion
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia
| | - Kiran Ijaz
- Affective Interactions Lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Paul Strutt
- School of Psychology, Western Sydney University, Kingswood, NSW, 2747, Australia
| | - Meredith Porte
- School of Computing, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Greg Savage
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Deborah Richards
- School of Computing, Macquarie University, Macquarie Park, NSW, 2109, Australia
| |
Collapse
|
2
|
Jahan E, Almansour R, Ijaz K, Baptista S, Giordan LB, Ronto R, Zaman S, O'Hagan E, Laranjo L. Smartphone Applications to Prevent Type 2 Diabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2024:S0749-3797(24)00021-7. [PMID: 38272243 DOI: 10.1016/j.amepre.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Evidence supporting the use of apps for lifestyle behavior change and diabetes prevention in people at high risk of diabetes is lacking. The aim of this systematic review was to determine the acceptability and effectiveness of smartphone applications (apps) for the prevention of type 2 diabetes. METHODS PubMed, Embase, CINAHL and PsychInfo were searched from 2008 to 2023. Included studies involved adults at high risk of developing diabetes evaluating an app intervention with the aim of preventing type 2 diabetes. Random-effects meta-analyses were conducted for weight loss, body mass index (BMI), glycated hemoglobin, and waist circumference. Narrative synthesis was conducted for all studies, including qualitative studies exploring user perspectives. RESULTS Twenty-four studies (n=2,378) were included in this systematic review, including 9 randomized controlled trials (RCTs) with an average duration of 6 months, 10 quasi-experimental and 7 qualitative studies. Socially disadvantaged groups were poorly represented. Six RCTs were combined in meta-analyses. Apps were effective at promoting weight loss [mean difference (MD) -1.85; 95% CI -2.90 to -0.80] and decreasing BMI [MD -0.90, 95% CI -1.53 to -0.27], with no effect on glycated hemoglobin and waist circumference. No studies reported on diabetes incidence. Qualitative studies highlighted the need for app personalization. DISCUSSION Smartphone apps have a promising effect on preventing type 2 diabetes by supporting weight loss. Future robust trials should include diverse populations in co-design and evaluation of apps and explore the role of artificial intelligence in further personalizing interventions for higher engagement and effectiveness.
Collapse
Affiliation(s)
- Esrat Jahan
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia; Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rawan Almansour
- College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaira Baptista
- The Australian Centre for Behavioural Research in Diabetes, Deakin University and the University of Melbourne, Melbourne, Victoria, Australia
| | - Leticia Bezerra Giordan
- Northern Beaches Hospital, 105 French's Forest Rd W, French's Forest, Sydney, NSW, Australia
| | - Rimante Ronto
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
3
|
Fraile Navarro D, Ijaz K, Rezazadegan D, Rahimi-Ardabili H, Dras M, Coiera E, Berkovsky S. Clinical named entity recognition and relation extraction using natural language processing of medical free text: A systematic review. Int J Med Inform 2023; 177:105122. [PMID: 37295138 DOI: 10.1016/j.ijmedinf.2023.105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/09/2022] [Revised: 04/14/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
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.
Collapse
Affiliation(s)
- David Fraile Navarro
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Dana Rezazadegan
- Department of Computer Science and Software Engineering. School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mark Dras
- Department of Computing, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Shlomo Berkovsky
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
4
|
Jan A, Ali S, Muhammad B, Arshad A, Shah Y, Bahadur H, Khan H, Khuda F, Akbar R, Ijaz K. Decoding type 2 diabetes mellitus genetic risk variants in Pakistani Pashtun ethnic population using the nascent whole exome sequencing and MassARRAY genotyping: A case-control association study. PLoS One 2023; 18:e0281070. [PMID: 36730981 PMCID: PMC9882913 DOI: 10.1371/journal.pone.0281070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023] Open
Abstract
Genome-wide association studies have greatly increased the number of T2DM associated risk variants but most of them have focused on populations of European origin. There is scarcity of such studies in developing countries including Pakistan. High prevalence of T2DM in Pakistani population prompted us to design this study. We have devised a two stage (the discovery stage and validation stage) case-control study in Pashtun ethnic population in which 500 T2DM cases and controls each have been recruited to investigate T2DM genetic risk variants. In discovery stage Whole Exome Sequencing (WES) was used to identify and suggest T2DM pathogenic SNPs, based on SIFT and Polyphen scores; whereas in validation stage the selected variants were confirmed for T2DM association using MassARRAY genotyping and appropriate statistical tests. Results of the study showed the target positive association of rs1801282/PPARG (OR = 1.24, 95%Cl = 1.20-1.46, P = 0.010), rs745975/HNF4A (OR = 1.30, 95%Cl = 1.06-1.38, P = 0.004), rs806052/GLIS3 (OR = 1.32, 95%Cl = 1.07-1.66, P = 0.016), rs8192552/MTNR1B (OR = 1.53, 95%Cl = 0.56-1.95, P = 0.012) and rs1805097/IRS-2 (OR = 1.27, 95%Cl = 1.36-1.92, P = 0.045), with T2DM; whereas rs6415788/GLIS3, rs61788900/NOTCH2, rs61788901/NOTCH2 and rs11810554/NOTCH2 (P>0.05) showed no significant association. Identification of genetic risk factors/variants can be used in defining high risk subjects assessment, and disease prevention.
Collapse
Affiliation(s)
- Asif Jan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
- * E-mail: (ZU); (AJ)
| | - Sajid Ali
- Department of Biotechnology, Abdul Wali Khan University, Mardan, Pakistan
| | - Basir Muhammad
- Atomic Energy Cancer Hospital, Swat Institute of Nuclear Medicine, Oncology & Radiotherapy, Swat, Pakistan
| | - Amina Arshad
- Rashid Latif College of Pharmacy, Lahore, Pakistan
| | - Yasar Shah
- Department of Pharmacy, Abdul Wali Khan University, Mardan, Pakistan
| | - Haji Bahadur
- Institute of Pharmaceutical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Hamayun Khan
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Fazli Khuda
- Department of Pharmacy, University of Peshawar, Peshawar, Pakistan
| | - Rani Akbar
- Department of Pharmacy, Abdul Wali Khan University, Mardan, Pakistan
| | - Kiran Ijaz
- Institute of Pharmaceutical Sciences, Khyber Medical University, Peshawar, Pakistan
| |
Collapse
|
5
|
Siette J, Dodds L, Dawes P, Richards D, Savage G, Strutt P, Ijaz K, Johnco C, Wuthrich V, Heger I, Deckers K, Köhler S, Armitage CJ. Protocol for a pre-post, mixed-methods feasibility study of the Brain Bootcamp behaviour change intervention to promote healthy brain ageing in older adults. PLoS One 2022; 17:e0272517. [PMID: 36445869 PMCID: PMC9707764 DOI: 10.1371/journal.pone.0272517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Behaviour change interventions represent key means for supporting healthy ageing and reducing dementia risk yet brief, scalable behaviour change interventions targeting dementia risk reduction in older adults is currently lacking. Here we describe the aims and design of the three-month Brain Bootcamp initiative that seeks to target multiple dementia risk and protective factors (healthy eating, physical, social and cognitive inactivity), through the use of multiple behaviour change techniques, including goal-setting for behaviour, information about health consequences and physical prompts to change behaviours that reduce dementia risk among older adults. Our secondary aim is to understand participants' views of dementia prevention and explore the acceptability and integration of this campaign into daily life. METHODS Brain Bootcamp is a pre-post feasibility trial conducted in Sydney, Australia beginning in January 2021 until late August. Participants aged ≥65 years living independently in the community (n = 252), recruited through social media and flyers, will provide information about their demographics, medical history, alcohol consumption, smoking habits, mental health, physical activity, cognitive activity, and diet to generate a dementia risk profile at baseline and assess change therein at three-month follow-up. During the intervention, participants will receive a resource pack containing their individual risk profile, educational booklet on dementia risk factors and four physical items designed to prompt physical, social and mental activity, and better nutrition. Outcome measures include change in dementia risk scores, dementia awareness and motivation. A qualitative process evaluation will interview a sample of participants on the acceptability and feasibility of the intervention. DISCUSSION This will be the first short-term multi-domain intervention targeting dementia risk reduction in older adults. Findings will generate a new evidence base on how to best support efforts targeting lifestyle changes and to identify ways to optimise acceptability and effectiveness towards brain health for older adults. TRIAL REGISTRATION NUMBER ACTRN 381046 (registered 17/02/2021); Pre-results.
Collapse
Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
| | - Laura Dodds
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Piers Dawes
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Deborah Richards
- Department of Computing, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Greg Savage
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Paul Strutt
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
- Department of Cognitive Science, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carly Johnco
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana Wuthrich
- Department of Psychology, Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, New South Wales, Australia
| | - Irene Heger
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
6
|
Tong HL, Quiroz JC, Kocaballi AB, Ijaz K, Coiera E, Chow CK, Laranjo L. A personalized mobile app for physical activity: An experimental mixed-methods study. Digit Health 2022; 8:20552076221115017. [PMID: 35898287 PMCID: PMC9309778 DOI: 10.1177/20552076221115017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To investigate the feasibility of the be.well app and its personalization
approach which regularly considers users’ preferences, amongst university
students. Methods We conducted a mixed-methods, pre-post experiment, where participants used
the app for 2 months. Eligibility criteria included: age 18–34 years; owning
an iPhone with Internet access; and fluency in English. Usability was
assessed by a validated questionnaire; engagement metrics were reported.
Changes in physical activity were assessed by comparing the difference in
daily step count between baseline and 2 months. Interviews were conducted to
assess acceptability; thematic analysis was conducted. Results Twenty-three participants were enrolled in the study (mean age = 21.9 years,
71.4% women). The mean usability score was 5.6 ± 0.8 out of 7. The median
daily engagement time was 2 minutes. Eighteen out of 23 participants used
the app in the last month of the study. Qualitative data revealed that
people liked the personalized activity suggestion feature as it was
actionable and promoted user autonomy. Some users also expressed privacy
concerns if they had to provide a lot of personal data to receive highly
personalized features. Daily step count increased after 2 months of the
intervention (median difference = 1953 steps/day, p-value
<.001, 95% CI 782 to 3112). Conclusions Incorporating users’ preferences in personalized advice provided by a
physical activity app was considered feasible and acceptable, with
preliminary support for its positive effects on daily step count. Future
randomized studies with longer follow up are warranted to determine the
effectiveness of personalized mobile apps in promoting physical
activity.
Collapse
Affiliation(s)
- Huong Ly Tong
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| |
Collapse
|
7
|
Tangari G, Ikram M, Sentana IWB, Ijaz K, Kaafar MA, Berkovsky S. Analyzing security issues of android mobile health and medical applications. J Am Med Inform Assoc 2021; 28:2074-2084. [PMID: 34338763 DOI: 10.1093/jamia/ocab131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/11/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We conduct a first large-scale analysis of mobile health (mHealth) apps available on Google Play with the goal of providing a comprehensive view of mHealth apps' security features and gauging the associated risks for mHealth users and their data. MATERIALS AND METHODS We designed an app collection platform that discovered and downloaded more than 20 000 mHealth apps from the Medical and Health & Fitness categories on Google Play. We performed a suite of app code and traffic measurements to highlight a range of app security flaws: certificate security, sensitive or unnecessary permission requests, malware presence, communication security, and security-related concerns raised in user reviews. RESULTS Compared to baseline non-mHealth apps, mHealth apps generally adopt more reliable signing mechanisms and request fewer dangerous permissions. However, significant fractions of mHealth apps expose users to serious security risks. Specifically, 1.8% of mHealth apps package suspicious codes (eg, trojans), 45.0% rely on unencrypted communication, and as much as 23.0% of personal data (eg, location information and passwords) is sent on unsecured traffic. An analysis of the app reviews reveals that mHealth app users are largely unaware of the surfaced security issues. CONCLUSION Despite being better aligned with security best practices than non-mHealth apps, mHealth apps are still far from ensuring robust security guarantees. App users, clinicians, technology developers, and policy makers alike should be cognizant of the uncovered security issues and weigh them carefully against the benefits of mHealth apps.
Collapse
Affiliation(s)
| | - Muhammad Ikram
- Department of Computing, Macquarie University, Sydney, Australia
| | | | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie
| | | | - Shlomo Berkovsky
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie
| |
Collapse
|
8
|
Abstract
OBJECTIVES To investigate whether and what user data are collected by health related mobile applications (mHealth apps), to characterise the privacy conduct of all the available mHealth apps on Google Play, and to gauge the associated risks to privacy. DESIGN Cross sectional study SETTING: Health related apps developed for the Android mobile platform, available in the Google Play store in Australia and belonging to the medical and health and fitness categories. PARTICIPANTS Users of 20 991 mHealth apps (8074 medical and 12 917 health and fitness found in the Google Play store: in-depth analysis was done on 15 838 apps that did not require a download or subscription fee compared with 8468 baseline non-mHealth apps. MAIN OUTCOME MEASURES Primary outcomes were characterisation of the data collection operations in the apps code and of the data transmissions in the apps traffic; analysis of the primary recipients for each type of user data; presence of adverts and trackers in the app traffic; audit of the app privacy policy and compliance of the privacy conduct with the policy; and analysis of complaints in negative app reviews. RESULTS 88.0% (n=18 472) of mHealth apps included code that could potentially collect user data. 3.9% (n=616) of apps transmitted user information in their traffic. Most data collection operations in apps code and data transmissions in apps traffic involved external service providers (third parties). The top 50 third parties were responsible for most of the data collection operations in app code and data transmissions in app traffic (68.0% (2140), collectively). 23.0% (724) of user data transmissions occurred on insecure communication protocols. 28.1% (5903) of apps provided no privacy policies, whereas 47.0% (1479) of user data transmissions complied with the privacy policy. 1.3% (3609) of user reviews raised concerns about privacy. CONCLUSIONS This analysis found serious problems with privacy and inconsistent privacy practices in mHealth apps. Clinicians should be aware of these and articulate them to patients when determining the benefits and risks of mHealth apps.
Collapse
Affiliation(s)
| | - Muhammad Ikram
- Department of Computing, Macquarie University, Sydney, NSW, Australia
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | | | - Shlomo Berkovsky
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
9
|
Ellis LA, Lee MD, Ijaz K, Smith J, Braithwaite J, Yin K. COVID-19 as 'Game Changer' for the Physical Activity and Mental Well-Being of Augmented Reality Game Players During the Pandemic: Mixed Methods Survey Study. J Med Internet Res 2020; 22:e25117. [PMID: 33284781 PMCID: PMC7758086 DOI: 10.2196/25117] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Location-based augmented reality (AR) games, such as Pokémon GO and Harry Potter: Wizards Unite, have been shown to have a beneficial impact on the physical activity, social connectedness, and mental health of their players. In March 2020, global social distancing measures related to the COVID-19 pandemic prompted the AR games developer Niantic Inc to implement several changes to ensure continued player engagement with Pokémon GO and Harry Potter: Wizards Unite. We sought to examine how the physical and mental well-being of players of these games were affected during the unprecedented COVID-19 restriction period as well as how their video game engagement was affected. OBJECTIVE The aims of this study were to examine the impact of COVID-19-related social restrictions on the physical and mental well-being of AR game players; to examine the impact of COVID-19-related social restrictions on the use of video games and motivations for their use; and to explore the potential role of AR games (and video games in general) in supporting well-being during COVID-19-related social restrictions. METHODS A mixed methods web-based self-reported survey was conducted in May 2020, during which COVID-19-related social restrictions were enforced in many countries. Participants were recruited on the web via four subreddits dedicated to Pokémon GO or Harry Potter: Wizards Unite. Data collected included quantitative data on demographics, time spent playing video games, physical activity, and mental health; qualitative data included motivations to play and the impact of video games on mental health during COVID-19 lockdown. RESULTS We report results for 2004 participants (1153/1960 male, 58.8%, average age 30.5 years). Self-reported physical activity during COVID-19-related social restrictions significantly decreased from 7.50 hours per week on average (SD 11.12) to 6.50 hours (SD 7.81) (P<.001). More than half of the participants reported poor mental health (925/1766, 52.4%; raw World Health Organization-5 Well-Being Index score <13). Female gender, younger age, and reduced exercise were significant predictors of poor mental health. Participants reported a significant increase in video game play time from 16.38 hours per week on average (SD 19.12) to 20.82 hours (SD 17.49) (P<.001). Approximately three quarters of the participants (n=1102/1427, 77.2%) reported that playing video games had been beneficial to their mental health. The changes made to Pokémon GO and Harry Potter: Wizards Unite were very well received by players, and the players continued to use these games while exercising and to maintain social connection. In addition to seeking an escape during the pandemic and as a form of entertainment, participants reported that they used video games for emotional coping and to lower stress, relax, and alleviate mental health conditions. CONCLUSIONS AR games have the potential to promote physical and mental health during the COVID-19 pandemic. Used by populations under isolation and distress, these games can improve physical and mental health by providing virtual socialization, sustained exercise, temporal routine, and mental structure. Further research is needed to explore the potential of AR games as digital behavioral interventions to maintain human well-being in the wider population.
Collapse
Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Matthew D Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - James Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Kathleen Yin
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| |
Collapse
|
10
|
Kocaballi AB, Ijaz K, Laranjo L, Quiroz JC, Rezazadegan D, Tong HL, Willcock S, Berkovsky S, Coiera E. Envisioning an artificial intelligence documentation assistant for future primary care consultations: A co-design study with general practitioners. J Am Med Inform Assoc 2020; 27:1695-1704. [PMID: 32845984 PMCID: PMC7671614 DOI: 10.1093/jamia/ocaa131] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The study sought to understand the potential roles of a future artificial intelligence (AI) documentation assistant in primary care consultations and to identify implications for doctors, patients, healthcare system, and technology design from the perspective of general practitioners. MATERIALS AND METHODS Co-design workshops with general practitioners were conducted. The workshops focused on (1) understanding the current consultation context and identifying existing problems, (2) ideating future solutions to these problems, and (3) discussing future roles for AI in primary care. The workshop activities included affinity diagramming, brainwriting, and video prototyping methods. The workshops were audio-recorded and transcribed verbatim. Inductive thematic analysis of the transcripts of conversations was performed. RESULTS Two researchers facilitated 3 co-design workshops with 16 general practitioners. Three main themes emerged: professional autonomy, human-AI collaboration, and new models of care. Major implications identified within these themes included (1) concerns with medico-legal aspects arising from constant recording and accessibility of full consultation records, (2) future consultations taking place out of the exam rooms in a distributed system involving empowered patients, (3) human conversation and empathy remaining the core tasks of doctors in any future AI-enabled consultations, and (4) questioning the current focus of AI initiatives on improved efficiency as opposed to patient care. CONCLUSIONS AI documentation assistants will likely to be integral to the future primary care consultations. However, these technologies will still need to be supervised by a human until strong evidence for reliable autonomous performance is available. Therefore, different human-AI collaboration models will need to be designed and evaluated to ensure patient safety, quality of care, doctor safety, and doctor autonomy.
Collapse
Affiliation(s)
- A Baki Kocaballi
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Faculty of Engineering & IT, University of Technology Sydney, Sydney, Australia
| | - Kiran Ijaz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Liliana Laranjo
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Juan C Quiroz
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Dana Rezazadegan
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Faculty of Science, Engineering and Technology, Swinburne University of Technology, Victoria, Australia
| | - Huong Ly Tong
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Simon Willcock
- Health Sciences Centre, Macquarie University, Sydney, Australia
| | - Shlomo Berkovsky
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
11
|
Ijaz K, Ahmadpour N, Naismith SL, Calvo RA. An Immersive Virtual Reality Platform for Assessing Spatial Navigation Memory in Predementia Screening: Feasibility and Usability Study. JMIR Ment Health 2019; 6:e13887. [PMID: 31482851 PMCID: PMC6751096 DOI: 10.2196/13887] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/16/2019] [Accepted: 07/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Traditional methods for assessing memory are expensive and have high administrative costs. Memory assessment is important for establishing cognitive impairment in cases such as detecting dementia in older adults. Virtual reality (VR) technology can assist in establishing better quality outcome in such crucial screening by supporting the well-being of individuals and offering them an engaging, cognitively challenging task that is not stressful. However, unmet user needs can compromise the validity of the outcome. Therefore, screening technology for older adults must address their specific design and usability requirements. OBJECTIVE This study aimed to design and evaluate the feasibility of an immersive VR platform to assess spatial navigation memory in older adults and establish its compatibility by comparing the outcome to a standard screening platform on a personal computer (PC). METHODS VR-CogAssess is a platform integrating an Oculus Rift head-mounted display and immersive photorealistic imagery. In a pilot study with healthy older adults (N=42; mean age 73.22 years, SD 9.26), a landmark recall test was conducted, and assessment on the VR-CogAssess was compared against a standard PC (SPC) setup. RESULTS Results showed that participants in VR were significantly more engaged (P=.003), achieved higher landmark recall scores (P=.004), made less navigational mistakes (P=.04), and reported a higher level of presence (P=.002) than those in SPC setup. In addition, participants in VR indicated no significantly higher stress than SPC setup (P=.87). CONCLUSIONS The study findings suggest immersive VR is feasible and compatible with SPC counterpart for spatial navigation memory assessment. The study provides a set of design guidelines for creating similar platforms in the future.
Collapse
Affiliation(s)
- Kiran Ijaz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Naseem Ahmadpour
- Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, Australia
| | | | - Rafael A Calvo
- School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia.,Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| |
Collapse
|
12
|
Allman-Farinelli M, Ijaz K, Tran H, Pallotta H, Ramos S, Liu J, Wellard-Cole L, Calvo RA. A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability. JMIR Form Res 2019; 3:e12456. [PMID: 30684440 PMCID: PMC6682284 DOI: 10.2196/12456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. Objective The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. Methods Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. Results One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). Conclusions Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy.
Collapse
Affiliation(s)
- Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Kiran Ijaz
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Helen Tran
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Hermes Pallotta
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Sidney Ramos
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Junya Liu
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Lyndal Wellard-Cole
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, University of Sydney, Australia
| | - Rafael A Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| |
Collapse
|
13
|
Galgalo T, Dalal S, Cain KP, Oeltmann J, Tetteh C, Kamau JG, Njenga MK, Breiman RF, Chakaya JM, Irimu HM, Miller B, De Cock KM, Bock NN, Ijaz K. Tuberculosis risk among staff of a large public hospital in Kenya. Int J Tuberc Lung Dis 2008; 12:949-954. [PMID: 18647456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
SETTING In sub-Saharan Africa, high rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection pose a serious threat for occupationally acquired TB among health care workers. OBJECTIVE To identify factors associated with TB disease among staff of an 1800-bed hospital in Kenya. DESIGN We calculated TB incidence among staff and conducted a case-control study where cases (n = 65) were staff diagnosed with TB and controls (n = 316) were randomly selected staff without recent TB. RESULTS The annual incidence of TB from 2001 to 2005 ranged from 645 to 1115 per 100000 population. Factors associated with TB disease were additional daily hours spent in rooms with patients (adjusted odds ratio [aOR] 1.3, 95%CI 1.2-1.5), working in areas where TB patients received care (aOR 2.1, 95%CI 1.1-4.2), HIV infection (aOR 29.1, 95%CI 5.1-167) and living in a slum (aOR 4.7, 95%CI 1.8-12.5) or hospital-provided low-income housing (aOR 2.6, 95%CI 1.2-5.6). CONCLUSION Hospital exposures were associated with TB disease among staff at this hospital regardless of their job designation, even after controlling for living conditions, suggesting transmission from patients. Health care facilities should improve infection control practices, provide quality occupational health services and encourage staff testing for HIV infection to address the TB burden in hospital staff.
Collapse
Affiliation(s)
- T Galgalo
- Field Epidemiology and Laboratory Training Programme, Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Jones E, Broaders S, Strazdas L, Ijaz K. Antimicrobial Effectiveness of an Alcohol-Based Hand Sanitizing Spray Against an Expanded Panel of 62 Different Bacteria and Fungi. Am J Infect Control 2007. [DOI: 10.1016/j.ajic.2007.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
McElroy PD, Ijaz K, Navin TR. Reply to Cook. Clin Infect Dis 2006. [DOI: 10.1086/500462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
16
|
Cave MD, Yang ZH, Stefanova R, Fomukong N, Ijaz K, Bates J, Eisenach KD. Epidemiologic import of tuberculosis cases whose isolates have similar but not identical IS6110 restriction fragment length polymorphism patterns. J Clin Microbiol 2005; 43:1228-33. [PMID: 15750088 PMCID: PMC1081265 DOI: 10.1128/jcm.43.3.1228-1233.2005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Isolates of Mycobacterium tuberculosis from patients with epidemiologic links frequently demonstrate identical IS6110 restriction fragment length polymorphism (RFLP) patterns (i.e., RFLP clustering) because they are infected with the same strain. Uncertainty arises with isolates that differ from one another by a few IS6110 hybridizing bands. During the period from 1 January 1996 to 31 December 1999, isolates from 585 tuberculosis (TB) cases were analyzed by RFLP, representing 98.2% of the 596 culture-positive TB cases reported in Arkansas during the study period. Of the 585 cases for which RFLP was available, 419 (71.6%) had an RFLP pattern with more than five copies of IS6110. Of the total 74 clusters, 48 comprised isolates with more than five copies of IS6110 and included 164 cases. Sixty-nine isolates with more than five copies of IS6110 comprising 16 clusters and 60 unique isolates were found to be similar to at least 1 other isolate (differing from it by one or two hybridizing bands). Among the 129 cases whose isolates were similar to other clustered or unique isolates, 16 cases were discovered with epidemiologic links: 14 (15.2%) were among the 92 cases with IS6110 RFLP patterns similar to those in clusters, and 2 (5.2%) were among the 37 unique cases that were similar to another unique case. The isolates from the epidemiologically linked patients shared common spoligotypes; all except one case shared common polymorphic GC-rich sequence (PGRS) patterns. Of the 129 patients whose isolates differed from another by one or two hybridizing IS6110 bands, 101 (78.3%) shared common spoligotypes and 87 (67.4%) shared common PGRS RFLP patterns.
Collapse
Affiliation(s)
- M D Cave
- Department of Neurobiology and Developmental Sciences, Slot 510, University of Arkansas for Medical Sciences, and Central Arkansas Veterans' Healthcare System, 4301 West Markham Street, Little Rock, AR 72205, USA.
| | | | | | | | | | | | | |
Collapse
|
17
|
Ijaz K, Yang Z, Templeton G, Stead WW, Bates JH, Cave MD. Persistence of a strain of Mycobacterium tuberculosis in a prison system. Int J Tuberc Lung Dis 2004; 8:994-1000. [PMID: 15305483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
SETTING A prison system with an average year-end census of 9084 inmates. OBJECTIVE To determine transmission dynamics of tuberculosis over a long period; to establish whether Mycobacterium tuberculosis strains responsible for disease in a prison system persist; and to determine whether patients in a community whose isolates cluster with those in a prison system are linked. DESIGN Retrospective epidemiologic analysis was performed on tuberculosis cases reported in a prison system over a 9-year period. In addition, IS6110 RFLP patterns of M. tuberculosis isolates obtained from prisoners were compared with those of other cases from the state at large. The results of the RFLP analysis and the epidemiologic investigation were compared. RESULTS Approximately 80% of tuberculosis cases in the prison system were clustered. Over 9 years, a single strain of M. tuberculosis accounted for more than 50% of cases. Patients from the community at large who were infected with the same strain were linked to the prison system. CONCLUSION In spite of intensive tuberculosis control efforts, a single strain of M. tuberculosis has persisted in the prison system. Its persistence is accounted for by activation of latent infection in patients who, prior to being diagnosed and treated, infected other patients, who then sustained the transmission chain.
Collapse
Affiliation(s)
- K Ijaz
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | | |
Collapse
|
18
|
Yang ZH, Rendon A, Flores A, Medina R, Ijaz K, Llaca J, Eisenach KD, Bates JH, Villarreal A, Cave MD. A clinic-based molecular epidemiologic study of tuberculosis in Monterrey, Mexico. Int J Tuberc Lung Dis 2001; 5:313-20. [PMID: 11334249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
SETTING A tuberculosis clinic associated with a university hospital in Monterrey, Mexico, an urban community with high tuberculosis incidence. OBJECTIVE To determine the diversity of DNA fingerprint patterns and the extent of drug resistance of Mycobacterium tuberculosis isolates from patients who attended the clinic. DESIGN Isolates of M. tuberculosis obtained from 186 patients during the period from 31 January 1996 to 31 March 1998 were tested for susceptibility to isoniazid, rifampicin, ethambutol and streptomycin. Demographic data and the social history of each patient were obtained prospectively by interview. The IS6110 DNA fingerprints were obtained for 166 of the 186 isolates. Secondary typing was carried out on isolates with fewer than six copies of IS6110. RESULTS Thirty-two per cent of the tested isolates (60/ 186) were drug-resistant, and 18% (33/186) were multidrug-resistant. Approximately 55% of the resistant isolates (33/60) were attributed to acquired resistance. A total of 106 different IS6110 fingerprint patterns were observed among the 166 fingerprinted isolates. Based on both IS6110 and pTBN12 fingerprinting, 65 (39%) of the 166 isolates were part of 22 DNA fingerprint clusters. Various drug susceptibility patterns were seen in most clusters. CONCLUSION Fingerprint clustering indicates extensive recent transmission of tuberculosis in patients attending the clinic. The prevalence of drug-resistant tuberculosis is high.
Collapse
Affiliation(s)
- Z H Yang
- Regional Tuberculosis Genotyping Laboratory, Central Arkansas Veterans Healthcare System, Little Rock 72205, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Yang ZH, Ijaz K, Bates JH, Eisenach KD, Cave MD. Spoligotyping and polymorphic GC-rich repetitive sequence fingerprinting of mycobacterium tuberculosis strains having few copies of IS6110. J Clin Microbiol 2000; 38:3572-6. [PMID: 11015365 PMCID: PMC87438 DOI: 10.1128/jcm.38.10.3572-3576.2000] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Several genetic loci have been utilized to genotype isolates of Mycobacterium tuberculosis. A shortcoming of the most commonly used method, IS6110 fingerprinting, is that it does not adequately discriminate between isolates having few copies of IS6110. This study was undertaken to compare pTBN12 fingerprinting of polymorphic GC-rich repetitive sequence genes and spoligotyping of the direct repeat locus as secondary typing procedures for M. tuberculosis isolates having fewer than six copies of IS6110. A total of 88 isolates (100% of the isolates with fewer than six copies of IS6110 isolated in Arkansas during 1996 and 1997) were included in this study. Among the 88 isolates, 34 different IS6110 patterns were observed, 10 of which were shared by more than 1 isolate, involving a total of 64 isolates. The 64 isolates were subdivided into 13 clusters (containing 37 isolates) and 27 unique isolates based on a combination of IS6110 and pTBN12 fingerprinting and into 11 clusters (containing 51 isolates) and 13 unique isolates based on a combination of IS6110 fingerprinting and spoligotyping. Identical spoligotypes were found among isolates having different IS6110 patterns, as well as among isolates showing different pTBN12 patterns. In contrast, all isolates that had different IS6110 patterns were found to be unique by pTBN12 typing. The clustering rate was 73, 58, and 42%, respectively, for IS6110 fingerprinting alone, IS6110 fingerprinting and spoligotyping combined, and IS6110 and pTBN12 combined fingerprinting. The data indicate that the pTBN12 method has greater discriminating power among low-copy-number isolates than does spoligotyping.
Collapse
Affiliation(s)
- Z H Yang
- Regional Tuberculosis Genotyping Laboratory, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | | | | |
Collapse
|
20
|
Ijaz K, Bates JH. Tuberculosis rises in homeless shelters. J Ark Med Soc 1999; 96:101, 103. [PMID: 10483154] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- K Ijaz
- Division of Tuberculosis at the Arkansas Department of Health
| | | |
Collapse
|
21
|
Khan AS, Maupin GO, Rollin PE, Noor AM, Shurie HH, Shalabi AG, Wasef S, Haddad YM, Sadek R, Ijaz K, Peters CJ, Ksiazek TG. An outbreak of Crimean-Congo hemorrhagic fever in the United Arab Emirates, 1994-1995. Am J Trop Med Hyg 1997; 57:519-25. [PMID: 9392589 DOI: 10.4269/ajtmh.1997.57.519] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A multi-faceted investigation was conducted in the United Arab Emirates to characterize the epidemiologic and ecologic factors underlying an outbreak of Crimean-Congo hemorrhagic fever (CCHF) noted in November 1994 among abattoir workers. A chart review was conducted among hospitalized suspected cases of viral hemorrhagic fever with onset between January 1994 and March 1995 coupled with serologic testing of available specimens for the presence of virus antigen and IgG and IgM antibodies by ELISA. Livestock handlers and animal skin processors were interviewed and tested for the presence of IgG antibody. Sera from imported and domestic ruminants were examined for antibody for CCHF virus, and ticks collected from these animals were tested with an antigen-capture ELISA. Thirty-five suspected cases of CCHF were identified (case fatality = 62%). Livestock market employees, abattoir workers, and animal skin processors accounted for 16 (57%) of 28 cases with known occupational status. Serologic evidence of past asymptomatic infection was noted in 12 (4%) of 291 livestock and abattoir workers but in none of the controls. Nineteen (7%) of 268 animals were positive for CCHF virus antibodies by ELISA including 12 ruminants from Somalia and Iran and five indigenous camels. One Hyalomma impeltatum and two H. excavatum from Somali cattle and one H. anatolicum from a Somali goat were positive for CCHF virus antigen.
Collapse
Affiliation(s)
- A S Khan
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|