METHODS: Eight scientific databases were searched. Two independent reviewers screened the literature in title and abstract stages, followed by full-text appraisal, data extraction, and synthesis of eligible studies. Studies were extracted to capture details of the mhealth tools used, the service issues addressed, the study design, and the outcomes evaluated. We then mapped the included studies using the 20 sub-strategies of the WHO Framework on Integrated People-Centred Health Services (IPCHS); as well as with the RE-AIM (Reach, effectiveness, adoption, implementation and maintenance) framework, to understand how studies implemented and evaluated interventions.
RESULTS: We identified 39 studies, predominantly from Australia (n = 16), China (n = 7), Malaysia (n = 4) and New Zealand (n = 4), and little from low income countries. The mHealth modalities included text messaging, voice and video communication, mobile applications and devices (point-of-care, GPS, and Bluetooth). Health issues addressed included: medication adherence, smoking cessation, cardiovascular disease, heart failure, asthma, diabetes, and lifestyle activities respectively. Almost all were community-based and focused on service issues; only half were disease-specific. mHealth facilitated integrated IPCHS by: enabling citizens and communities to bypass gatekeepers and directly access services; increasing affordability and accessibility of services; strengthening governance over the access, use, safety and quality of clinical care; enabling scheduling and navigation of services; transitioning patients and caregivers between care sectors; and enabling the evaluation of safety and quality outcomes for systemic improvement. Evaluations of mHealth interventions did not always report the underlying theories. They predominantly reported cognitive/behavioural changes rather than patient outcomes. The utility of mHealth to support and improve IPCHS was evident. However, IPCHS strategy 2 (participatory governance and accountability) was addressed least frequently. Implementation was evaluated in regard to reach (n = 30), effectiveness (n = 24); adoption (n = 5), implementation (n = 9), and maintenance (n = 1).
CONCLUSIONS: mHealth can transition disease-centred services towards people-centred services. Critical appraisal of studies highlighted methodological issues, raising doubts about validity. The limited evidence for large-scale implementation and international variation in reporting of mHealth practice, modalities used, and health domains addressed requires capacity building. Information-enhanced implementation and evaluation of IPCHS, particularly for participatory governance and accountability, is also important.
OBJECTIVE: To measure factors associated with mHealth adoption among primary care physicians (PCPs) in Malaysia.
METHODS: A cross-sectional study using a self-administered questionnaire was conducted among PCPs. The usage of mHealth apps by the PCPs has divided into the use of mHealth apps to support PCPs' clinical work and recommendation of mHealth apps for patient's use. Factors associated with mHealth adoption were analysed using multivariable logistic regression.
RESULTS: Among 217 PCPs in the study, 77.0% used mHealth apps frequently for medical references, 78.3% medical calculation and 30.9% interacting with electronic health records (EHRs). Only 22.1% of PCPs frequently recommended mHealth apps to patients for tracking health information, 22.1% patient education and 14.3% use as a medical device. Performance expectancy and facilitating conditions were associated with mHealth use for medical references. Family medicine trainees, working in a government practice and performance expectancy were the facilitators for the use of mHealth apps for medical calculation. Internet connectivity, performance expectancy and use by colleagues were associated with the use of mHealth with EHR. Performance expectancy was associated with mHealth apps' recommendation to patients to track health information and provide patient education.
CONCLUSIONS: PCPs often used mHealth apps to support their clinical work but seldom recommended mHealth apps to their patients. Training for PCPs is needed on the appraisal and knowledge of the mHealth apps for patient use.
OBJECTIVE: The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening.
METHODS: The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review.
RESULTS: Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth.
CONCLUSIONS: mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective.
OBJECTIVE: The objective of this study was to determine the effects of folic acid or l-5-MTHF supplementation on blood folate concentrations, methyl nutrient metabolites, and DNA methylation in women living in Malaysia, where there is no mandatory fortification policy.
METHODS: In a 12-wk, randomized, placebo-controlled intervention trial, healthy Malaysian women (n = 142, aged 20-45 y) were randomly assigned to receive 1 of the following supplements daily: 1 mg (2.27 μmol) folic acid, 1.13 mg (2.27 μmol) l-5-MTHF, or a placebo. The primary outcomes were plasma and RBC folate and vitamin B-12 concentrations. Secondary outcomes included plasma total homocysteine, total cysteine, methionine, betaine, and choline concentrations and monocyte long interspersed nuclear element-1 (LINE-1) methylation.
RESULTS: The folic acid and l-5-MTHF groups had higher (P
METHODS: Pooled urine samples of patients with BTG (n=10), patients with PTC (n=9) and healthy controls (n=10) were subjected to iTRAQ analysis and immunoblotting.
RESULTS: The ITRAQ analysis of the urine samples detected 646 proteins, 18 of which showed significant altered levels (p<0.01; fold-change>1.5) between patients and controls. Whilst four urinary proteins were commonly altered in both BTG and PTC patients, 14 were unique to either BTG or PTC. Amongst these, four proteins were further chosen for validation using immunoblotting, and the enhanced levels of osteopontin in BTG patients and increased levels of a truncated gelsolin fragment in PTC patients, relative to controls, appeared to corroborate the findings of the iTRAQ analysis.
CONCLUSION: The data of the present study is suggestive of the potential application of urinary osteopontin and gelsolin to discriminate patients with BTG from those with PTC non-invasively. However, this needs to be further validated in studies of individual urine samples.
METHODS: We established an isogeneic cell model consisting of parental dermal fibroblasts, fibroblast-like iPSC-derivatives (iPS-fibro) and iPS-fibro lacking beta-2-microglobulin (B2M). Using the cells obtained from two patients, we analyzed the activation of autologous and allogeneic T-lymphocytes and NK-cells co-cultured with target cells.
RESULTS: Here we report that cells differentiated from iPSCs can be recognized by NK-cells rather than by autologous T-cells. We observed that iPS-fibro elicited a high level of NK-cell degranulation and cytotoxicity, while isogeneic parental skin fibroblasts used to obtain iPSCs barely triggered an NK-cell response. iPSC-derivatives with B2M knockout did not cause an additional increase in NK-cell activation, although they were devoid of HLA-I, the major inhibitory molecules for NK-cells. Transcriptome analysis revealed a significant imbalance of ligands for activating and inhibitory NK-cell receptors in iPS-fibro. Compared to parental fibroblasts, iPSC-derivatives had a reduced expression of HLA-I simultaneously with an increased gene expression of major activating ligands, such as MICA, NECTIN2, and PVR. The lack of inhibitory signals might be due to insufficient maturity of cells differentiated from iPSCs. In addition, we showed that pretreatment of iPS-fibro with proinflammatory cytokine IFNγ restored the ligand imbalance, thereby reducing the degranulation and cytotoxicity of NK-cells.
CONCLUSION: In summary, we showed that iPSC-derived cells can be sensitive to the cytotoxic potential of autologous NK-cells regardless of HLA-I status. Thus, the balance of ligands for NK-cell receptors should be considered prior to iPSC-based cell therapies. Trial registration Not applicable.
RESULTS: iCLIP analysis found SAFB1 binding was enriched, specifically in exons, ncRNAs, 3' and 5' untranslated regions. SAFB1 was found to recognise a purine-rich GAAGA motif with the highest frequency and it is therefore likely to bind core AGA, GAA, or AAG motifs. Confirmatory RT-PCR experiments showed that the expression of coding and non-coding genes with SAFB1 cross-link sites was altered by SAFB1 knockdown. For example, we found that the isoform-specific expression of neural cell adhesion molecule (NCAM1) and ASTN2 was influenced by SAFB1 and that the processing of miR-19a from the miR-17-92 cluster was regulated by SAFB1. These data suggest SAFB1 may influence alternative splicing and, using an NCAM1 minigene, we showed that SAFB1 knockdown altered the expression of two of the three NCAM1 alternative spliced isoforms. However, when the AGA, GAA, and AAG motifs were mutated, SAFB1 knockdown no longer mediated a decrease in the NCAM1 9-10 alternative spliced form. To further investigate the association of SAFB1 with splicing we used exon array analysis and found SAFB1 knockdown mediated the statistically significant up- and downregulation of alternative exons. Further analysis using RNAmotifs to investigate the frequency of association between the motif pairs (AGA followed by AGA, GAA or AAG) and alternative spliced exons found there was a highly significant correlation with downregulated exons. Together, our data suggest SAFB1 will play an important physiological role in the central nervous system regulating synaptic function. We found that SAFB1 regulates dendritic spine density in hippocampal neurons and hence provide empirical evidence supporting this conclusion.
CONCLUSIONS: iCLIP showed that SAFB1 has previously uncharacterised specific RNA binding properties that help coordinate the isoform-specific expression of coding and non-coding genes. These genes regulate splicing, axonal and synaptic function, and are associated with neuropsychiatric disease, suggesting that SAFB1 is an important regulator of key neuronal processes.
METHODS: Currently available indicators from both household and facility surveys were collated through publicly available global databases and respective survey instruments. We then developed a suite of potential indicators and associated data points for the 45 WHO Essential Interventions spanning preconception to newborn care. Four types of performance indicators were identified (where applicable): process (i.e. coverage) and outcome (i.e. impact) indicators for both screening and treatment/prevention. Indicators were evaluated by an international expert panel against the eRegistries indicator evaluation criteria and further refined based on feedback by the eRegistries technical team.
RESULTS: Of the 45 WHO Essential Interventions, only 16 were addressed in any of the household survey data available. A set of 216 potential indicators was developed. These indicators were generally evaluated favourably by the panel, but difficulties in data ascertainment, including for outcome measures of cause-specific morbidity and mortality, were frequently reported as barriers to the feasibility of indicators. Indicators were refined based on feedback, culminating in the final list of 193 total unique indicators: 93 for preconception and antenatal care; 53 for childbirth and postpartum care; and 47 for newborn and small and ill baby care.
CONCLUSIONS: Large gaps exist in the availability of information currently collected to support the implementation of the WHO Essential Interventions. The development of this suite of indicators can be used to support the implementation of eRegistries and other data platforms, to ensure that data are utilised to support evidence-based practice, facilitate measurement and accountability, and improve maternal and child health outcomes.