Background: A randomized controlled trial of the SMART4MD tablet application was conducted for pe... more Background: A randomized controlled trial of the SMART4MD tablet application was conducted for persons with mild cognitive impairment (PwMCI) and their informal caregivers to improve or maintain quality of life. Objective: The objective was to conduct economic evaluation of SMART4MD compared to standard care in Sweden from a healthcare provider perspective based on a 6-month follow-up period. Methods: Three hundred forty-five dyads were enrolled: 173 dyads in the intervention group and 172 in standard care. The primary outcome measures for PwMCI and informal caregivers were quality-adjusted life years (QALY). The results are presented as incremental cost-effectiveness ratios, and confidence intervals are calculated using non-parametric bootstrap procedure. Results: For PwMCI, the mean difference in total costs between intervention and standard care was € 12 (95% CI: –2090 to 2115) (US$ = € 1.19) and the mean QALY change was –0.004 (95% CI: –0.009 to 0.002). For informal caregivers, ...
Background Older people’s use of the internet is increasingly coming into focus with the demograp... more Background Older people’s use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people’s internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective The aim of this study was to create an instrument to measure an older person’s perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods A short instrument for measuring social participation over ...
Background Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as i... more Background Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as in legal settings when entities need an estimate of chronological age (CA) when valid documents are lacking. The latter case presents itself as critical as the law is harsher for adults and granted rights along with imputability changes drastically if the individual is a minor. Traditional BAA methods have drawbacks such as exposure of minors to radiation, they do not consider factors that might affect the bone age, and they mostly focus on a single region. Given the critical scenarios in which BAA can affect the lives of young individuals, it is important to focus on the drawbacks of the traditional methods and investigate the potential of estimating CA through BAA. Objective This study aims to investigate CA estimation through BAA in young individuals aged 14-21 years with machine learning methods, addressing the drawbacks of research using magnetic resonance imaging (MRI), assessment o...
International Journal of Environmental Research and Public Health, 2021
The increasing use of technology by older persons and their preferences for living at home and be... more The increasing use of technology by older persons and their preferences for living at home and being independent have created an avenue for self-care and care delivery using mobile technologies and health communication. This study aimed to explain how older persons with cognitive impairment experienced technology-based health communication through the use of a mobile application to facilitate a sense of coherence. Individual, semi-structured interviews with 16 participants in the SMART4MD project were conducted. The interviews were transcribed then coded deductively and thematically, creating themes that corresponded to the central components of the sense of coherence model: comprehensibility, manageability, and meaningfulness. The findings produced an overall theme: a challenging technology that can provide support, based on the three identified themes: making sense of mobile technologies, mastering mobile technologies, and the potential added value to use mobile technologies. The ...
International Journal of Environmental Research and Public Health, 2020
Population ageing within Europe has major social and economic consequences. One of the most devas... more Population ageing within Europe has major social and economic consequences. One of the most devastating conditions that predominantly affects older people is dementia. The SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia) project aims to develop and test a health application specifically designed for people with mild dementia. The aim of this feasibility study was to evaluate the design of the SMART4MD protocol, including recruitment, screening, baseline examination and data management, and to test the SMART4MD application for functionality and usability before utilization in a full-scale study. The feasibility study tested the protocol and the app in Spain and Sweden. A total of nineteen persons with cognitive impairment, and their informal caregivers, individually performed a task-based usability test of the SMART4MD app model in a clinical environment, followed by four-week testing of the app in the home environment. By employing a user-centered design appro...
International Journal of Environmental Research and Public Health, 2020
The use of the internet has considerably increased over recent years, and the importance of inter... more The use of the internet has considerably increased over recent years, and the importance of internet use has also grown as services have gone online. Sweden is largely an information society like other countries with high reported use amongst European countries. In line with digitalization development, society is also changing, and many activities and services today take place on the internet. This development could potentially lead to those older persons who do not use the internet or do not follow the development of services on the internet finding it difficult to take part in information and activities that no longer occur in the physical world. This has led to a digital divide between groups, where the older generations (60+), in particular, have been affected. In a large study of Sweden’s adult population in 2019, 95 percent of the overall population was said to be internet users, and the corresponding number for users over 66 years of age was 84%. This study shows that the num...
International Journal of Environmental Research and Public Health, 2020
The objective of this study was to critically assess and review empirical evidence on the cost-ef... more The objective of this study was to critically assess and review empirical evidence on the cost-effectiveness of Mobile Health (mHealth) interventions for older adults. We systematically searched databases such as Pubmed, Scopus, and Cumulative Index of Nursing and Allied Literature (CINAHL) for peer-reviewed economic evaluations published in English from 2007 to 2018. We extracted data on methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and assessed if this evidence supported the reported findings in terms of cost-effectiveness. The consolidated health economic evaluation reporting standards (CHEERS) checklist was used to assess the reporting quality of the included studies. Eleven studies were identified and categorized into two groups: complex smartphone communication and simple text-based communication. Substantial heterogeneity among the studies in terms of methodological approaches and types of intervention was observed. The cost-effectivene...
Background Growth development is traditionally evaluated with plain radiographs of the hand and w... more Background Growth development is traditionally evaluated with plain radiographs of the hand and wrist to visualize bone structures using ionizing radiation. Meanwhile, MRI visualizes bone and cartilaginous tissue without radiation exposure. Purpose To determine the state of growth plate closure of the knee in healthy adolescents and young adults and compare the reliability of staging using cartilage sequences and T1-weighted (T1W) sequence between pediatric and general radiologists. Material and Methods A prospective, cross-sectional study of MRI of the knee with both cartilage and T1W sequences was performed in 395 male and female healthy subjects aged between 14.0 and 21.5 years old. The growth plate of the femur and the tibia were graded using a modified staging scale by two pediatric and two general radiologists. Femur and tibia were graded separately with both sequences. Results The intraclass correlation was overall excellent. The inter- and intra-observer agreement for pediat...
International Journal of Environmental Research and Public Health, 2020
Digital health technologies such as mobile health (mHealth) are considered to have the potential ... more Digital health technologies such as mobile health (mHealth) are considered to have the potential to support the needs of older adults with cognitive impairment. However, the evidence for improving health with the use of mHealth applications is of limited quality. Few studies have reported on the consequences of technology use concerning the older adults’ quality of life. The purpose of this study was to describe perceptions of mHealth and its impact on health-related quality of life (HRQoL) among older adults with cognitive impairment. The study was conducted using a qualitative design with a phenomenographic approach. A total of 18 older participants with cognitive impairment were interviewed. The interviews were analyzed in order to apply phenomenography in a home-care context. The results showed variations in the older adults’ perceptions that were comprised within three categories of description; Require technology literacy, Maintain social interaction, and Facilitate independen...
International Journal of Environmental Research and Public Health, 2020
Dementia is a neurodegenerative disorder that affects the older adult population. To date, no cur... more Dementia is a neurodegenerative disorder that affects the older adult population. To date, no cure or treatment to change its course is available. Since changes in the brains of affected individuals could be evidenced as early as 10 years before the onset of symptoms, prognosis research should consider this time frame. This study investigates a broad decision tree multifactorial approach for the prediction of dementia, considering 75 variables regarding demographic, social, lifestyle, medical history, biochemical tests, physical examination, psychological assessment and health instruments. Previous work on dementia prognoses with machine learning did not consider a broad range of factors in a large time frame. The proposed approach investigated predictive factors for dementia and possible prognostic subgroups. This study used data from the ongoing multipurpose Swedish National Study on Aging and Care, consisting of 726 subjects (91 presented dementia diagnosis in 10 years). The prop...
BACKGROUND The nursing profession has undergone several changes the past decades and new challeng... more BACKGROUND The nursing profession has undergone several changes the past decades and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, the primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective it is of great importance that students are prepared for new demands and needs of the patients. From a societal point of view, the society, healthcare included, is facing a number of challenges related to technological developments and digitization. Preparation for the next decade of nursing education/practice must be done, without the advantage of certainty. A training for not yet existing technologies where educators should not be limited by present practice paradigms is desirable. This paper presents the design, method and protocol for a study that investigate undergraduate nursing students’ internet use, knowledge about eHealth, attitudes to te...
BACKGROUND Both usability and acceptance of a specific technology or service are important factor... more BACKGROUND Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a HIT intervention. Psychometric measures are seldom included in evaluation of health technology. However, basic attitudes and sentiments towards technology, e.g. technophilia, could be argued to influence both the level of satisfaction with the technology itself, as well as the perception and acceptance of the health intervention outcome. OBJECTIVE The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement on the new instrument is that it should be short and simple to make it usable also for evaluation of health technology for older people with mild cognitive impairments and normal aging cognitive decline. METHODS Initial items for the TechPH questionnaire were drawn from a content analysis o...
BACKGROUND Population aging has major social and economic consequences. Although many older peopl... more BACKGROUND Population aging has major social and economic consequences. Although many older people can support themselves and continue to make important contributions to society, the burden of disease and disability increases with age. One condition that affects older people is dementia. Even in the early stages it can be burdensome for those affected as well as their relatives. Technology to support the day-to-day living activities at home for people with cognitive impairments have been developed during the last years. Most products focus on single problem solution and few are integrated into a single product. The impact of these devices is seldom studied in other ways than through feasibility studies. Randomized controlled studies (RCT) investigating the effect or effectiveness of these products are sparse. OBJECTIVE We aim to test the influence on Quality of Life (QoL) of persons with mild cognitive impairment (PwMCI) and carers who use a digital platform (SMART4MD). Also studied...
Background: A randomized controlled trial of the SMART4MD tablet application was conducted for pe... more Background: A randomized controlled trial of the SMART4MD tablet application was conducted for persons with mild cognitive impairment (PwMCI) and their informal caregivers to improve or maintain quality of life. Objective: The objective was to conduct economic evaluation of SMART4MD compared to standard care in Sweden from a healthcare provider perspective based on a 6-month follow-up period. Methods: Three hundred forty-five dyads were enrolled: 173 dyads in the intervention group and 172 in standard care. The primary outcome measures for PwMCI and informal caregivers were quality-adjusted life years (QALY). The results are presented as incremental cost-effectiveness ratios, and confidence intervals are calculated using non-parametric bootstrap procedure. Results: For PwMCI, the mean difference in total costs between intervention and standard care was € 12 (95% CI: –2090 to 2115) (US$ = € 1.19) and the mean QALY change was –0.004 (95% CI: –0.009 to 0.002). For informal caregivers, ...
Background Older people’s use of the internet is increasingly coming into focus with the demograp... more Background Older people’s use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people’s internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective The aim of this study was to create an instrument to measure an older person’s perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods A short instrument for measuring social participation over ...
Background Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as i... more Background Bone age assessment (BAA) is used in numerous pediatric clinical settings as well as in legal settings when entities need an estimate of chronological age (CA) when valid documents are lacking. The latter case presents itself as critical as the law is harsher for adults and granted rights along with imputability changes drastically if the individual is a minor. Traditional BAA methods have drawbacks such as exposure of minors to radiation, they do not consider factors that might affect the bone age, and they mostly focus on a single region. Given the critical scenarios in which BAA can affect the lives of young individuals, it is important to focus on the drawbacks of the traditional methods and investigate the potential of estimating CA through BAA. Objective This study aims to investigate CA estimation through BAA in young individuals aged 14-21 years with machine learning methods, addressing the drawbacks of research using magnetic resonance imaging (MRI), assessment o...
International Journal of Environmental Research and Public Health, 2021
The increasing use of technology by older persons and their preferences for living at home and be... more The increasing use of technology by older persons and their preferences for living at home and being independent have created an avenue for self-care and care delivery using mobile technologies and health communication. This study aimed to explain how older persons with cognitive impairment experienced technology-based health communication through the use of a mobile application to facilitate a sense of coherence. Individual, semi-structured interviews with 16 participants in the SMART4MD project were conducted. The interviews were transcribed then coded deductively and thematically, creating themes that corresponded to the central components of the sense of coherence model: comprehensibility, manageability, and meaningfulness. The findings produced an overall theme: a challenging technology that can provide support, based on the three identified themes: making sense of mobile technologies, mastering mobile technologies, and the potential added value to use mobile technologies. The ...
International Journal of Environmental Research and Public Health, 2020
Population ageing within Europe has major social and economic consequences. One of the most devas... more Population ageing within Europe has major social and economic consequences. One of the most devastating conditions that predominantly affects older people is dementia. The SMART4MD (Support Monitoring and Reminder Technology for Mild Dementia) project aims to develop and test a health application specifically designed for people with mild dementia. The aim of this feasibility study was to evaluate the design of the SMART4MD protocol, including recruitment, screening, baseline examination and data management, and to test the SMART4MD application for functionality and usability before utilization in a full-scale study. The feasibility study tested the protocol and the app in Spain and Sweden. A total of nineteen persons with cognitive impairment, and their informal caregivers, individually performed a task-based usability test of the SMART4MD app model in a clinical environment, followed by four-week testing of the app in the home environment. By employing a user-centered design appro...
International Journal of Environmental Research and Public Health, 2020
The use of the internet has considerably increased over recent years, and the importance of inter... more The use of the internet has considerably increased over recent years, and the importance of internet use has also grown as services have gone online. Sweden is largely an information society like other countries with high reported use amongst European countries. In line with digitalization development, society is also changing, and many activities and services today take place on the internet. This development could potentially lead to those older persons who do not use the internet or do not follow the development of services on the internet finding it difficult to take part in information and activities that no longer occur in the physical world. This has led to a digital divide between groups, where the older generations (60+), in particular, have been affected. In a large study of Sweden’s adult population in 2019, 95 percent of the overall population was said to be internet users, and the corresponding number for users over 66 years of age was 84%. This study shows that the num...
International Journal of Environmental Research and Public Health, 2020
The objective of this study was to critically assess and review empirical evidence on the cost-ef... more The objective of this study was to critically assess and review empirical evidence on the cost-effectiveness of Mobile Health (mHealth) interventions for older adults. We systematically searched databases such as Pubmed, Scopus, and Cumulative Index of Nursing and Allied Literature (CINAHL) for peer-reviewed economic evaluations published in English from 2007 to 2018. We extracted data on methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and assessed if this evidence supported the reported findings in terms of cost-effectiveness. The consolidated health economic evaluation reporting standards (CHEERS) checklist was used to assess the reporting quality of the included studies. Eleven studies were identified and categorized into two groups: complex smartphone communication and simple text-based communication. Substantial heterogeneity among the studies in terms of methodological approaches and types of intervention was observed. The cost-effectivene...
Background Growth development is traditionally evaluated with plain radiographs of the hand and w... more Background Growth development is traditionally evaluated with plain radiographs of the hand and wrist to visualize bone structures using ionizing radiation. Meanwhile, MRI visualizes bone and cartilaginous tissue without radiation exposure. Purpose To determine the state of growth plate closure of the knee in healthy adolescents and young adults and compare the reliability of staging using cartilage sequences and T1-weighted (T1W) sequence between pediatric and general radiologists. Material and Methods A prospective, cross-sectional study of MRI of the knee with both cartilage and T1W sequences was performed in 395 male and female healthy subjects aged between 14.0 and 21.5 years old. The growth plate of the femur and the tibia were graded using a modified staging scale by two pediatric and two general radiologists. Femur and tibia were graded separately with both sequences. Results The intraclass correlation was overall excellent. The inter- and intra-observer agreement for pediat...
International Journal of Environmental Research and Public Health, 2020
Digital health technologies such as mobile health (mHealth) are considered to have the potential ... more Digital health technologies such as mobile health (mHealth) are considered to have the potential to support the needs of older adults with cognitive impairment. However, the evidence for improving health with the use of mHealth applications is of limited quality. Few studies have reported on the consequences of technology use concerning the older adults’ quality of life. The purpose of this study was to describe perceptions of mHealth and its impact on health-related quality of life (HRQoL) among older adults with cognitive impairment. The study was conducted using a qualitative design with a phenomenographic approach. A total of 18 older participants with cognitive impairment were interviewed. The interviews were analyzed in order to apply phenomenography in a home-care context. The results showed variations in the older adults’ perceptions that were comprised within three categories of description; Require technology literacy, Maintain social interaction, and Facilitate independen...
International Journal of Environmental Research and Public Health, 2020
Dementia is a neurodegenerative disorder that affects the older adult population. To date, no cur... more Dementia is a neurodegenerative disorder that affects the older adult population. To date, no cure or treatment to change its course is available. Since changes in the brains of affected individuals could be evidenced as early as 10 years before the onset of symptoms, prognosis research should consider this time frame. This study investigates a broad decision tree multifactorial approach for the prediction of dementia, considering 75 variables regarding demographic, social, lifestyle, medical history, biochemical tests, physical examination, psychological assessment and health instruments. Previous work on dementia prognoses with machine learning did not consider a broad range of factors in a large time frame. The proposed approach investigated predictive factors for dementia and possible prognostic subgroups. This study used data from the ongoing multipurpose Swedish National Study on Aging and Care, consisting of 726 subjects (91 presented dementia diagnosis in 10 years). The prop...
BACKGROUND The nursing profession has undergone several changes the past decades and new challeng... more BACKGROUND The nursing profession has undergone several changes the past decades and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, the primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective it is of great importance that students are prepared for new demands and needs of the patients. From a societal point of view, the society, healthcare included, is facing a number of challenges related to technological developments and digitization. Preparation for the next decade of nursing education/practice must be done, without the advantage of certainty. A training for not yet existing technologies where educators should not be limited by present practice paradigms is desirable. This paper presents the design, method and protocol for a study that investigate undergraduate nursing students’ internet use, knowledge about eHealth, attitudes to te...
BACKGROUND Both usability and acceptance of a specific technology or service are important factor... more BACKGROUND Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a HIT intervention. Psychometric measures are seldom included in evaluation of health technology. However, basic attitudes and sentiments towards technology, e.g. technophilia, could be argued to influence both the level of satisfaction with the technology itself, as well as the perception and acceptance of the health intervention outcome. OBJECTIVE The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement on the new instrument is that it should be short and simple to make it usable also for evaluation of health technology for older people with mild cognitive impairments and normal aging cognitive decline. METHODS Initial items for the TechPH questionnaire were drawn from a content analysis o...
BACKGROUND Population aging has major social and economic consequences. Although many older peopl... more BACKGROUND Population aging has major social and economic consequences. Although many older people can support themselves and continue to make important contributions to society, the burden of disease and disability increases with age. One condition that affects older people is dementia. Even in the early stages it can be burdensome for those affected as well as their relatives. Technology to support the day-to-day living activities at home for people with cognitive impairments have been developed during the last years. Most products focus on single problem solution and few are integrated into a single product. The impact of these devices is seldom studied in other ways than through feasibility studies. Randomized controlled studies (RCT) investigating the effect or effectiveness of these products are sparse. OBJECTIVE We aim to test the influence on Quality of Life (QoL) of persons with mild cognitive impairment (PwMCI) and carers who use a digital platform (SMART4MD). Also studied...
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