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1. At-Home use of App-Based Mindfulness for Children: A Randomized Active-Controlled Trial

   https://doi.org/10.1007/s12671-023-02231-3  

   Treves, Isaac N. ; Olson, Halie A. ; Ozernov-Palchik, Ola ; Li, Cindy E. ; Wang, Kimberly L. ; Arechiga, Xochitl M. ; Goldberg, Simon B. ; Gabrieli, John D. E. ( October 2023 , Mindfulness)

   School-based mindfulness interventions in children have shown benefits to child well-being. Here, we investigated the effectiveness of a remote, app-based mindfulness intervention for promoting well-being in children.

   We conducted a randomized controlled trial (RCT) with two control groups to examine the effects of an 8-week mindfulness intervention in U.S. children ages 8–10. We compared pre-post effects between a mindfulness intervention using theInner Explorerapp, and two audiobook control interventions. The 279 children who participated in the interventions were assessed on self-report measures of anxiety and depression symptoms, perceived stress and trait mindfulness and we also collected parental reports.

   Over 80% of children completed the intervention in each condition. There was evidence for reduced self-perceived stress in children and reduced negative affect in children by parental reports using the mindfulness app, but no significant reduction for anxiety or depression symptoms. In general, between-group effect sizes were small (d < 0.45). Regular use, defined as at least 30 days of mindfulness practice within the study period, was associated with reduced child negative affect by parental reports, as well as reduced parental stress and child self-perceived stress.

   These findings suggest that home use of a mindfulness app in young children can have a positive impact on children’s emotional well-being if the app is used regularly, specifically for at least 30 days in the 8-week study period. Strategies aimed at promoting regular use of the mindfulness app at home could lead to even better outcomes for children.

   Preregistered on OSF athttps://osf.io/23vax

    

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2. Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial

   https://doi.org/10.2196/32163  

   Dodson, John A ; Schoenthaler, Antoinette ; Sweeney, Greg ; Fonceva, Ana ; Pierre, Alicia ; Whiteson, Jonathan ; George, Barbara ; Marzo, Kevin ; Drewes, Wendy ; Rerisi, Elizabeth ; et al ( January 2022 , JMIR Research Protocols)

   Background Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults’ uptake, and efficacy data are currently lacking. Objective This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID) DERR1-10.2196/32163 

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3. Evaluation of the preference for and viability of clean cookstove adoption in rural Tanzania

   https://doi.org/10.1186/s13705-023-00422-3  

   Gill-Wiehl, Annelise ; Sievers, Sara ; Katikiro, Robert ; Kammen, Daniel M. ( November 2023 , Energy, Sustainability and Society)

   Sustainable Development Goal (SDG) 7 calls for “universal access to affordable, reliable, modern energy services” for the 2.6 billion individuals lacking access to clean cooking fuels and stoves. Low- and middle-income countries are designing policies towards clean fuels, but often prioritize World Health Organization defined ‘clean’ fuels and stoves to urban areas. As clean solutions are explored, it remains unclear what rural households prefer as their clean alternative.

   This study conducted household energy surveys with main cooks across four villages in Shirati, Tanzania to understand rural household preferences within the viable clean fuels. Data analysis includes descriptive statistics and a generalized linear model with the Poisson family and log link to estimate prevalence ratios, all of which were conducted in Microsoft Excel and STATA 16.1.

   The results revealed that while 83% of households (n = 187) stacked a combination of firewood, charcoal, liquified petroleum gas (LPG), and/or kerosene, 82% [95% Confidence Interval: 74%, 89%] of households stated a preference to use LPG. We found that aggregate expenditure on LPG was less than daily purchases of charcoal and firewood. Our analysis found that all villages had a higher prevalence of stacking firewood, charcoal, and LPG, than areas further from the main trading center. Both areas with trading posts had a lower prevalence of using only firewood.

   Household preference should be systematically incorporated into clean cooking policy decisions. Our results imply that LPG should not be pursued only in urban contexts. We discuss how preference affect adoption and the need to include user preferences to meet universal clean cooking access (SDG 7).

    

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4. Breath-synchronized electrical stimulation of the expiratory muscles in mechanically ventilated patients: a randomized controlled feasibility study and pooled analysis

   https://doi.org/10.1186/s13054-020-03352-0  

   Jonkman, Annemijn H. ; Frenzel, Tim ; McCaughey, Euan J. ; McLachlan, Angus J. ; Boswell-Ruys, Claire L. ; Collins, David W. ; Gandevia, Simon C. ; Girbes, Armand R. ; Hoiting, Oscar ; Kox, Matthijs ; et al ( December 2020 , Critical Care)

   null (Ed.)

   Abstract Background Expiratory muscle weakness leads to difficult ventilator weaning. Maintaining their activity with functional electrical stimulation (FES) may improve outcome. We studied feasibility of breath-synchronized expiratory population muscle FES in a mixed ICU population (“Holland study”) and pooled data with our previous work (“Australian study”) to estimate potential clinical effects in a larger group. Methods Holland: Patients with a contractile response to FES received active or sham expiratory muscle FES (30 min, twice daily, 5 days/week until weaned). Main endpoints were feasibility (e.g., patient recruitment, treatment compliance, stimulation intensity) and safety. Pooled: Data on respiratory muscle thickness and ventilation duration from the Holland and Australian studies were combined ( N  = 40) in order to estimate potential effect size. Plasma cytokines (day 0, 3) were analyzed to study the effects of FES on systemic inflammation. Results Holland: A total of 272 sessions were performed (active/sham: 169/103) in 20 patients ( N  = active/sham: 10/10) with a total treatment compliance rate of 91.1%. No FES-related serious adverse events were reported. Pooled: On day 3, there was a between-group difference ( N  = active/sham: 7/12) in total abdominal expiratory muscle thickness favoring the active group [treatment difference (95% confidence interval); 2.25 (0.34, 4.16) mm, P  = 0.02] but not on day 5. Plasma cytokine levels indicated that early FES did not induce systemic inflammation. Using a survival analysis approach for the total study population, median ventilation duration and ICU length of stay were 10 versus 52 ( P  = 0.07), and 12 versus 54 ( P  = 0.03) days for the active versus sham group. Median ventilation duration of patients that were successfully extubated was 8.5 [5.6–12.2] versus 10.5 [5.3–25.6] days ( P  = 0.60) for the active ( N  = 16) versus sham ( N  = 10) group, and median ICU length of stay was 10.5 [8.0–14.5] versus 14.0 [9.0–19.5] days ( P  = 0.36) for those active ( N  = 16) versus sham ( N  = 8) patients that were extubated and discharged alive from the ICU. During ICU stay, 3/20 patients died in the active group versus 8/20 in the sham group ( P  = 0.16). Conclusion Expiratory muscle FES is feasible in selected ICU patients and might be a promising technique within a respiratory muscle-protective ventilation strategy. The next step is to study the effects on weaning and ventilator liberation outcome. Trial registration: ClinicalTrials.gov, ID NCT03453944. Registered 05 March 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03453944 . 

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5. The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study

   https://doi.org/10.2196/25018  

   Sobolev, Michael ; Vitale, Rachel ; Wen, Hongyi ; Kizer, James ; Leeman, Robert ; Pollak, J P ; Baumel, Amit ; Vadhan, Nehal P ; Estrin, Deborah ; Muench, Frederick ( January 2021 , JMIR mHealth and uHealth)

   null (Ed.)

   Background The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life. Objective The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public. Methods The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app. Results We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research. Conclusions This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions. Trial Registration ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653 

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