| Title | Artificial Intelligence in Dermatology: A Primer. |
| Authors | Young, AT; Xiong, M; Pfau, J; Keiser, MJ; Wei, ML |
| Journal | The Journal of investigative dermatology |
| Publication Date | 1 Aug 2020 |
| Date Added to PubMed | 2 Apr 2020 |
| Abstract | Artificial intelligence is becoming increasingly important in dermatology, with studies reporting accuracy matching or exceeding dermatologists for the diagnosis of skin lesions from clinical and dermoscopic images. However, real-world clinical validation is currently lacking. We review dermatological applications of deep learning, the leading artificial intelligence technology for image analysis, and discuss its current capabilities, potential failure modes, and challenges surrounding performance assessment and interpretability. We address the following three primary applications: (i) teledermatology, including triage for referral to dermatologists; (ii) augmenting clinical assessment during face-to-face visits; and (iii) dermatopathology. We discuss equity and ethical issues related to future clinical adoption and recommend specific standardization of metrics for reporting model performance. |
| Link | http://doi.org/10.1016/j.jid.2020.02.026 |
| Title | Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. |
| Authors | Katz, ME; Mszar, R; Grimshaw, AA; Gunderson, CG; Onuma, OK; Lu, Y; Spatz, ES |
| Journal | JAMA network open |
| Publication Date | 5 Feb 2024 |
| Date Added to PubMed | 14 Feb 2024 |
| Abstract | Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes. |
| Link | http://doi.org/10.1001/jamanetworkopen.2023.56070 |
| Title | Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review. |
| Authors | Wongvibulsin, S; Habeos, EE; Huynh, PP; Xun, H; Shan, R; Porosnicu Rodriguez, KA; Wang, J; Gandapur, YK; Osuji, N; Shah, LM; Spaulding, EM; Hung, G; Knowles, K; Yang, WE; Marvel, FA; Levin, E; Maron, DJ; Gordon, NF; Martin, SS |
| Journal | Journal of medical Internet research |
| Publication Date | 8 Feb 2021 |
| Date Added to PubMed | 9 Feb 2021 |
| Abstract | Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions. |
| Link | http://doi.org/10.2196/18773 |
| Title | Viral mHealth. |
| Authors | Fölster, S |
| Journal | Global health action |
| Publication Date | 1 Jun 2017 |
| Date Added to PubMed | 26 Aug 2017 |
| Abstract | Thousands of mHealth applications are developed every year, but few of these spread or 'go viral'. Even clinical applications that provide health benefits and social value often linger after an initial pilot phase. An examination of common hindrances in low-income countries suggests that more subsidies and education of health care personnel are insufficient solutions. Instead we propose better a priori screening of mHealth applications based on four criteria that may largely determine whether an mHealth application will spread. Further, we illustrate how using these criteria forms a good basis for involving 'impact investors' in the development of mHealth applications. This can reduce risks for public health care providers and increase the likelihood of success. |
| Link | http://doi.org/10.1080/16549716.2017.1336006 |
| Title | Digital health equity for older populations. |
| Authors | |
| Journal | The Lancet. Digital health |
| Publication Date | 1 Jul 2023 |
| Date Added to PubMed | 1 Jul 2023 |
| Abstract | |
| Link | http://doi.org/10.1016/S2589-7500(23)00114-0 |
| Title | Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era. |
| Authors | Chang, JE; Lai, AY; Gupta, A; Nguyen, AM; Berry, CA; Shelley, DR |
| Journal | The Milbank quarterly |
| Publication Date | 1 Jun 2021 |
| Date Added to PubMed | 3 Jun 2021 |
| Abstract | Policy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. The study analyzed data about small primary care practices' telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents' telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas. Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. |
| Link | http://doi.org/10.1111/1468-0009.12509 |
| Title | Digital health, gender and health equity: invisible imperatives. |
| Authors | Sinha, C; Schryer-Roy, AM |
| Journal | Journal of public health (Oxford, England) |
| Publication Date | 1 Dec 2018 |
| Date Added to PubMed | 18 Oct 2018 |
| Abstract | A growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind. |
| Link | http://doi.org/10.1093/pubmed/fdy171 |
| Title | Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems. |
| Authors | Koehle, H; Kronk, C; Lee, YJ |
| Journal | Yearbook of medical informatics |
| Publication Date | 1 Aug 2022 |
| Date Added to PubMed | 5 Dec 2022 |
| Abstract | Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar. We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies. |
| Link | http://doi.org/10.1055/s-0042-1742512 |
| Title | Advancing digital health equity: Directions for behavioral and social science research. |
| Authors | Jaworski, BK; Webb Hooper, M; Aklin, WM; Jean-Francois, B; Elwood, WN; Belis, D; Riley, WT; Hunter, CM |
| Journal | Translational behavioral medicine |
| Publication Date | 3 Apr 2023 |
| Date Added to PubMed | 2 Nov 2022 |
| Abstract | The field of digital health is evolving rapidly and encompasses a wide range of complex and changing technologies used to support individual and population health. The COVID-19 pandemic has augmented digital health expansion and significantly changed how digital health technologies are used. To ensure that these technologies do not create or exacerbate existing health disparities, a multi-pronged and comprehensive research approach is needed. In this commentary, we outline five recommendations for behavioral and social science researchers that are critical to promoting digital health equity. These recommendations include: (i) centering equity in research teams and theoretical approaches, (ii) focusing on issues of digital health literacy and engagement, (iii) using methods that elevate perspectives and needs of underserved populations, (iv) ensuring ethical approaches for collecting and using digital health data, and (v) developing strategies for integrating digital health tools within and across systems and settings. Taken together, these recommendations can help advance the science of digital health equity and justice. |
| Link | http://doi.org/10.1093/tbm/ibac088 |