Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults.

Introduction This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. Methods The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). Results The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. Conclusion Although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. It is critical that National Health Service managers and clinicians have realistic expectations of what can be achieved in a relatively short period of time.

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Introduction: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on integrated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives.

Perinatal depression (PND) affects up to 15% of women within the United Kingdom and has a lasting impact on a woman's quality of life, birth outcomes and her child's development. Suicide is the leading cause of maternal mortality. However, it is estimated that at least 50% of PND cases go undiagnosed. This paper presents the results of the first feasibility study to examine the potential of mobile devices to engage women in antenatal mental health screening. Using a mobile application, 254 women attending 14 National Health Service midwifery clinics provided 2,280 momentary and retrospective reports of their wellbeing over a 9-month period. Women spoke positively of the experience, installing and engaging with this technology regardless of age, education, wellbeing, number of children, marital or employment status, or past diagnosis of depression. 39 women reported a risk of depression, self-harm or suicide; two-thirds of whom were not identified by screening in-clinic.

Objective: Evaluate a method for the estimation of the nocturnal systolic blood pressure (SBP) dip from 24-hour blood pressure trends using a wrist-worn photoplethysmography (PPG) sensor and a deep neural network in free-living individuals, comparing the deep neural network to traditional machine learning and non-machine learning baselines.Approach: A wrist-worn PPG sensor was worn by 106 healthy individuals for 226 days during which 5111 reference values for blood pressure (BP) were obtained with a 24-hour ambulatory BP monitor and matched with the PPG sensor data. Features based on heart rate variability and pulse morphology were extracted from the PPG waveforms. Long-and short term memory (LSTM) networks, dense networks, random forests and linear regression models were trained and evaluated in their capability of tracking trends in BP, as well as the estimation of the SBP dip.Main results: Best performance for estimating the SBP dip were obtained with a deep LSTM neural network with a root mean squared error (RMSE) of 3.12±2.20 ∆mmHg and a correlation of 0.69 (p = 3 * 10 −5 ). This dip was derived from trend estimates of BP which had an RMSE of 8.22±1.49 mmHg for systolic and 6.55±1.39 mmHg for diastolic BP (DBP). While other models had similar performance for the tracking of relative BP, they did not perform as well as the LSTM for the SBP dip.Significance: The work provides first evidence for the unobtrusive estimation of the nocturnal SBP dip, a highly prognostic clinical parameter. It is also the first to evaluate unobtrusive BP measurement in a large data set of unconstrained 24hour measurements in free-living individuals and provides evidence for the utility of LSTM models in this domain.

BackgroundThere is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi.Methods/designThis is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017.DiscussionThis is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries.Trial registrationClinicalTrials.gov, ID: NCT02763345. Registered on 3 May 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2213-z) contains supplementary material, which is available to authorized users.

ObjectiveMobile phone-based interventions have been proven to be effective tools for smoking cessation, at least in the short term. Gamification, that is, the use of game-design elements in a non-game context, has been associated with increased engagement and motivation, critical success factors for long-term success of mobile Health solutions. However, to date, no app review has examined the use of gamification in smoking cessation mobile apps. Our review aims to examine and quantify the use of gamification strategies (broad principles) and tactics (on-screen features) among existing mobile apps for smoking cessation in the UK.MethodsThe UK Android and iOS markets were searched in February 2018 to identify smoking cessation apps. 125 Android and 15 iOS apps were tested independently by two reviewers for primary functionalities, adherence to Five A smoking cessation guidelines, and adoption of gamification strategies and tactics. We examined differences between platforms with χ2tests. Correlation coefficients were calculated to explore the relationship between adherence to guidelines and gamification.ResultsThe most common functionality of the 140 mobile apps we reviewed allowed users to track the days since/until the quit date (86.4%). The most popular gamification strategy across both platforms was performance feedback (91.4%). The majority of apps adopted a medium level of gamification strategies (55.0%) and tactics (64.3%). Few adopted high levels of gamification strategies (6.4%) or tactics (5.0%). No statistically significant differences between the two platforms were found regarding level of gamification (p>0.05) and weak correlations were found between adherence to Five A’s and gamification strategies (r=0.38) and tactics (r=0.26).ConclusionThe findings of this review show that a high level of gamification is adopted by a small minority of smoking cessation apps in the UK. Further exploration of the use of gamification in smoking cessation apps may provide insights into its role in smoking cessation.