Current Health Research Articles

Psychometric Properties and Factorial Invariance of the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) in Basque Population.

Anxiety and depression are the most common current mental health problems. Due to their comorbidity, there is a need for instruments that measure them simultaneously. Moreover, given that their prevalence varies by gender and age, it is important to examine the factorial invariance of such instruments. The present study aimed to analyze the dimensionality and factorial invariance of the Basque version of the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) as a function of gender and age, and to gather additional evidence of its validity. The sample comprised 2131 participants (54.2% female) between 7 and 24 years old ( M = 13.2; SD = 3.52). The CECAD was found to have a two-dimensional structure invariant to gender and age, with higher latent means for girls in both dimensions, and for those aged 14 and over in depression, but with small effect sizes. Both reliability and convergent validity values were good. The Basque version of the CECAD has good evidence of validity and reliability for assessing anxiety and depression in Basque-speaking children and adolescents.

Understanding puberty and its measurement: Ideas for a maturing field

Puberty is a complex developmental process involving neuroendocrine changes (e.g., hormones, brain development), physical maturity (e.g., breast development, facial hair growth), and social reorganization (e.g., new social roles and relationships). Despite robust literature on the psychological correlates of pubertal development, research is limited by (1) a narrow conceptualization of puberty, (2) a focus on single pubertal markers (e.g., onset), and (3) invasive clinical exams that may limit access to representative samples. Indeed, many aspects of pubertal development - when it begins, how quickly or slowly youth progress through puberty, and how one’s maturity is viewed by others - are central to young people’s development and their future health and wellbeing. Further, while pubertal measures can reflect many different aspects of puberty, each telling a distinct story about development, they are frequently used and understood in similar ways, often privileging the experiences of White youth (and especially, girls) over those with marginalized social identities.The goals of this symposium are to bring together three researchers who will discuss the conceptualization and measurement of puberty as well as the implications of different measurement approaches for understanding youth’s current and future health and wellbeing. In the first presentation, Niamh MacSweeney will present data from the Adolescent Brain Cognitive Development (ABCD) Study demonstrating the sex-specific association of adrenal and gonadal pubertal timing with brain development and subsequently, depression over four years. In the second presentation, Natasha Chaku will use data from the Study of Early Childcare and Youth Development (SECCYD) to explore how different measures (i.e., Tanner stages vs. parent reports) and analytic approaches (i.e., latent growth curves vs. sex and age-related residuals) for understanding pubertal timing can impact inferences related to adolescent mental health. In the final presentation, Anne-Lise Goddings will review the state of current pubertal assessment measures, discussing limitations identified from youth, clinicians, and researchers and the development of a novel digital tool, co-developed with young people. The discussant, Lindsay Till Hoyt, will integrate the findings, highlighting the importance of considering the accuracy and meaning of different pubertal measures and how they relate to the biopsychosocial experiences of diverse youth.

Expanded Systematic Evidence Map for Hundreds of Per- and Polyfluoroalkyl Substances (PFAS) and Comprehensive PFAS Human Health Dashboard.

Per- and polyfluoroalkyl substances (PFAS) encompass a class of chemically and structurally diverse compounds that are extensively used in industry and detected in the environment. The US Environmental Protection Agency (US EPA) 2021 PFAS Strategic Roadmap describes national research plans to address the challenge of PFAS. Systematic Evidence Map (SEM) methods were used to survey and summarize available epidemiological and mammalian bioassay evidence that could inform human health hazard identification for a set of 345 PFAS that were identified by the US EPA's Center for Computational Toxicology and Exposure (CCTE) for in vitro toxicity and toxicokinetic assay testing and through interagency discussions on PFAS of interest. This work builds from the 2022 evidence map that collated evidence on a separate set of PFAS. Like our previous work, this SEM does not include PFAS that are the subject of ongoing or completed assessments at the US EPA. SEM methods were used to search, screen, and inventory mammalian bioassay and epidemiological literature from peer-reviewed and gray literature sources using manual review and machine-learning software. For each included study, study design details and health end points examined were summarized in interactive web-based literature inventories. Some included studies also underwent study evaluation and detailed extraction of health end point data. All underlying data is publicly available online as interactive visuals with downloadable metadata. More than 13,000 studies were identified from scientific databases. Screening processes identified 121 mammalian bioassay and 111 epidemiological studies that met screening criteria. Epidemiological evidence (available for 12 PFAS) mostly assessed the reproductive, endocrine, developmental, metabolic, cardiovascular, and immune systems. Mammalian bioassay evidence (available for 30 PFAS) commonly assessed effects in the reproductive, whole-body, nervous, and hepatic systems. Overall, 41 PFAS had evidence across mammalian bioassay and epidemiology data streams (roughly 11% of searched chemicals). No epidemiological and/or mammalian bioassay evidence were identified for most of the PFAS included in our search. Results from this SEM, our 2022 SEM on PFAS, and other PFAS assessment products from the US EPA are compiled into a comprehensive PFAS dashboard that provides researchers and regulators an overview of the current PFAS human health landscape including data gaps and can serve as a scoping tool to facilitate prioritization of PFAS-related research and/or risk assessment activities. https://doi.org/10.1289/EHP13423.

Defining the role of digital public health in the evolving digital health landscape: policy and practice implications in Canada.

Introduction In this article, we argue that current digital health strategies across Canada do not appropriately consider the implications of digital technologies (DTs) for public health functions because they adopt a primarily clinical focus. We highlight differences between clinical medicine and public health, suggesting that conceptualizing digital public health (DPH) as a field distinct from, but related to, digital health is essential for the development of DTs in public health. Focussing on DPH may allow for DTs that deeply consider fundamental public health principles of health equity, social justice and action on the social and ecological determinants of health. Moreover, the digital transformation of health services catalyzed by the COVID-19 pandemic and changing public expectations about the speed and convenience of public health services necessitate a specific DPH focus. This imperative is reinforced by the need to address the growing role of DTs as determinants of health that influence health behaviours and outcomes. Making the distinction between DPH and digital health will require more specific DPH strategies that are aligned with emergent digital strategies across Canada, development of intersectoral transdisciplinary partnerships and updated competencies of the public health workforce to ensure that DTs in public health can improve health outcomes for all Canadians.

Assessment of children's physical fitness and school health in the province of San Luis, Argentina.

Introduction. The assessment of physical fitness (PF), is useful strategy to know the current status of schoolchildren. Our primary objective was to measure the current health status and PF levels of schoolchildren in San Luis and to develop PF reference tables. Population and methods. Schoolchildren aged 9 to 12 years (boys and girls) were assessed based on 2 health indicators: body mass index and blood pressure. PF was measured using the ALPHA-Fitness test battery. Blood pressure, body mass, height, foot and hand length, standing long jump, 30 m sprint, 4 × 10 m agility test, and 20 m shuttle run test were assessed. The body mass index (BMI) and biological maturation were estimated. Results. A total of 15 548 schoolchildren were assessed. Average systolic blood pressure was 101 ± 10 mmHg and diastolic blood pressure, 66 ± 7 mmHg; BMI: 20.2 ± 4.3 kg/m 2 . Average PF was, in the cardiorespiratory component, VO2 max.: 39.87 ± 3.2 mL/kg/min and speed reached during the 20 m shuttle run test: 8.9 ± 0.6 km/h; in the musculoskeletal component, standing long jump: 120.6 ± 23.9 cm, 30 m sprint: 6.56 ± 0.85 s, 4 × 10 m agility test: 15.17 ± 1.82 s. The performance was better in the boys group (p < 0.001). Conclusion. Blood pressure was normal. Fifty percent of the sample was overweight or obese as per their BMI. Both boys and girls showed low PF levels. PF reference tables for schoolchildren from San Luis were developed for the first time.

Narratives of stressful and traumatic personal experience disclosed by students with mental health conditions in medical consultations

Abstract This paper advances the field of narratives by focusing on the narratives of personal experience disclosed by students with mental health conditions, in particular depression, anxiety and borderline personality disorder, in medical consultations. I draw on sociolinguistic and discourse-analytic approaches to the analysis of narratives in interaction, viewing language as a tool for constructing social reality, and examine the content, structural properties and functions of the stories (Labov &amp; Waletzky, 1967; De Fina &amp; Georgakopoulou, 2011). Engaging in self-disclosure and sharing stories of stressful and traumatic experience in medical consultations allows the students (1) to explain symptoms and interpret causes of their current health problems, (2) manage accountability, and (3) confront and cope with their painful experience and stigma.

Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic

BackgroundAffected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic.MethodsThis cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac.ResultsAccording to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p < 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p = 0.151). Dunn’s post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p < 0.001).ConclusionCurrent mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students’ depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing.

Maternal pertussis immunization and the blunting of routine vaccine effectiveness: a meta-analysis and modeling study

A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38–1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization’s short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.

Veterans in crisis: Describing the complexity of presentations to a mainstream UK Veterans’ mental health service

LAY SUMMARY Armed forces Veterans often delay seeking help for mental health problems until a crisis point is reached. However, the clinical presentation of UK Veterans in mental health crisis is poorly understood. This study explored the presenting demographics, mental health problems, and factors that contributed to the current mental health crisis of UK Veterans who were referred to a Veterans’ crisis service, delivered as part of the mainstream health system. It showed that Veterans in crisis were similar in age and gender to the wider population at higher risk of crisis. Veterans presented with a broad range of symptoms of mental ill health and factors that were driving their current crises. Findings suggest that crisis services that address a broad range of symptoms and factors may be best positioned to address Veterans’ needs. It also suggests that these services need to ensure they are responsive to the needs of the whole Veteran population, including younger Veterans and women.

A national survey of digital health company experiences with electronic health record application programming interfaces.

This study sought to capture current digital health company experiences integrating with electronic health records (EHRs), given new federally regulated standards-based application programming interface (API) policies. We developed and fielded a survey among companies that develop solutions enabling human interaction with an EHR API. The survey was developed by the University of California San Francisco in collaboration with the Office of the National Coordinator for Health Information Technology, the California Health Care Foundation, and ScaleHealth. The instrument contained questions pertaining to experiences with API integrations, barriers faced during API integrations, and API-relevant policy efforts. About 73% of companies reported current or previous use of a standards-based EHR API in production. About 57% of respondents indicated using both standards-based and proprietary APIs to integrate with an EHR, and 24% worked about equally with both APIs. Most companies reported use of the Fast Healthcare Interoperability Resources standard. Companies reported that standards-based APIs required on average less burden than proprietary APIs to establish and maintain. However, companies face barriers to adopting standards-based APIs, including high fees, lack of realistic clinical testing data, and lack of data elements of interest or value. The industry is moving toward the use of standardized APIs to streamline data exchange, with a majority of digital health companies using standards-based APIs to integrate with EHRs. However, barriers persist. A large portion of digital health companies use standards-based APIs to interoperate with EHRs. Continuing to improve the resources for digital health companies to find, test, connect, and use these APIs "without special effort" will be crucial to ensure future technology robustness and durability.

Progress in Investigating the Current Mental Health Status Among Caregivers for Surgical Oncology Patients

This article aims to discuss the current state and research progress concerning the mental health of caregivers for surgical oncology patients. The goal is to offer insights that can serve as a reference for further enhancements in caregivers’ mental well-being. This article conducts a comprehensive review and analysis of recent studies on the mental health of caregivers for patients undergoing oncologic surgery. These studies reveal that caregivers commonly grapple with mental health issues, including anxiety, depression, and stress. These problems are closely linked to the stress of the patient’s condition and treatment, the caregiver’s own mental strain, and a lack of social support. In addition, the mental health status of caregivers significantly influences the patient’s treatment and recovery process. Implementing various interventions, such as mental health education, services, the establishment of mental health support teams, and engagement in mental health promotion activities, can contribute to the improvement of caregivers’ mental well-being. This, in turn, has the potential to enhance treatment outcomes and the overall quality of life for patients.

Macro level system mapping of the provision of mental health services to young people living in a conflict context in Colombia

Colombia has one of the longest running internal armed conflicts, which has significantly impacted the mental health of the population. This article is the first to present a national level mapping of the provision of mental health services to young people living in Colombia, through detailed review of documentation, interviews with key stakeholders and quantitative analysis of existing data on mental health and suicide. It explores the existing public mental health provision in the country, focussing on where mental health resources are concentrated and how these are implemented. We use this mapping to understand how the current mental health system in Colombia fits with international approaches to youth mental health. We show that whilst mental health policy is variously framed (biomedical, biosocial, psychologically or through human rights), Colombian policy clearly focusses on a differential approach. This differential approach shapes service provision to target support at those in need, consequently neglecting whole population level mental health support. This means that not all stakeholders were clearly articulated or included in policy and that key institutional stakeholders, such as the education sector, were not linked to implementation plans or activity. Policy approaches were also over-centralised with little cross-institutional collaboration. Youth were specifically missing from services, as was explicit understanding of the intergenerational effects and impact of conflict. This was exacerbated by unequal distribution of mental health care services concentrated in populous, urban areas away from conflict-affected regions. Suicide is the second most prevalent cause of death with 10% of population who were recorded as dying by violence, dying from completed suicide. Triangulation implies a strong relationship between suicide and poorer access to professional support in conflict-affected areas and suggests that international frameworks and policy approaches to supporting youth mental health have been insufficiently adapted for conflict and post conflict contexts.

Exploring the facilitators and barriers to addressing social media's impact on anxiety within primary care: a qualitative study.

Several researchers and policymakers have acknowledged the alarming association between social media (SM) usage and anxiety symptoms in young adults. While primary care holds a crucial role in the improvement of health outcomes for those presenting with anxiety, there has been no research on GPs' perceptions of the impact of SM on anxiety. Furthermore, there has been little discussion of SM as a risk factor in anxiety-related consultations. This study is the first to use empirical research to inform how primary care can adapt to address SM's impact on anxiety within young adults. To identify the facilitators and barriers within primary care to addressing SM's impact on anxiety among young adults. A qualitative study of GPs in the UK. Following an exploratory pilot interview, semi-structured interviews with GPs (n = 7) were transcribed and thematically analysed, following an inductive approach. The following six facilitators were identified: a framework to facilitate discussion; open GP attitudes; GP training; referral pathways; larger stakeholder influence; and young adult education of social media's impact on anxiety. The following three barriers were identified: a lack of GP awareness of SM's impact on anxiety; cautious GP attitudes; and increased pressure on the health service. This qualitative study revealed a diversity of perceptions, and these novel findings are instructive in the adaptation of primary care services to meet the current mental health needs of young adults, as well as better assisting GPs in engaging in these conversations, especially within university practice.

Associations of current and childhood socioeconomic status and health outcomes amongst patients with knee or hip osteoarthritis in a Mexico City family-practice setting

ObjectivesTo examine the association of current and childhood socioeconomic status (SES) with patient-reported functional status, quality of life and disability in patients with knee or hip osteoarthritis (OA).MethodsCross-sectional study amongst individuals seeking care for any medical reason in a primary care family-practice clinic in Mexico City. We included individuals with self-reported doctor-diagnosed arthritis, recruited through waiting-room posters and invitations by treating family physicians. We administered a survey using validated Spanish language versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Osteoarthritis of Lower Limbs and Quality of Life (AMICAL), and the Stanford Health Assessment Questionnaire-Disability Index (HAQ-DI). To estimate current and childhood SES, we collected data on education level and occupation type for both the patient and their parents, as well as using a validated tool to estimate income quintile.ResultsWe recruited 154 patients and excluded 8 patients. There was a high correlation between outcome scores. Estimated income and education levels were correlated with WOMAC, AMICAL and HAQ-DI scores, and significant differences were found in all scores by occupation type. The associations for current SES variables and outcome scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension, and were largely explained by current income in mutually adjusted models. Childhood SES – in particular as measured through maternal education – was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES.ConclusionsCurrent Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. The WOMAC, AMICAL and HAQ-DI scores correlate with each other and are all potentially useful markers of disease severity. More research is needed to elucidate the relationships between childhood SES and OA outcomes. Awareness of life-course SES may be useful in identifying patients at risk for worse outcomes.

Examining the New Consensus Criteria for Traumatic Encephalopathy Syndrome in Community-Dwelling Older Adults.

In 2021, an expert panel of clinician-scientists published the first consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES), a clinical condition thought to be associated with chronic traumatic encephalopathy neuropathological change. This study evaluated the TES criteria in older adults and assessed associations between TES criteria and a history of repetitive head impacts. This cross-sectional, survey-based study examined the symptoms of TES, previous repetitive head impacts, and a variety of current health difficulties. To meet symptom criteria for TES, participants had to report progressive changes with memory, executive functioning, and/or neurobehavioral dysregulation. To meet the criterion for substantial exposure to repetitive head impacts via contact sports, participants reported at least 5 years of contact sport exposure (with 2+ years in high school or beyond). A sample of 507 older adults (mean age = 70.0 years, 65% women) completed the survey and 26.2% endorsed having one or more of the progressive core clinical features of TES. Those who had a significant history of contact sport exposure were not significantly more likely to meet TES criteria compared with those who did not (31.3% vs. 25.3%, p = 0.46). In a binary logistic regression predicting TES status, current depression or anxiety (odds ratio [OR] = 12.55; 95% confidence interval [CI] = 4.43-35.51), history of psychiatric disorders (OR = 2.07, 95% CI = 1.22-3.49), male sex (OR = 1.87), and sleep problems (OR = 1.71, 95% CI = 1.01-2.91) were associated with meeting TES criteria. The sport exposure criterion, age, and current pain were not significantly associated with TES status (ps > 0.05). A significant minority of participants with no history of neurotrauma endorsed symptoms consistent with TES (22.0% of men and 19.8% of women). Nearly 80% of neurotrauma naïve participants with clinically significant anxiety/depression met criteria for TES. In summary, approximately one in four older adults met the symptom criteria for TES, many of whom had no history of repetitive neurotrauma. Mental health problems and sleep issues were associated with TES, whereas having a history of repetitive head impacts in contact sports was not. These data suggest that the new consensus diagnostic criteria for TES may have low specificity and may carry a higher risk of misdiagnosing those with other physical and mental health conditions as having TES.

Using enrollment records to evaluate self-reports of monthly coverage in the redesigned current population survey health insurance module.

To evaluate the veracity of self-reports of month-level health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS). The CHIME (Comparing Health Insurance Measurement Error) study used health insurance enrollment records from a large regional Midwest insurer as sample for primary data collection in spring 2015. A sample of individuals enrolled in a range of public and private coverage types (including Medicaid and marketplace) was administered the CPS health insurance module, which included questions about month-level coverage, by type, over a 17-18-month time span. Survey data was then matched to enrollment records covering that same time frame, and concordance between the records and self-reports was assessed. Sample was drawn by the insurer's informatics specialists and Census Bureau interviewers conducted the survey. Following data collection, updated enrollment records were matched to the survey data to produce a person-level file of coverage by type at the month-level. For 91% of the overall sample, coverage status and type were reported accurately for at least 75% of observed months. Results varied somewhat by stability of coverage. Among those who were continuously covered throughout the 17-18 month observation period (which comprised 64% of the overall sample), that level of reporting accuracy was observed for 94% of the sample; for those who had censored spells (34% of the overall sample), the figure was 87%; and among those with gaps and/or changes according to the records (2% of the overall sample), for 82% of the group at least 75% of months were reported accurately. Findings suggest that reporting accuracy of month-level coverage in the CPS is high and that the survey could become a valuable new data source for studying the dynamics of coverage, including the Medicaid unwinding.

How Public Health Organizational Structure Affected the Response to the COVID-19 Pandemic: A Case Study in British Columbia, Canada.

Objectives: This study sought to examine how public health organizational structures affected decision-making and provides recommendations to strengthen future public health crisis preparedness. Methods: The Institutions-Politics-Organizations-Governance (IPOG) framework and an organizational lens was applied to the analysis of COVID-19 governance within British Columbia (BC). Organizational charts detailing the structure of public health systems were compiled using available data and supplemented with data collected through key informant interviews. Results: In response to the COVID-19 pandemic, BC initiated several changes in its public health organization. BC's COVID-19 response attempted to utilize a centralized command structure within a decentralized health system. Four key themes were identified pertaining to the 1) locus of decision-making and action; 2) role of emergency structures; 3) challenges in organizational structure; and 4) balance between authority and participation in decision-making. Conclusion: The organizational adaptations enabled a substantively effective response. However, our findings also illustrate deficiencies in organizational structure in the current public health system. Two recommendations for consideration are: 1) a more formal vertical organizational structure; and 2) developing new mechanisms to link health and general emergency response structures.

Novel Human Activity Recognition and Recommendation Models for Maintaining Good Health of Mobile Users

With the continuous improvement of the living standard, people have changed their concept from disease treatment to health management. However, most of the current health management software makes recommendations based on users’ static information, with low updating frequency. The effect of targeted suggestions becomes weak with time, and it is hard for the recommendation effect to be satisfactory. Based on the use of smartphones for recognizing human activities in real-time, firstly, a novel 'CNN+GRU' model is proposed in this paper, utilizing both convolutional neural networks (CNNs) and gated recurrent units (GRUs). 'CNN+GRU' can improve the recognition speed and extract the features in sensor data more accurately by achieving in the conducted experiments an average accuracy of 91.27%, thus outperforming other models compared. Secondly, another model, named SimilRec, is proposed for physical activity recommendation to users based on their health profile, the similarities between their current physical activity sequence, and the historical physical activity sequence of other (similar) users.

Autologous Skin Cell Suspension for Full-Thickness Skin Defect Reconstruction: Current Evidence and Health Economic Expectations.

Despite differing etiologies, acute thermal burn injuries and full-thickness (FT) skin defects are associated with similar therapeutic challenges. When not amenable to primary or secondary closure, the conventional standard of care (SoC) treatment for these wound types is split-thickness skin grafting (STSG). This invasive procedure requires adequate availability of donor skin and is associated with donor site morbidity, high healthcare resource use (HCRU), and costs related to prolonged hospitalization. As such, treatment options that can facilitate effective healing and donor skin sparing have been highly anticipated. The RECELL® Autologous Cell Harvesting Device facilitates preparation of an autologous skin cell suspension (ASCS) for the treatment of acute thermal burns and FT skin defects. In initial clinical trials, the approach showed superior donor skin-sparing benefits and comparable wound healing to SoC STSG among patients with acute thermal burn injuries. These findings led to approval of RECELL for this indication by the US Food and Drug Administration (FDA) in 2018. Subsequent clinical evaluation in non-thermal FT skin wounds showed that RECELL, when used in combination with widely meshed STSG, provides donor skin-sparing advantages and comparable healing outcomes compared with SoC STSG. As a result, the device received FDA approval in June of 2023 for treatment of FT skin defects caused by traumatic avulsion or surgical excision or resection. Given that health economic advantages have been demonstrated for RECELL ± STSG versus STSG alone when used for burn therapy, it is prudent to examine similarities in the burn and FT skin defect treatment pathways to forecast the potential health economic advantages for RECELL when used in FT skin defects. This article discusses the parallels between the two indications, the clinical outcomes reported for RECELL, and the HCRU and cost benefits that may be anticipated with use of the device for non-thermal FT skin defects.

Chatbots in Health Care: Connecting Patients to Information

Why Is This an Issue?&#x0D; &#x0D; Artificial intelligence (AI) is increasingly being used in health care settings. Chatbots geared toward patient use are becoming more widely available, but the clinical evidence of their effectiveness remains limited.&#x0D; &#x0D; What Is the Technology?&#x0D; &#x0D; AI-based chatbots are computer programs or software applications that have been designed to engage in simulated conversation with humans using humanlike language.&#x0D; Chatbots can help humans save time and allow them to focus on more high-level creative or strategic thinking by taking over more routine or repetitive tasks, such as automated customer service chats, appointments, or staff scheduling.&#x0D; &#x0D; What Is the Potential Impact?&#x0D; &#x0D; Anyone with access to an internet-enabled computer or a smartphone could use these chatbots to access health information.&#x0D; Chatbots can provide patients with 24/7 access to health information, such as symptom assessment, supportive information, medication reminders, or appointment scheduling, allowing access to information when health care providers are unavailable. There appear to be trends toward efficacy and user satisfaction, but the evidence to support the clinical effectiveness of chatbots in health care is still being established.&#x0D; Existing health care chatbots are mostly free for patients to access, although some developers and health care providers charge fees to access additional features or content. Some apps may be prescribed to patients by providers. These could be covered by insurance or licensed to health care providers by the developer.&#x0D; &#x0D; What Else Do We Need to Know?&#x0D; &#x0D; Ethical and data privacy issues remain top of mind when considering the widespread implementation of chatbots for patient use in health care settings.&#x0D; ChatGPT and other AI tools that were not developed specifically for health care do not necessarily provide the level of data privacy that is required of health care information. They are also trained on historical datasets and do not provide responses based on the most current clinical recommendations or health data.&#x0D; The development of AI-specific ethical frameworks could facilitate safer and more consistent development of AI tools in health care by preventing the misuse of AI technologies and minimizing the spread of misinformation.&#x0D; AI tools still require human oversight in terms of moderation and troubleshooting.&#x0D;