Digital health interventions (DHIs), delivered via digital platforms such as internet-based programs, mobile applications or short messages, may improve patient-reported outcomes (PROs), but comparative effectiveness is unclear. We conducted a network meta-analysis of randomized controlled trials in adults undergoing elective surgery under general anesthesia, identified in PubMed, Embase, CENTRAL, and Web of Science to March 1, 2025. Standardized mean differences (SMDs), mean differences (MDs) with minimal important differences (MIDs), and 95% CIs were estimated. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Fifty-six trials (6,154 patients) were included. Extended reality (XR) most effectively reduced perioperative anxiety (SMD 0.60; 95% CI 0.37-0.84; MD 8.05; MID 6.71; moderate-certainty). For postoperative pain, mobile applications (SMD 0.64; 95% CI 0.32-0.95; MD 1.36; MID 1.0; moderate-certainty) and XR (SMD 0.51; 95% CI 0.26-0.76; MD 1.09; MID 1.0; moderate-certainty) were probably effective. For quality of life, 2D video yielded the greatest gain (SMD 0.99; 95% CI 0.11-1.88; MD 0.11; MID 0.05; high-certainty). XR also improved satisfaction (SMD 1.27; 95% CI 0.63-1.91; MD 1.91; MID 0.75; moderate-certainty). These findings suggest that DHIs may improve perioperative PROs.

Introduction Type 2 diabetes mellitus (T2DM) represents a global public health problem. In Ecuador, it is the second leading cause of death among women and the third among men. Digital health technologies, including mobile applications, messaging platforms, and web-based tools, have emerged as promising interventions for managing this condition, although a gap remains between their theoretical potential and their effective implementation in clinical practice. Objective To explore and synthesize the available evidence on the experiences, perceptions, barriers, and facilitators reported by adult users with type 2 diabetes mellitus regarding the use of digital health technologies for managing their disease in community or outpatient settings. Methodology An integrative systematic review of literature published between 2015 and 2025 was conducted in PubMed, Scopus, and Google Scholar. Qualitative, quantitative, and mixed-methods studies in English and Spanish involving adults using mobile applications for T2DM were included. Methodological quality was assessed using the Johns Hopkins Evidence-Based Practice model. Results A total of 66 studies were analyzed, with qualitative designs predominating (n=28), followed by randomized clinical trials (n=13) and experimental studies (n=14). Most studies were rated as high (n=35) or good quality (n=28). Experiences were grouped into three categories: positive (usefulness, satisfaction, empowerment, educational support), conditioning factors (individual, contextual, and design-related), and barriers (technological, usability, personal). Perceptions focused on usefulness, usability, and impact on self-care. Facilitators included simple design, personalization, professional support, cultural adequacy, and motivation. Conclusions Digital health technologies promote self-management and glycemic control, although barriers persist that limit their sustained adoption. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251241989.

IntroductionClinical follow-up for cochlear implant (CI) users is typically carried out in a face-to-face session in a clinical site. Users must travel to the site, which incurs burdens of travel time, expenses, and time lost from work or education. To help alleviate this, a mobile health application, Remote Check, has been developed to facilitate the remote evaluation of both the functionality of the CI system and the hearing performance of the user. Here, we report the results of a real-world field test of Remote Check with a cohort of 29 CI users across two clinics.MethodsPaired Remote Check and face-to-face clinical follow-up session were performed with a cohort of 29 experienced CI users. A psychometric instrument for the evaluation of mobile health applications (the mHealth App Usability Questionnaire, MAUQ) was administered to both users and clinical professionals, along with an ad-hoc survey to evaluate users’ experiences regarding travel distances, travel times, costs, and other parameters associated with different types of clinical follow-up sessions. Professionals were also surveyed on the performance of the tool. The durations of Remote Check and face-to-face follow up sessions were compared, and the agreement rate of post-session follow-up actions was determined.ResultsBoth technical checks of the CI and evaluation of hearing performance were possible with Remote Check. Both users and professionals rated the tool highly on the MAUQ instrument. This tool facilitated shorter session times and had strong agreement with face-to-face follow up in terms of further actions. Users also perceived Remote Check as offering the possibility of saving them money.ConclusionMED-EL Remote Check is an adequate tool for the remote evaluation of both the CI system and the users’ hearing performance. Remote Check may reduce barriers to care, particularly for rural populations.

Heart failure (HF) is associated with substantial morbidity and mortality worldwide. Although self-care is crucial for long-term HF management, individuals with HF often face challenges in maintaining self-care behaviors over time. This highlights the need to understand people's motivation to engage in self-care and how those motivations might change over time. Self-determination theory provides a valuable framework for understanding the link between motivation and self-care, but the specific conditions that shape this relationship in daily life remain uncertain. An ecological momentary assessment study was conducted to investigate the relationship between intention and self-care among patients with HF, as well as the moderating role of motivation types. Participants completed 2 surveys per day for a week using the Sema3 mobile application. A total of 63 patients with HF (49.2% male) with a mean age of 61.7 years (standard deviation = 17.1) completed the study. Medication adherence demonstrated high stability (intraclass correlation coefficient [ICC] = 0.99) in daily life, while diet (ICC = 0.80) and weighing behaviors (ICC = 0.79) were also largely consistent within participants. In contrast, exercise demonstrated greater day-to-day fluctuation (ICC = 0.46). Morning self-care intentions significantly predicted evening behaviors for weighing and exercise, but not for diet-related self-care. Identified and integrated motivation were the most commonly endorsed types of motivation across different self-care behaviors. This study highlighted the dynamic nature of motivation and self-care in daily life. Health professionals should recognize that intention does not necessarily translate into actual behavior, and some behaviors require greater support than others.

Using AI-powered mobile applications for mental health screening can help reduce maternal mental health disparities among Black mothers who are pregnant or parenting in the United States. A maternal health education question and answer mobile application chatbot has the potential to intervene in the maternal depression cascade, specifically screening. Extant research demonstrates the usability of mobile applications addressing mental health. However, limited scholarship explores the intersection between AI-powered mobile application chatbots and maternal mental health. This study uses a multimethod analysis to evaluate the usability of an AI-powered mobile application to address maternal mental health among Black women. Data sources, including mobile application engagement, mental health disorder scales, and secondary qualitative analysis from focus group discussions (n = 5), will be assessed through a multimethod approach. The study team previously collected data across the United States for this clinical intervention in 2022. Findings indicate that the mobile application demonstrated promise in the application's usability to screen for maternal health depression indicators. This was achieved using the mobile application's intent classification functionality that classified users' questions that contained targeted search terms (e.g., postpartum depression) or specific inquiries about mental health and appropriate follow-up from the study team to provide mental health resources. Critical interconnected themes were assessed and reflected high confidence, acceptance, and usability of the mobile application in addressing maternal mental health inquiries. Findings contribute to evidence about the usability of AI-powered mobile applications informed by Black mothers in appropriate screening for maternal depression indicators and inquiries. This study provides insight into closing the gap in maternal health disparities in depression outcomes for Black mothers.Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.

Adopting Taylor and Todd’s “decomposed theory of planned behavior” as a theoretical framework, this study examines the key factors influencing users’ intention to use Mobile Augmented Reality applications for shopping activities. A structural equation modeling approach, utilizing the SmartPLS software version 4.0.9.4, was employed to empirically test the research hypotheses. 261 responses were collected through the survey questionnaire. The results of the study indicate that users’ attitudes, social norms, and perceived behavioral control are significant determinants of user intention to continue using mobile augmented reality applications. Furthermore, interactivity, perceived mobility, and trust positively influenced users’ attitudes toward mobile augmented reality applications. The study provides insights into the essential factors affecting users’ intentions to continue using MAR applications for shopping. Drawing from the study’s findings, developers of mobile augmented reality applications should prioritize offering quick and stable interactive platforms for virtual product try-ons. The current research adds to the body of knowledge regarding both the DTPB and MAR. Firstly, the study applies the DTPB framework to understand user continuance intention in the context of mobile augmented reality shopping applications. It extends the application of DTPB to a relatively new technological domain.

This research successfully developed a digital Indonesian language textbook based on the local wisdom of Baduy culture, which has proven useful in improving the narrative and descriptive writing skills of primary school students in Lebak Regency. Although qualitative data showed that teachers and students gave satisfactory responses, especially those related to increased engagement and deeper awareness of local cultural values, quantitative data showed a clear improvement in students' writing skills after using the textbook. Incorporating Baduy cultural values into digital learning tools not only enhances teaching materials but also provides a more contextualized and significant learning environment, thus helping students deepen their cultural identity. Therefore, this digital textbook product provides not only a means of literacy but also a means of cultural preservation, supporting the implementation of the Merdeka Belajar curriculum, which emphasizes culture- and technology-oriented education. Although this study has favorable results, there are opportunities for further development. Further research could expand this reach by involving more people from various backgrounds and assessing the effectiveness of digital textbooks in other Indonesian local cultural frameworks. Further research could examine how other technologies, such as mobile applications or augmented reality, can be incorporated to increase the interactivity and appeal of the learning environment. Based on local knowledge to improve literacy, this approach is projected to provide a more complete picture of the potential of digital media, which is the basis for the sustainability of local culture in the ever-evolving digital age.

Notched sound therapy (NST) is a mobile application that has been shown to provide tinnitus relief by reducing dysfunctional auditory cortex reorganization. This study aimed to evaluate the role of compliance with notched sound therapy (NST) on the effectiveness of reducing tinnitus symptoms. A prospective randomized control trial was performed in patients older than or equal to 18 years at a tertiary referral center. Patients were randomized at enrollment to either the NST group and given a free subscription to the NST mobile application or the standard of care (SOC) group. Continued enrollment in the study, NST use, and tinnitus handicap index (THI) were evaluated at 6 weeks, 3 months, 6 months, and 12 months in the NST versus SOC group and in NST users versus non-users. Patients in the NST group were 2.2 times more likely to use NST at 6-week follow-up compared with the SOC group (70% vs. 32%, P =0.020). Initial THI score, age, and tinnitus frequency and loudness did not significantly impact follow-up rates or NST use. Assignment to the NST treatment group was associated with a significantly increased reduction in THI compared with the SOC group (β: -10.02, 95% CI: -18.20, -1.83, P =0.017). However, NST use was not associated with any significant changes in THI compared with NST non-users. Overall, reduced cost of NST treatment was associated with greater tinnitus relief; however, compliance with treatment was not significantly associated with THI changes. Therefore, these changes may be explained by psychological factors reinforcing patient empowerment, perceived support, and accountability.

ABSTRACTDiabetes is a leading cause of morbidity and mortality, contributing to complications such as cardiovascular disease, kidney failure and lower‐limb amputations. Diabetic foot complications, such as structural deformities, ulceration and infection, present significant risks, necessitating early detection and intervention. This study explores the development and validation of artificial intelligence (AI) image analysis for diabetic foot screening, focusing on structural deformity identification which includes callus, hallux valgus and hammer toes, because they represent the earliest detectable visual risk markers for ulceration, preceding wound formation. Leveraging datasets comprising over 1000 healthy foot images and 215 diabetic foot deformity images, the model employed YOLOv5 for object detection, a convolutional autoencoder for anomaly detection, and DenseNet201 for anomaly classification. Initial internal validation yielded 91.1% anomaly detection accuracy, while anomaly classification accuracy improved to 88.57% following refinement. External validation using 27 participants achieved an overall accuracy of 85.2% and anomaly classification accuracy of 66.7%. Final evaluation on 35 unlabelled images demonstrated promising performance, with 88.57% accuracy, 90.47% precision and an F1 score of 86.11%. Integrated into the ‘Foot at Risk’ (FAR) mobile application, this AI‐driven solution offers a scalable tool for early diabetic foot deformity detection. With larger dataset input for training and development, it can be utilised as an early screening tool for diabetic foot and integrated into existing community diabetic care model, facilitating timely intervention and improving patient outcomes.

Background: Type 2 diabetes mellitus affects more than 500 million adults worldwide. Digital health interventions such as SMS, mobile applications, and telemedicine provide scalable approaches to improve glycaemic control. This systematic review and network meta-analysis assessed the effect of these interventions on HbA1c reduction in adults with T2DM compared with usual care. Methods: Following PRISMA-NMA guidelines and PROSPERO registration (CRD420251181626), we searched six databases and grey literature for RCTs from 2010 to 2025. We included 31 RCTs in narrative synthesis and 15 (∼3,500 participants) in pairwise and network meta-analyses using random-effects models. Results: DHIs significantly reduced HbA1c by a pooled mean difference of -0.37%. Subgroup analyses showed SMS interventions achieved the largest reduction (-0.48%), followed by apps (-0.24%), with lower heterogeneity for SMS. Effects attenuated over longer follow-up. Network meta-analysis indicated no significant differences between modalities, though SMS trended superior. RE-AIM assessment revealed strong reach and effectiveness but limited long-term maintenance. Conclusion: DHIs, especially SMS-based approaches, offer modest yet clinically meaningful HbA1c reductions and are scalable adjuncts to type 2 diabetes management, including in resource-limited settings.

Digital health integration in chronic kidney disease.

This review highlights recent advances in neuro-vestibular rehabilitation, with emphasis on vestibular adaptation and emerging mobile technologies. It summarizes developments in promoting vestibular plasticity and discusses novel tools such as virtual reality, wearable sensors, and telehealth platforms that enhance access, engagement, and outcomes. The scope is broad, focusing on general principles rather than specific populations. New methods to enhance vestibulo-ocular reflex (VOR) adaptation include incremental adaptation devices and gamified exercises. Inducing VOR gain-down adaptation temporarily increases postural sway, which normalizes via sensory reweighting, demonstrating central compensation. Portable tools like StableEyes show promise in boosting VOR gain with brief sessions. Concurrently, technology-driven approaches are gaining traction. Gamified mobile applications and wearable sensors allow home-based rehabilitation with remote supervision and monitoring, showing promising results in conditions like multiple sclerosis. Virtual reality interventions and telehealth models accelerated during the COVID-19 era, expanding therapy delivery to underserved populations. Adjunctive methods such as vibrotactile feedback and galvanic vestibular stimulation are emerging as complementary therapies. Recent developments are advancing vestibular rehabilitation by refining adaptive training techniques and leveraging digital tools to overcome barriers in access and adherence. These innovations point to a more personalized, technology-enabled approach to optimizing neuro-vestibular recovery.

Hydroponic salad cultivation is becoming increasingly popular. However, a common challenge is the lack of time to maintain hydroponic vegetables due to other responsibilities. This study presents a hydroponic system based on the internet of things (IoT) technique, designed to save time by enabling remote control through a mobile application connected to a NodeMCU microcontroller. Various sensors are integrated with the NodeMCU for real-time monitoring and automation. The study also explores the use of RGB LEDs, which significantly accelerated plant growth and reduced cultivation time. A comparative experimental design was employed to evaluate the growth rate of green oak salad vegetables under two different greenhouse systems. The primary factor compared was the greenhouse system type, with plant growth rate as the outcome variable. Each treatment was replicated 10 times. F-tests were used to statistically determine significant differences in growth rates between the two systems across measured intervals. Results showed that the automated greenhouse system produced the highest leaf width and plant weight values. The use of RGB LEDs reduced the cultivation period from 45 days to 30 days, enabling more planting cycles and ultimately increasing overall yield.

This two-year follow-up study evaluated the sustained impact of the AIMS suicide prevention pathway, a structured, short-term intervention delivered by the Wellbeing Team (WBT) in a large Australian metropolitan mental health service. The retrospective cohort included 232 individuals who engaged with the WBT for at least 2 weeks and were discharged to primary care. Re-presentation to public mental health services was examined across three thresholds: any service contact (Condition 1), secondary care involvement (Condition 2) and sustained case management (Condition 3). At 24 months, 66.4% of participants had not re-presented to any public mental health service. Only 8.2% required further engagement with secondary services, and just 3.0% transitioned into longer-term case management. Survival analysis showed no statistically significant differences based on prior service contact, suggesting the AIMS pathway was broadly effective across diverse clinical histories. These findings indicate that AIMS supports not only crisis stabilisation but sustainable recovery. Its dual emphasis on clarity and growth is foundational: clarity through structured clinical actions, Assessment, Intervention, Monitoring and Step Up/Down (AIMS) and growth through guided discovery, values alignment, and peer support. The model is further strengthened by integration of the SAFE framework for dynamic safety planning and the HOPE framework for values-based recovery, both of which are embedded in the Safe Life Guide mobile application. By meeting individuals where they are and addressing both immediate safety and long-term purpose, AIMS offers a system-level reimagining of crisis care, one that reduces dependency, restores direction, and fosters life in motion.

Waste management remains a significant issue in Indonesia, particularly in the aspect of proper waste sorting. Introducing environmental education to elementary school students is essential to help them develop long-term positive habits. This study presents the design and development of a mobile application aimed at educating elementary school children about correct waste-sorting practices. The application integrates gamification elements—such as points, quizzes, learning modules, and interactive mini-games—to enhance engagement and motivation throughout the learning process. The resulting prototype features a child-friendly interface, educational content on waste categories, and interactive activities designed to reinforce user understanding. This application is intended to function as an engaging and interactive learning tool that makes waste-sorting education more enjoyable, thereby supporting environmental awareness from an early age.

This community service initiative evaluates the impact of mobile applications, namely Haji Pintar–Satu Haji and Kawal Haji, in enhancing digital literacy and ritual understanding among pilgrims at KBIHU Ahmad Dahlan, Pringsewu. The program was implemented over a one-month period and involved participants engaging in mobile-based tutorials and mentoring activities designed to support comprehensive Hajj preparation. The learning materials focused on improving participants’ understanding of Hajj rituals while simultaneously strengthening their ability to use digital applications effectively. Survey results indicated that nearly all participants had access to Android smartphones, with 41.3% of respondents assessing their digital skills as “very good.” Among the available features, video tutorials were the most frequently accessed, accounting for 34.8% of usage, as they were perceived as clear and easy to understand. The majority of pilgrims reported improved comprehension of Hajj rituals after participating in the program. Despite these positive outcomes, several challenges were identified, including infrequent application usage, accessibility limitations for some users, and participant requests for offline learning content. Overall, the findings demonstrate the significant potential of mobile applications to support Hajj preparation through religious education and digital engagement. The study recommends further development through more inclusive application design, offline accessibility, and sustained digital engagement strategies to enhance the effectiveness of community outreach programs in religious education.

Fracture toughness of Khaya ivorensis and Magnolia obovata for mobility applications

The frequency of hypertension in Ghana has risen dramatically in recent decades. Inadequate diagnosis and inappropriate care of diagnosed cases has led to increased mortality and morbidity from poor blood pressure control and associated consequences, especially in areas with low socioeconomic status. This study aimed to assess the prevalence of hypertension and its determinants in underserved coastal communities in Ghana. This screening survey is part of a quasi-experimental initiative in 8 coastal towns to detect hypertension patients and connect them to local care. The initial survey examined 10000 consenting individuals aged 18years and older in these localities. Poisson regression model was used to determine the associations of socioeconomic factors with hypertension occurrence. The median age of the study participants was 38years, majority being women (65.3%). The overall age-standardized hypertension rate was 26.0% (95% CI: 25.1-26.9), with significant variability across subdistricts and communities ranging from 22.0% (95% CI: 20.1-23.8) in Ga South to 32.7% (95% CI: 30.2-35.2) in Krowor. The prevalence of hypertension decreased with increasing levels of monthly income with those earning GHC 1501-2000 having the lowest adjusted prevalence ratio (aPR, 0.64; 95% CI: 0.49-0.84). Besides age, female sex (aPR, 1.18; 95% CI: 1.08-1.28), being married (aPR, 1.19; 95% CI: 1.05-1.35), and alcohol consumption (aPR, 1.23; 95% CI: 1.13-1.35), were significantly associated with increased prevalence of hypertension. The coastal communities in Ghana are highly affected by hypertension with a remarkably high prevalence in women. Tailored public health strategies such as education on lifestyle modification, creation of recreational areas, use of telemedicine and mobile applications for monitoring, and follow-up may help to decrease the risk of hypertension and its complications in these communities.

Self-monitoring of state dissociation and inner tension in psychotherapy for borderline personality disorder.

The architectures of oriental matrix are the material and tangible testimony of a culture that for centuries has invested southern Italy, and in particular the eastern regions close to Greece, which had specific geographical and orographic configurations. The traces of this incredible story are, in some cases, striking, majestic, and complex architectural masterpieces; in other cases, minute and widespread, myriads of small artefacts, lined up along the ancient paths. The theme of this research aims to connect, in an organic network, the small artefacts that belong to the oriental tradition and which are present along the Sicilian and Calabrian eastern coasts The aim of the research is not to reconstruct medieval perceptions – a methodologically problematic operation, as well as scientifically risky in the absence of sources – but rather to investigate how contemporary communities reinterpret the Italian-Greek heritage, how they have tacitly assimilated it into the surrounding landscapes, and how digital tools (photogrammetry, participatory methods and mobile applications) can mediate this relationship and contribute to its intangible cultural value.