Symptom Check Research Articles

Opportunities and challenges of traditional Chinese medicine doctors in the era of artificial intelligence.

With the exponential advancement of artificial intelligence (AI) technology, the realm of medicine is experiencing a paradigm shift, engendering a multitude of prospects and trials for healthcare practitioners, encompassing those devoted to the practice of traditional Chinese medicine (TCM). This study explores the evolving landscape for TCM practitioners in the AI era, emphasizing that while AI can be helpful, it cannot replace the role of TCM practitioners. It is paramount to underscore the intrinsic worth of human expertise, accentuating that artificial intelligence (AI) is merely an instrument. On the one hand, AI-enabled tools like intelligent symptom checkers, diagnostic assistance systems, and personalized treatment plans can augment TCM practitioners' expertise and capacity, improving diagnosis accuracy and treatment efficacy. AI-empowered collaborations between Western medicine and TCM can strengthen holistic care. On the other hand, AI may disrupt conventional TCM workflow and doctor-patient relationships. Maintaining the humanistic spirit of TCM while embracing AI requires upholding professional ethics and establishing appropriate regulations. To leverage AI while retaining the essence of TCM, practitioners need to hone holistic analytical skills and see AI as complementary. By highlighting promising applications and potential risks of AI in TCM, this study provides strategic insights for stakeholders to promote the integrated development of AI and TCM for better patient outcomes. With proper implementation, AI can become a valuable assistant for TCM practitioners to elevate healthcare quality.

Short paths to diagnosis with artificial intelligence: systematic literature review on diagnostic decision support systems

Rare diseases are often recognized late. Their diagnosis is particularly challenging due to the diversity, complexity and heterogeneity of clinical symptoms. Computer-aided diagnostic aids, often referred to as diagnostic decision support systems (DDSS), are promising tools for shortening the time to diagnosis. Despite initial positive evaluations, DDSS are not yet widely used, partly due to alack of integration with existing clinical or practice information systems. This article provides an insight into currently existing diagnostic support systems that function without access to electronic patient records and only require information that is easily obtainable. Asystematic literature search identified eight articles on DDSS that can assist in the diagnosis of rare diseases with no need for access to electronic patient records or other information systems in practices and hospitals. The main advantages and disadvantages of the identified rare disease diagnostic support systems were extracted and summarized. Symptom checkers and DDSS based on portrait photos and pain drawings already exist. The degree of maturity of these applications varies. DDSS currently still face anumber of challenges, such as concerns about data protection and accuracy, and acceptance and awareness continue to be rather low. On the other hand, there is great potential for faster diagnosis, especially for rare diseases, which are easily overlooked due to their large number and the low awareness of them. The use of DDSS should therefore be carefully considered by doctors on acase-by-case basis.

'Better see a doctor?' Status quo of symptom checker apps in Germany: A cross-sectional survey with a mixed-methods design (CHECK.APP).

Symptom checker apps (SCAs) offer symptom classification and low-threshold self-triage for laypeople. They are already in use despite their poor accuracy and concerns that they may negatively affect primary care. This study assesses the extent to which SCAs are used by medical laypeople in Germany and which software is most popular. We examined associations between satisfaction with the general practitioner (GP) and SCA use as well as the number of GP visits and SCA use. Furthermore, we assessed the reasons for intentional non-use. We conducted a survey comprising standardised and open-ended questions. Quantitative data were weighted, and open-ended responses were examined using thematic analysis. This study included 850 participants. The SCA usage rate was 8%, and approximately 50% of SCA non-users were uninterested in trying SCAs. The most commonly used SCAs were NetDoktor and Ada. Surprisingly, SCAs were most frequently used in the age group of 51-55 years. No significant associations were found between SCA usage and satisfaction with the GP or the number of GP visits and SCA usage. Thematic analysis revealed skepticism regarding the results and recommendations of SCAs and discrepancies between users' requirements and the features of apps. SCAs are still widely unknown in the German population and have been sparsely used so far. Many participants were not interested in trying SCAs, and we found no positive or negative associations of SCAs and primary care.

Somatosensory Amplification Scale-Chinese version: psychometric properties and its mediating role in the relationship between alexithymia and somatization.

The Somatosensory Amplification Scale (SSAS) was designed to measure individual's tendency to experience visceral and somatic sensations as unusually intense, disturbing and alarming. In this study, we aimed to investigate the reliability and validity of the SSAS in the Chinese general population, as well as the mediating effect of somatosensory amplification in the relationship between alexithymia and somatization. A total of 386 healthy adults were enrolled in this study. Participants completed the Chinese versions of the Somatosensory Amplification Scale (SSAS-C), the somatization subscale of the Symptom Check List 90 (SCL-90 som), the Toronto Alexithymia Scale (TAS-20), and the Short form Health Anxiety Inventory (SHAI). One hundred and thirty-three participants were randomly selected to complete the SSAS-C again two weeks after the initial assessment. The reliability and validity of the SSAS-C were analyzed. Confirmatory factor analysis showed that the one-factor model achieved adequate model fits; one item was deleted due to low factor loading. The revised SSAS-C showed good internal consistency and test-retest reliability. The SSAS-C scores correlated positively with the scores of SCL-90 som, TAS-20 and the SHAI, showing good convergent validity. In addition, somatosensory amplification mediated the association between alexithymia and somatization. The Chinese version of SSAS has acceptable reliability and validity for the general population. In addition, alexithymia may increase somatization through higher somatosensory amplification.

TRANSFORMATION OF TELEMEDICINE PRACTICES THROUGH THE USE OF MULTIFUNCTIONAL EXAM DEVICES: CASE OF GEORGIA

In the last decade, digital health has captured special interest of healthcare systems and stakeholders, worldwide. Particularly, in times of COVID-19 pandemics, importance and utilization of telemedicine has increased dramatically. Nevertheless, for the effective utilization of telemedicine services, confidence of medical professionals and acceptance from the side of patients carries critical importance. To achieve same quality of consultation, utilization of digital technologies, such as symptom checkers and multifunctional telemedicine exam kits became increasingly popular in digital health. The purpose of this study is to evaluate usefulness of multifunctional telemedicine exam devices, in scope of perception, attitudes and satisfaction of patients and providers (nurses and doctors). The overall objective is to identify barriers and lessons learned for successful transformation of primary healthcare and implementation of digital health, in developing country contexts. In scope of the study, evaluation pilot has been conducted with duration of five months. For the research purposes qualitative research methods were applied. In particular, focus group discussions (FGDs) were conducted with nurses operating in villages and with doctors providing virtual consultations. Furthermore, in-depth interviews were conducted with patients who received virtual consultations during the pilot project and partners of the project (administrators and coordinators). Overall, thirty-five respondents were surveyed via video/audio call. Convenience sampling was used for the selection of respondent patients and all administrative personnel (six persons) was interviewed. According to the opinions of respondents, multifunctional telemedicine devices improve effectiveness of telemedicine consultation. However, barriers and challenges were also revealed. More specifically, selection of right motivational system for providers, adequate training of involved personnel and well aligned schedules for consultations are needed. Moreover, communication issues (nurse-to-doctor and doctor-to-patient) also represent a challenge and require proper approaches.

Влияние пролонгированной стрессовой ситуации на мировозренческие установки, особенности мышления и моральные решения

<p style="text-align: justify;"><strong>Objective. </strong>The study of the influence of prolonged stressful situation on world assumptions, peculiarities of thinking and moral decisions. <br><strong>Background. </strong>The pandemic situation can be considered as a model stressful situation. The assessment of its impact makes it possible to predict the consequences of society experiencing a high level of stress in a situation of danger and/or uncertainty. <br><strong>Study design. </strong>The level of distress, moral decisions, world assumptions, and peculiarities of thinking before the pandemic and in the conditions of the pandemic were compared. Methods of variance analysis, the Kraskal-Wallace criterion, and correlation analysis were used. <br><strong>Participants. </strong>"Moral dilemmas" <em>N</em> = 621 (23,4% of men), age – 33,7 ± 11,32; Constructive thinking questionnaire <em>N</em> = 700 (20,7% of men), age – 31,55 ± 9,7; Scale of basic beliefs <em>N </em>= 412 (18,2% of men), age – 35,6 ± 11,2. <br><strong>Measurements. </strong>"Moral dilemmas", "World Assumptions Scale” (WAS), “Constructive Thinking Inventory” (CTI), Symptom Check List-90-Revised (SCL-90R). <br><strong>Results. </strong>During the pandemic, the level of distress experienced is higher, the ability to distinguish between personal and "distant" violence is lower, and indicators of constructive thinking and emotional coping are lower. The belief in benevolence, justice of the world, the value of one's own self is reduced. All these changes are associated with a high level of distress. <br><strong>Conclusions. </strong>The stressful situation led to a change in moral decisions. The change was not directly related to basic beliefs and thinking patterns and is a consequence of "emotional detachment" in stressful situation.</p>

Moana: Alternate surveillance for COVID-19 in a Unique Population (MASC-UP)

ObjectiveCreate a longitudinal, multi-modal and multi-level surveillance cohort that targets early detection of symptomatic and asymptomatic COVID-19 cases among Native Hawaiian and Pacific Islander adults in the Continental US and identify effective modalities for participatory disease surveillance and sustainably integrate them into ongoing COVID-19 and other public health surveillance efforts. Materials and methodsWe recruited cohorts from three sites: Federal Way, WA; Springdale, AR; and remotely. Participants received a survey that included demographic characteristics and questions regarding COVID-19. Participants completed symptom checks via text message every month and recorded their temperature daily using a Kinsa smart thermometer. ResultsRecruitment and data collection is ongoing. Presently, 441 adults have consented to participate. One-third of participants were classified as essential workers during the pandemic. DiscussionOver the past 18 months, we have improved our strategies to elicit better data from participants and have learned from some of the weaknesses in our initial deployment of this type of surveillance system. Other limitations stem from historic inequities and barriers which limited Native Hawaiian and Pacific Island representation in academic and clinical environments. One manifestation of this was the limited ability to provide study materials and support in multiple languages. We hope that continued partnership with the community will allow further opportunities to help restore trust in academic and medical institutions, thus generating knowledge to advance health equity. ConclusionThis participatory disease surveillance mechanism complements traditional surveillance systems by engaging underserved communities. We may also gain insights generalizable to other pathogens of concern.

Benchmarking the symptom-checking capabilities of ChatGPT for a broad range of diseases.

This study evaluates ChatGPT's symptom-checking accuracy across a broad range of diseases using the Mayo Clinic Symptom Checker patient service as a benchmark. We prompted ChatGPT with symptoms of 194 distinct diseases. By comparing its predictions with expectations, we calculated a relative comparative score (RCS) to gauge accuracy. ChatGPT's GPT-4 model achieved an average RCS of 78.8%, outperforming the GPT-3.5-turbo by 10.5%. Some specialties scored above 90%. The test set, although extensive, was not exhaustive. Future studies should include a more comprehensive disease spectrum. ChatGPT exhibits high accuracy in symptom checking for a broad range of diseases, showcasing its potential as a medical training tool in learning health systems to enhance care quality and address health disparities.

The Frequency of Psychological Symptoms in the Elderly: A Cross-Sectional Field Study in Istanbul, Turkey

Introduction: Various reports have documented the psychological issues that affect the elderly. According to estimates, approximately 20% of the geriatric population experiences at least one psychological symptom or disorder. The aim of this study is to establish the frequency of psychological symptoms in the elderly population in İstanbul, Turkey.
 
 Methods: This cross-sectional study was conducted with 350 participants aged 65 and over, between 01.02.2019 and 19.07.2019. The psychiatric symptoms of the participants were evaluated with the Symptom Check List-90 Revised (SCL-90-R) test.
 
 Results: Psychological symptoms are present in 32.9% of the elderly population. The prevalence of depressive symptoms is 32.9% and the rate of obsessions is 26.6%. Somatization is present in 13.4% of cases, while interpersonal sensitivity is observed in 8.9% of cases. The paranoid symptom rate is 10.6%. While 6.9% of the participants have possible anger disorder symptoms, the rate of participants with anxiety symptoms is 6.6%. The rate of participants with probable phobic symptoms is 5.4%, and the rate of those with psychotic symptoms is 4.0%.
 
 Conclusion: Psychiatric problems encountered in old age negatively affect the quality of life. Because the most common psychological symptoms were depression, obsession, and somatization, family physicians should conduct screenings for possible mental problems in elderly individuals registered with them, regardless of the reason.

Group schema therapy: the temporal relationship between early maladaptive schemas and global psychological distress

Objective: Schema therapy is an effective treatment for personality disorders (PDs). The theory of schema therapy assumes that the decrease of global psychological distress is mediated by change in Early Maladaptive Schemas. The few studies that have investigated a temporal relationship have produced contradictory results. This study examined the temporal relationship between changes in Early Maladaptive Schemas and global psychological distress in Group Schema Therapy (GST) for patients with personality disorders. Method: Assessments were made of 115 patients at baseline, after 20, 40 and after 60 sessions of treatment. We used the Young Schema Questionnaire (YSQ) to measure the severity of Early Maladaptive Schemas and the Symptom Check List-90 Revisited (SCL-90R) to measure global psychological distress. Linear mixed model analyzes were used to examine the temporal relationship between the initial phase (0–20 and 0–40 sessions) and the later phase (40–60 sessions). Results: Change in Early Maladaptive Schemas does not precede change in global psychological distress. Conversely, global psychological distress does not precede change in Early Maladaptive Schemas; the improvement in both indicators is concurrent. Conclusion: In this study, we could not confirm that the decrease of Early Maladaptive Schemas precedes decrease of global psychological distress. We found a concurrent relationship.

Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study.

The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19-related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement.

The role of psychotic-like experiences in the association between aberrant salience and anxiety: A psychopathological proposal based on a case-control study.

Aberrant salience (AS) and psychotic-like experiences (PLEs) have been proven to be linked. Moreover, anxiety is a key symptom in psychosis-prone subjects and most psychotic patients. We propose a model that attempts to interpret the role of PLEs in the association between AS and anxiety among healthy controls and psychotic patients. Demographic and psychometric data (Aberrant Salience Inventory, Community Assessment of Psychic Experiences, Symptom Check List-90-revised) from 163 controls and 44 psychotic patients was collected. Descriptive statistics, correlations, a linear regression model and a mediation analysis with covariates were subsequently performed. AS correlated with more frequent positive PLEs and higher anxiety levels in both patients and controls. However, positive PLEs' frequency mediated the relationship between AS and anxiety only among controls. PLEs linked to AS appear to induce anxiety among the control group but not among psychotic patients. The progressive loss of both novelty and insight, which may, respectively, impair the somatic emotional reactivity to PLEs and the ability to recognize some bodily phenomena as the embodied correlates of anxiety, is seen as the most probable theoretical explanation.

“Do I really not need to go to the doctor?” - Unveiling usage patterns and explaining usage of Symptom Checker Apps: an explorative longitudinal mixed-method study. (Preprint)

“Do I really not need to go to the doctor?” - Unveiling usage patterns and explaining usage of Symptom Checker Apps: an explorative longitudinal mixed-method study. (Preprint)

Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study.

Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways.

Triage Accuracy and the Safety of User-Initiated Symptom Assessment With an Electronic Symptom Checker in a Real-Life Setting: Instrument Validation Study.

Previous studies have evaluated the accuracy of the diagnostics of electronic symptom checkers (ESCs) and triage using clinical case vignettes. National Omaolo digital services (Omaolo) in Finland consist of an ESC for various symptoms. Omaolo is a medical device with a Conformité Européenne marking (risk class: IIa), based on Duodecim Clinical Decision Support, EBMEDS. This study investigates how well triage performed by the ESC nurse triage within the chief symptom list available in Omaolo (anal region symptoms, cough, diarrhea, discharge from the eye or watery or reddish eye, headache, heartburn, knee symptom or injury, lower back pain or injury, oral health, painful or blocked ear, respiratory tract infection, sexually transmitted disease, shoulder pain or stiffness or injury, sore throat or throat symptom, and urinary tract infection). In addition, the accuracy, specificity, sensitivity, and safety of the Omaolo ESC were assessed. This is a clinical validation study in a real-life setting performed at multiple primary health care (PHC) centers across Finland. The included units were of the walk-in model of primary care, where no previous phone call or contact was required. Upon arriving at the PHC center, users (patients) answered the ESC questions and received a triage recommendation; a nurse then assessed their triage. Findings on 877 patients were analyzed by matching the ESC recommendations with triage by the triage nurse. Safe assessments by the ESC accounted for 97.6% (856/877; 95% CI 95.6%-98.0%) of all assessments made. The mean of the exact match for all symptom assessments was 53.7% (471/877; 95% CI 49.2%-55.9%). The mean value of the exact match or overly conservative but suitable for all (ESC's assessment was 1 triage level higher than the nurse's triage) symptom assessments was 66.6% (584/877; 95% CI 63.4%-69.7%). When the nurse concluded that urgent treatment was needed, the ESC's exactly matched accuracy was 70.9% (244/344; 95% CI 65.8%-75.7%). Sensitivity for the Omaolo ESC was 62.6% and specificity of 69.2%. A total of 21 critical assessments were identified for further analysis: there was no indication of compromised patient safety. The primary objectives of this study were to evaluate the safety and to explore the accuracy, specificity, and sensitivity of the Omaolo ESC. The results indicate that the ESC is safe in a real-life setting when appraised with assessments conducted by triage nurses. Furthermore, the Omaolo ESC exhibits the potential to guide patients to appropriate triage destinations effectively, helping them to receive timely and suitable care. RR2-10.2196/41423.

Bridging evidence-to-care gaps with mHealth: Designing a symptom checker for parents accessing knowledge translation resources on acute children's illnesses in a smartphone application.

Smartphone applications offer a novel platform for delivering health information to parents. This study created and evaluated an app-based symptom checker that recommends educational tools to parents based on their child's symptoms. Symptoms extracted from 23 knowledge translation (KT) tools for 10 children's illnesses comprised a set of plain-language symptoms. The symptom checker works by producing confusion matrices evaluating a child's reported symptoms against possible illnesses, comparing precision scores to examine how well each illness matched reported symptoms, and ordering possible illnesses by performance score. Performance was evaluated by extracting symptoms from 8 clinical vignettes, and examining correct first-try matches. We created a final list of 54 plain-language symptoms. Visualizations of the symptom set creation process and logic mapping are presented, as well as images of the working symptom checker. The symptom checker matched 100% (8/8) of tested clinical vignettes to the appropriate illness resource. Symptom checkers are a potentially useful tool to integrate into apps that parents use for their children's health. The design of these systems has the potential to change parents' relationship with technology, affecting both their adoption and acceptance of symptom checkers. Our design choices contribute to addressing current barriers to the adoption of symptom checkers, reducing functional, critical, and interactive literacy requirements for parents.

Comparison of the Mental Health Status of Left-Behind Children Before and After the COVID-19 Pandemic.

To investigate and discuss the mental health status of left-behind children in Anhui Province before and after the COVID-19 pandemic and analyze its influencing factors. A total of 82 left-behind children studying in grades 4 to 6 in Anhui Province, China were investigated by using the Symptom Check List-90 (SCL-90), Perceived Social Support Scale (PSSS) and Self-Esteem Scale (SES). Differences in the mental health status, perceived social support, and self-esteem of left-behind children before and after the COVID-19 pandemic were analyzed using the independent sample t-test. The relationship between mental health, perceived social support, and self-esteem before and after the pandemic was determined using the Pearson product-moment correlation test, and the factors influencing mental health before and after the pandemic were identified using regression analysis. The SCL-90 scores of left-behind children during and after the pandemic were 134.45 ± 23.17 and 114.52 ± 22.56, respectively, indicating that the SCL-90 score during the pandemic was significantly higher than that after the pandemic. The perceived social support scores of left-behind children during and after the pandemic were 58.99 ± 12.45 and 65.57 ± 11.76, respectively, indicating that the score during the pandemic was significantly lower than that after the pandemic. The self-esteem scores of left-behind children during and after the pandemic were 25.04 ± 4.95 and 28.39 ± 3.84, respectively, indicating that the score during the pandemic was significantly lower than that after the pandemic. The SCL-90 scores before and after the pandemic were significantly negatively correlated with perceived social support and self-esteem. The regression analysis results showed that self-esteem and perceived social support together could explain 25% of variations in the SCL-90 score during the pandemic and 34% of variations in the SCL-90 score after the pandemic. The mental health level, perceived social support, and self-esteem of left-behind children improved after the pandemic compared with those during the pandemic. Good perceived social support and self-esteem can effectively promote the mental health of left-behind children.

Inferiority and Superiority Complex: Examination in Terms of Gender, Birth Order and Psychological Symptoms

Inferiority and superiority complex are personality structures that point to unhealthy development in Adlerian theory. In this study, the aim was to examine inferiority and superiority complex in terms of socio-demographic characteristics of adult individuals, and to determine the predictive relationships between psychological symptoms and inferiority and superiority complex. A total of 361 (205 females, 156 males) adults between the ages of 18 and 62, reached through the convenient sampling method, participated in the study. Data were collected through the Turkish Version of the Adlerian Inferiority and Superiority Complex Shortened Scales, the Symptom Check List, and the Personal Information Form. In the study, it was found that the main effects of gender and birth order were significant in inferiority complex, while the main effect of birth order was significant in superiority complex. Gender main effect for superiority complex and gender-birth order interaction effect for both complexes were not significant. In addition, it was determined that psychological symptoms were a significant predictor of inferiority complex, but not a significant predictor of superiority complex.

Genetic newborn screening and digital technologies: A project protocol based on a dual approach to shorten the rare diseases diagnostic path in Europe.

Since 72% of rare diseases are genetic in origin and mostly paediatrics, genetic newborn screening represents a diagnostic "window of opportunity". Therefore, many gNBS initiatives started in different European countries. Screen4Care is a research project, which resulted of a joint effort between the European Union Commission and the European Federation of Pharmaceutical Industries and Associations. It focuses on genetic newborn screening and artificial intelligence-based tools which will be applied to a large European population of about 25.000 infants. The neonatal screening strategy will be based on targeted sequencing, while whole genome sequencing will be offered to all enrolled infants who may show early symptoms but have resulted negative at the targeted sequencing-based newborn screening. We will leverage artificial intelligence-based algorithms to identify patients using Electronic Health Records (EHR) and to build a repository "symptom checkers" for patients and healthcare providers. S4C will design an equitable, ethical, and sustainable framework for genetic newborn screening and new digital tools, corroborated by a large workout where legal, ethical, and social complexities will be addressed with the intent of making the framework highly and flexibly translatable into the diverse European health systems.

Development of "DiabetesSutra" a mobile application for lifestyle management of Type 2 Diabetes in India.

Multiple mhealth (mobile health) interventions and mobile applications have been developed to support diabetes self-management. However, most of the apps are developed without the need for assessment and evaluation by experts in the field. This study aimed to design and develop a mobile application (app) supporting diabetes self-management for people with Type 2 Diabetes Mellitus (T2D) using a systematic approach. In this study mixed method design was used to develop the mobile application. The mhealth intervention was designed and developed in five steps: i) Extensive literature search, ii) Needs assessment of patients with T2D with the help of healthcare providers and patients (Interviews with 15 healthcare providers like clinicians, dietitians, and diabetes educators, and 2 focus group discussions with patients) iii) Ideation and content development of app based on outcomes of needs assessment; iv) content validation (by 10 healthcare providers) and v) App development on a hybrid platform. Evaluation of the app by users i.e., type 2 diabetes patients was done using the users' Mobile App rating scale (uMARS). The app was evaluated by 40 patients and rated on the uMARS questionnaire. A patient-centric mobile app was developed for the nutritional management of diabetes with three modules: The patient module, the Evaluation module, and the Healthcare provider module. The patient module was the app that was provided to the patients with features like diet, physical activity, blood glucose log, education, etc., in addition to, a symptom checker, Stress meter blog, and FAQ. The evaluation module was integrated with the app it works when a user enters any log, it evaluates the entry against the standard cutoffs and flash prompts on the screen. The Healthcare provider module interacts with the server to provide them with patient data, comments, and feedback. The users found the app to be satisfactory. Incorporating additional features to enhance the user interface and streamline navigation could potentially enhance user engagement, thereby aiding in the management of T2D.