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JMIR Dermatology
Technologies, devices, apps, and informatics applications for patient education in dermatology, including preventative interventions, and clinical care for people with dermatological conditions
JMIR Dermatology (JDerm) is a new sister journal of JMIR (the leading open-access journal in health informatics), focusing on technologies, medical devices, apps, engineering, informatics applications for patient education in dermatology, including preventative interventions (e.g. skin cancer prevention) and clinical care for people with dermatological conditions.
As an open access journal, we are read by clinicians and patients alike and have (as with all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
During a limited period of time, there are no fees to publish in this journal. Articles are carefully copyedited and XML-tagged, ready for submission in PubMed Central.
Background: Social media has emerged as a common source of dermatological information. Monitoring the patterns of social media use and engagement is important to counteract the limitations of social media. However, evidence in Vietnamese dermatology patients is lacking.
Objective: This study aimed to explore social media use and engagement by dermatology patients and to identify factors associated with social media use and engagement.
Methods: A cross-sectional study was conducted with 519 participants at the Vietnam National Hospital of Dermatology and Venereology during September to November 2018. Data about sociodemographic characteristics, social media use, and social media engagement were collected. Multivariate logistic and tobit regression models were used to identify factors associated with social media use and engagement.
Results: Interest in information about “cosmetic, beauty, and skincare techniques” was the greatest (184/519, 46.2%). The mean engagement score was 8.4 points (SD 2.4 points). Female patients were more likely to use social media (odds ratio [OR] 2.23, 95% CI 1.23-4.06) and be interested dermatological information on social media (OR 3.09, 95% CI 1.35-7.09). Women also had higher social media engagement scores (coefficient=0.68, 95% CI 0.17-1.18). Higher social media engagement scores were related with Instagram use (coefficient=0.58, 95% CI 0.00-1.15) and higher credibility scores for “family members” (coefficient=0.15, 95% CI 0.03-0.26) and “dermatology companies” (coefficient=0.22, 95% CI 0.04-0.39).
Conclusions: This study discovered high social media usage among dermatology patients. However, only moderate utilization and credibility levels were reported regarding the use of social media as a source of dermatological information. More efforts should focus on involving dermatologists in the development of individualized information on social media targeting specific groups of dermatology patients.
Background: Spin is the misrepresentation of study findings, which may positively or negatively influence the reader’s interpretation of the results. Little is known regarding the prevalence of spin in abstracts of systematic reviews, specifically systematic reviews pertaining to the management and treatment of acne vulgaris.
Objective: The primary objective of this study was to characterize and determine the frequency of the most severe forms of spin in systematic review abstracts and to evaluate whether various study characteristics were associated with spin.
Methods: Using a cross-sectional study design, we searched PubMed and EMBASE for systematic reviews focusing on the management and treatment of acne vulgaris. Our search returned 316 studies, of which 36 were included in our final sample. To be included, each systematic review must have addressed either pharmacologic or nonpharmacologic treatment of acne vulgaris. These studies were screened, and data were extracted in duplicate by two blinded investigators. We analyzed systematic review abstracts for the nine most severe types of spin.
Results: Spin was present in 31% (11/36) of abstracts. A total of 12 examples of spin were identified in the 11 abstracts containing spin, with one abstract containing two instances of spin. The most common type of spin, selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention, was identified five times (5/12, 42%). A total of 44% (16/36) of studies did not report a risk of bias assessment. Of the 11 abstracts containing spin, six abstracts (55%) had not reported a risk of bias assessment or performed a risk of bias assessment but did not discuss it. Spin in abstracts was not significantly associated with a specific intervention type, funding source, or journal impact factor.
Conclusions: Spin is present in the abstracts of systematic reviews and meta-analyses covering the treatment of acne vulgaris. This paper raises awareness of spin in abstracts and emphasizes the importance of its recognition, which may lead to fewer incidences of spin in future studies.
Background: Infection with the herpes simplex virus (HSV) is common but not well understood. Furthermore, there remains a social stigma surrounding HSV that can have psychosocial implications for those infected. Despite many patients infected with HSV experiencing mild-to-severe physical symptoms, only one subeffective treatment is available. A registry collecting real-world data reported by individuals potentially infected with HSV could help patients to better understand and manage their condition.
Objective: This study aimed to report on the development of a registry to collect real-world data reported by people who might be infected with HSV.
Methods: A case study design was selected as it provides a systematic and in-depth approach to investigating the planning phase of the registry. The case study followed seven stages: plan, design, prepare, collect, analyze, create, and share. We carried out semistructured interviews with experts, which were thematically analyzed and used to build use cases for the proposed registry. These use cases will be used to generate detailed models of how a real-world evidence registry might be perceived and used by different users.
Results: The following key themes were identified in the interviews: (1) stigma and anonymity, (2) selection bias, (3) understanding treatment and outcome gaps, (4) lifestyle factors, (5) individualized versus population-level data, and (6) severe complications of HSV. We developed use cases for different types of users of the registry, including individuals with HSV, members of the public, researchers, and clinicians.
Conclusions: This case study revealed key considerations and insights for the development of an appropriate registry to collect real-world data reported by people who might be infected with HSV. Further development and testing of the registry with different users is required. The registry must also be evaluated for the feasibility and effectiveness of collecting data to support symptom management. This registry has the potential to contribute to the development of vaccines and treatments and provide insights into the impact of HSV on other conditions.
Background: Information-seeking Psoriasis or Psoriatic Arthritis patients are confronted with numerous educational materials when looking through the internet. Literature suggests that only 17.0%-21.4% of (Psoriasis, Psoriatic Arthritis) patients have a good level of knowledge about psoriasis treatment and self-management. A study from 1994 found that English Psoriasis/Psoriatic Arthritis brochures required a reading level between grades 8-12 to be understandable, which was confirmed in a follow-up study 20 years later. As readability of written health-related text material should not exceed the sixth-grade level, Psoriasis/Psoriatic Arthritis material seems to be ill-suited to its target audience. However, no data is available on the readability levels of Psoriasis/Psoriatic Arthritis brochures for German-speaking patients, and both the volume and their scope are unclear.
Objective: This study aimed to analyze freely available educational materials for Psoriasis/Psoriatic Arthritis patients written in German, quantifying their difficulty by assessing both the readability and the vocabulary used in the collected brochures.
Methods: Data collection was conducted manually via an internet search engine for Psoriasis/Psoriatic Arthritis–specific material, published as PDF documents. Next, raw text was extracted, and a computer-based readability and vocabulary analysis was performed on each brochure. For the readability analysis, we applied the Flesch Reading Ease (FRE) metric adapted for the German language, and the fourth Vienna formula (WSTF). To assess the laymen-friendliness of the vocabulary, the computation of an expert level was conducted using a specifically trained Support Vector Machine classifier. A two-sided, two-sample Wilcoxon test was applied to test whether the difficulty of brochures of pair-wise topic groups was different from each other.
Results: In total, 68 brochures were included for readability assessment, of which 71% (48/68) were published by pharmaceutical companies, 22% (15/68) by nonprofit organizations, and 7% (5/68) by public institutions. The collection was separated into four topic groups: basic information on Psoriasis/Psoriatic Arthritis (G1/G2), lifestyle, and behavior with Psoriasis/Psoriatic Arthritis (G3/G4), medication and therapy guidance (G5), and other topics (G6). On average, readability levels were comparatively low, with FRE=31.58 and WSTF=11.84. However, two-thirds of the educational materials (69%; 47/68) achieved a vocabulary score ≤4 (ie, easy, very easy) and were, therefore, suitable for a lay audience. Statistically significant differences between brochure groups G1 and G3 for FRE (P=.0001), WSTF (P=.003), and vocabulary measure (L) (P=.01) exist, as do statistically significant differences for G2 and G4 in terms of FRE (P=.03), WSTF (P=.03) and L (P=.03).
Conclusions: Online Psoriasis/Psoriatic Arthritis patient education materials in German require, on average, a college or university education level. As a result, patients face barriers to understanding the available material, even though the vocabulary used seems appropriate. For this reason, publishers of Psoriasis/Psoriatic Arthritis brochures should carefully revise their educational materials to provide easier and more comprehensible information for patients with lower health literacy levels.
Background: Research impact has traditionally been measured using citation count and impact factor (IF). Academics have long relied heavily on this form of metric system to measure a publication’s impact. A higher number of citations is viewed as an indicator of the importance of the research and a marker for the impact of the publishing journal. Recently, social media and online news sources have become important avenues for dissemination of research, resulting in the emergence of an alternative metric system known as altmetrics.
Objective: We assessed the correlation between altmetric attention score (AAS) and traditional scientific impact markers, namely journal IF and article citation count, for all the dermatology journal and published articles of 2017.
Methods: We identified dermatology journals and their associated IFs available in 2017 using InCites Journal Citation Reports. We entered all 64 official dermatology journals into Altmetric Explorer, a Web-based platform that enables users to browse and report on all attention data for every piece of scholarly content for which Altmetric Explorer has found attention.
Results: For the 64 dermatology journals, there was a moderate positive correlation between journal IF and journal AAS (rs=.513, P<.001). In 2017, 6323 articles were published in the 64 dermatology journals. Our data show that there was a weak positive correlation between the traditional article citation count and AAS (rs=.257, P<.001).
Conclusions: Our data show a weak correlation between article citation count and AAS. Temporal factors may explain this weak association. Newer articles may receive increased online attention after publication, while it may take longer for scientific citation counts to accumulate. Stories that are at times deemed newsworthy and then disseminated across the media and social media platforms border on sensationalism and may not be truly academic in nature. The opposite can also be true.
Background: Skin cancers are caused by the development of abnormal cells that can invade or spread to other parts of the body. The countries whose authors contribute the most amount of articles on skin cancer to academia is still unknown.
Objective: The objectives of this study are to apply an author-weighted scheme (AWS) to quantify the credits for coauthors on an article byline and allocate the author weights to the country-level credits in articles.
Methods: On July 20, 2019, we obtained 16,804 abstracts published since 1938, based on a keyword search of “skin cancer” in PubMed. The author names, countries/areas, and journals were recorded. International author collaborations on skin cancer were analyzed based on country-level credits in articles. We aimed to do the following: (1) present country distribution for the first authors and the most popular journals, (2) show choropleth maps to highlight the most influential countries, and (3) draw scatter plots based on the Kano model to characterize the features of country-level research achievements. We programmed Excel Visual Basic for Applications (Microsoft Corp) routines to extract data from PubMed. Google Maps was used to display graphical representations.
Results: Our results suggest that researchers in the United States have published most frequently, accounting for 30.37% (5103), while Germany accounts for 7.34% (1234), followed by Australia (997, 5.93%). The top three continents for the proportion of published articles are North America, Europe, and Asia, accounting for 32.29%, 31.71%, and 10.41%, respectively.
Conclusions: This study offers an objective picture of the representativeness and evolution of international research on the topic of skin cancer. The research approaches used here have the potential to be applied to other areas besides skin cancer.
Background: Skin cancer is the most common cancer in the United States, disproportionately affecting young women. Since many young adults use Twitter, it may be an effective channel to communicate skin cancer prevention information.
Objective: The study aimed to assess the reach of the National Council on Skin Cancer Prevention (NCSCP)’s 2018 Don’t Fry Day Twitter campaign, categorize the types of individuals or tweeters who engaged in the campaign, and identify themes of the tweets.
Methods: Descriptive statistics were used, and a content analysis of Twitter activity during the 2018 Don’t Fry Day campaign was conducted. The NCSCP tweeted about Don’t Fry Day and skin cancer prevention for 14 days in May 2018. Twitter contributors were categorized into groups. The number of impressions (potential views) and retweets were recorded. Content analysis was used to describe the text of the tweets.
Results: A total of 1881 Twitter accounts, largely health professionals, used the Don’t Fry Day hashtag, generating over 45 million impressions. These accounts were grouped into nine categories (eg, news or media and public figures). The qualitative content analysis revealed informative, minimally informative, and self-interest campaign promotion themes. Informative tweets involved individuals and organizations who would mention and give further context and information about the #DontFryDay campaign. Subthemes of the informative theme were sun safety, contextual, and epidemiologic information. Minimally informative tweets used the hashtag (#DontFryDay) and other types of hashtags but did not give any further context or original material in the tweets. Self-interest campaign promotion involved businesses, firms, and medical practices that would utilize and promote the campaign to boost their own ventures.
Conclusions: These analyses demonstrate the large potential reach of social media public health campaigns. However, limitations of such campaigns were also identified, for example, the relatively homogeneous groups actively engaged in the campaign. This study contributes to the understanding of the types of accounts and messages engaged in social media campaigns utilizing a hashtag, providing insight into the messages and participants that are effective and those that are not to achieve campaign goals. Further research on the potential impact of social media on health behaviors and outcomes is necessary to ensure wide-reaching implications.
Background: Reproducible research is a foundational component for scientific advancements, yet little is known regarding the extent of reproducible research within the dermatology literature.
Objective: This study aimed to determine the quality and transparency of the literature in dermatology journals by evaluating for the presence of 8 indicators of reproducible and transparent research practices.
Methods: By implementing a cross-sectional study design, we conducted an advanced search of publications in dermatology journals from the National Library of Medicine catalog. Our search included articles published between January 1, 2014, and December 31, 2018. After generating a list of eligible dermatology publications, we then searched for full text PDF versions by using Open Access Button, Google Scholar, and PubMed. Publications were analyzed for 8 indicators of reproducibility and transparency—availability of materials, data, analysis scripts, protocol, preregistration, conflict of interest statement, funding statement, and open access—using a pilot-tested Google Form.
Results: After exclusion, 127 studies with empirical data were included in our analysis. Certain indicators were more poorly reported than others. We found that most publications (113, 88.9%) did not provide unmodified, raw data used to make computations, 124 (97.6%) failed to make the complete protocol available, and 126 (99.2%) did not include step-by-step analysis scripts.
Conclusions: Our sample of studies published in dermatology journals do not appear to include sufficient detail to be accurately and successfully reproduced in their entirety. Solutions to increase the quality, reproducibility, and transparency of dermatology research are warranted. More robust reporting of key methodological details, open data sharing, and stricter standards journals impose on authors regarding disclosure of study materials might help to better the climate of reproducible research in dermatology.
Background: Almost one-third of US adults (29%) have a tattoo, and almost half (47%) of millennials reported having a tattoo. With more people getting tattoos, there is an increased risk of infectious diseases, skin infections, and allergic reactions. Tattoo artists can influence these health risks with their standards of practice, tattoo inks, and sterilization techniques. Although tattoos are becoming mainstream, it was unclear if tattoo artists would be a hard-to-reach population. Using social media sites represents a promising method for recruiting tattoo artists for Web-based survey studies. Objective: The aim of this study was to evaluate various Web-based platforms and traditional methods for recruiting tattoo artists into a descriptive Web-based survey study. Methods: Recruitment occurred via Facebook ads , Instagram, Twitter, website, Web-based advertisement, emails, and postcards mailed to tattoo shops. Results: Recruitment methods resulted in 2332 respondents, of which 1845 answered question 1, “Are you a tattoo artist?” Only 1571 were tattoo artists. Facebook ads recruited the most study participants. Facebook accounted for 1228 (1228/1571, 78.17%) respondents who were tattoo artists. This number surpassed the next leading category of HTTP Referer unknown, which had 268 (268/1571, 17.06%). The Tattoo Survey 2015 website recruited 45 (45/1571, 2.86%) tattoo artists, whereas other Web-based sources contributed to the recruitment of 28 (28/1571, 1.78%) tattoo artists. Twitter and email had the lowest response rate with only 0.06% (1/1571) each. Conclusions: Social media sites enhanced survey participation, making it easier to reach tattoo artists nationwide. Of the recruitment methods used, Facebook ads were the most effective option, both for cost and recruitment rates. This study’s findings extend those of the previous research studies that demonstrated the timeliness, ease, and effectiveness of using Facebook ads for recruitment.
Skin cancer is a growing public health problem. Early and accurate detection is important, since prognosis and cost of treatment are highly dependent on cancer stage at detection. However, access to specialized health care professionals is not always straightforward, and population screening programs are unlikely to become implemented. Furthermore, there is a wide margin for improving the efficiency of skin cancer diagnostics. Specifically, the diagnostic accuracy of general practitioners and family physicians in differentiating benign and malignant skin tumors is relatively low. Both access to care and diagnostic accuracy fuel interest in developing smartphone apps equipped with algorithms for image analyses of suspicious lesions to detect skin cancer. Based on a recent review, seven smartphone apps claim to perform image analysis for skin cancer detection, but as of October 2018, only three seemed to be active. These apps have been criticized in the past due to their lack of diagnostic accuracy. Here, we review the development of the SkinVision smartphone app, which has more than 900,000 users worldwide. The latest version of the SkinVision app (October 2018) has a 95% sensitivity (78% specificity) for detection of skin cancer. The current accuracy of the algorithm may warrant the use of this app as an aid by lay users or general practitioners. Nonetheless, for mobile health apps to become broadly accepted, further research is needed on their health impact on the health system and the user population. Ultimately, mobile health apps could become a powerful tool to reduce health care costs related to skin cancer management and minimize the morbidity of skin cancer in the population.
Background: Teledermatology (TD) is one of the applications of electronic health and telemedicine that involves the use of information and communication technologies (ICTs) for the care of skin diseases. Previous studies on TD indicate that it seems to be effective in diagnosing early malignant pathologies, such as melanoma, and in reducing waiting lists by prioritizing urgent cases of pathology. Despite these advantages, the implementation of TD is still low in many areas. Objective: Most previous studies on TD have focused on analyzing the results of TD use. However, to completely understand TD, it is necessary to consider the determinants of its use. This study analyzes the factors that motivate medical professionals to use TD in their clinical practice. Methods: A survey that targeted a total population of 743 medical professionals from health care institutions in Andalusia (Spain) was used. The study sample comprised 223 doctors (87 dermatologists and 136 primary care physicians). Results: Using an extended Technology Acceptance Model and microdata for the 223 physicians, a cluster analysis (of the user’s ICT profile) and binary logistic regression analysis were conducted. This analysis demonstrated the presence of 3 clusters in the sample with respect to the use of technology (cluster 1: advanced use of ICTs; cluster 2: moderate use of ICTs; and cluster 3: scarce use of ICTs). The analysis performed confirmed the model’s goodness of fit, which allowed 69% of the variable’s variance to be explained. The outcomes revealed that the factors that were most important when implementing a TD system were the user’s ICT profile (P=.048), system efficiency (P<.001), and preference of the subjects involved (P=.008; P<.005). The quality of the assistance, the difficulties arising from the use of technology (information security and confidentiality), or interests of the administration were not decisive factors for the implementation of TD. Subsequently, we performed a logistic regression analysis, separating primary care doctors from dermatologists. For the former, the determining factors were the ICT profile and the efficiency of the system, whereas, among dermatologists, only the preference of each individual was considered to be a determining factor. Conclusions: The use of TD should be accompanied by a comprehensive program of validation and evaluation. These results show that determinants of TD implementation differ depending on the subjects involved. Therefore, it is essential to perform studies before the implementation of a TD system to identify and influence the aforementioned predictive factors.
Background: Skin cancer is the most common type of cancer in the United States. Rates of melanoma, a malignant form of skin cancer, are on the rise and are high among people under 30 years of age. Objective: This study aims to explore factors related to sun protection and tanning behavior and examine the influence of social media use and health information-seeking behaviors (HISB) on sun protection actions among a group of college students. Methods: In this cross-sectional study, students (N=258) at a large public university completed a survey that included questions on sun safety and tanning attitudes and behaviors, as well as HISB. A sun protection behavior score was created on the basis of behaviors related to seeking shade, using sunscreen, tanning booth and bed use, and the number of lifetime blistering sunburns. Multivariate logistic regression analyses were performed to assess associations between high and low sun protection behavior and sun safety and tanning attitudes and HISB. Results: The majority of participants were females (164/258, 63.8%), 31.0% (80/258) were white, and the mean age was 20.3 (SD 4.1) years. Females (odds ratio [OR] 0.42, 95% CI 0.22-0.81) and believers that suntan improves appearance (OR 0.25, 95% CI 0.10-0.66) were less likely to have “high” sun protection behaviors. Conclusions: The cultural belief that having a suntan improves appearance, especially among female college students, results in low sun protection behaviors. Interventions can be developed to improve skin cancer-related HISB among college students with the aim of developing better cognizance of skin cancer and sun protection behaviors.
