environmental risk factor

环境危险因素
  • 文章类型: Journal Article
    尽管癌症治疗的最新进展延长了癌症患者的寿命,他们也带来了新的挑战,包括慢性健康问题,例如由预先存在的风险因素或癌症治疗引起的心血管疾病。因此,心血管疾病已成为癌症患者非癌症相关死亡的主要原因,推动心脏肿瘤领域的快速发展。环境因素,特别是空气污染,显著促进与心血管疾病和特定癌症相关的死亡,比如肺癌。尽管有这些统计数据,在患者护理和研究中,空气污染对心脏肿瘤学的健康影响在很大程度上被忽视.值得注意的是,空气污染的影响在地理区域和个人之间差异很大,导致不同的暴露后果。这篇综述旨在巩固将空气污染与心脏肿瘤学联系起来的流行病学和临床前证据,同时探索相关的健康差异和环境正义问题。
    Although recent advancements in cancer therapies have extended the lifespan of patients with cancer, they have also introduced new challenges, including chronic health issues such as cardiovascular disease arising from pre-existing risk factors or cancer therapies. Consequently, cardiovascular disease has become a leading cause of non-cancer-related death among cancer patients, driving the rapid evolution of the cardio-oncology field. Environmental factors, particularly air pollution, significantly contribute to deaths associated with cardiovascular disease and specific cancers, such as lung cancer. Despite these statistics, the health impact of air pollution in the context of cardio-oncology has been largely overlooked in patient care and research. Notably, the impact of air pollution varies widely across geographic areas and among individuals, leading to diverse exposure consequences. This review aims to consolidate epidemiologic and preclinical evidence linking air pollution to cardio-oncology while also exploring associated health disparities and environmental justice issues.
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  • 文章类型: Journal Article
    胆道菌群失调与胆囊癌(GBC)有关。我们旨在寻找在GBC患者中特异性检测到的胆道细菌。我们使用基于16SrRNA的宏基因组分析来阐明30个GBC和30个胆结石相关的慢性胆囊炎患者的胆道微生物群。五个属的相对丰度,链球菌,肠球菌,Halomonas,大肠埃希氏菌和枯草杆菌与GBC显著相关。15种,7在GBC中检测到显著较高,硬化链球菌,星座链球菌,中间链球菌,鲍德尼放线菌,放线菌以色列,放线菌,和大肠杆菌为生物安全2级感染细菌;其他8种为生物安全1级细菌。这些细菌可能与GBC的发病机理有关。
    Biliary dysbiosis is associated with gallbladder cancer (GBC). We aimed to look for biliary bacteria specifically detected in GBC patients. We used 16S rRNA-based metagenomic analysis to elucidate biliary microbiota in 30 GBC and 30 gallstones-associated chronic cholecystitis patients. Relative abundance of five genera, Streptococcus, Enterococcus, Halomonas, Escherichia and Caulobacter was significantly associated with GBC. Of 15-species, 7 were detected significantly higher in GBC, Streptococcus anginosus, Streptococcus constellatus, Streptococcus intermedius, Actinomyces bowdenii, Actinomyces israelii, Actinomyces gerencseriae, and Escherichia fergusonii were biosafety level-2 infectious bacteria; other 8 species were biosafety level-1 bacteria. These bacterial species may be involved in pathogenesis of GBC.
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  • 文章类型: Journal Article
    髋关节发育不良(DDH)的诊断主要依靠体格检查和超声检查,并且这两种方法都依赖于运算符。晚期检测可导致年轻人的并发症。目前的证据支持环境和遗传因素的参与,例如单核苷酸变体(SNV)。将遗传因素纳入诊断方法对于实施受影响个体的早期检测和管理将是有用的。我们的目的是分析DDH患者的环境因素和SNV。我们包括287例DDH病例和284例对照。Logistic回归显示性别相关(OR9.85,95%CI5.55-17.46,p=0.0001),家族史(OR2.4,95%CI1.2-4.5,p=0.006),胎儿表现(OR3.19,95%CI1.55-6.54,p=0.002),羊水过少(OR2.74,95CI1.12-6.70,p=0.026)。包括这些变量在内的预测DDH风险的模型显示出敏感性,特异性,PPV,和净现值分别为0.91、0.53、0.74和0.80。TGFB1中的SNVrs1800470显示出关联,OR0.49(95%CI0.27-0.90),p=0.02。当rs1800470包含在等式中时,灵敏度,特异性,PPV和NPV分别为0.90、0.61、0.84和0.73。在检测方法中纳入无操作员因变量和SNV可能有助于建立统一的临床指南和优化健康资源。
    Diagnosis of developmental dysplasia of the hip (DDH) mostly relies on physical examination and ultrasound, and both methods are operator-dependent. Late detection can lead to complications in young adults. Current evidence supports the involvement of environmental and genetic factors, such as single nucleotide variants (SNVs). Incorporating genetic factors into diagnostic methods would be useful for implementing early detection and management of affected individuals. Our aim was to analyze environmental factors and SNVs in DDH patients. We included 287 DDH cases and 284 controls. Logistic regression demonstrated an association for sex (OR 9.85, 95% CI 5.55-17.46, p = 0.0001), family history (OR 2.4, 95% CI 1.2-4.5, p = 0.006), fetal presentation (OR 3.19, 95% CI 1.55-6.54, p = 0.002), and oligohydramnios (OR 2.74, 95%CI 1.12-6.70, p = 0.026). A model predicting the risk of DDH including these variables showed sensitivity, specificity, PPV, and NPV of 0.91, 0.53, 0.74, and 0.80 respectively. The SNV rs1800470 in TGFB1 showed an association when adjusted for covariables, OR 0.49 (95% CI 0.27-0.90), p = 0.02. When rs1800470 was included in the equation, sensitivity, specificity, PPV and NPV were 0.90, 0.61, 0.84, and 0.73, respectively. Incorporating no-operator dependent variables and SNVs in detection methods could be useful for establishing uniform clinical guidelines and optimizing health resources.
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  • 文章类型: Journal Article
    背景:耳鸣的病理生理学尚未完全了解。尽管有大量证据表明交通噪声暴露与非听觉健康结果相关,没有证据表明噪声烦恼对耳鸣等听觉障碍的影响。
    目标:因此,我们旨在调查一般人群中由于不同来源引起的噪声烦恼与耳鸣和困扰之间的关系。
    方法:使用了来自大型德国人群队列的6813名参与者的数据(古腾堡健康研究)。参与者被问及耳鸣的存在以及他们受到耳鸣的困扰。此外,道路交通带来的烦恼信息,飞机,铁路,工业,通过验证的问卷收集白天和睡眠的邻里噪音。
    结果:耳鸣患病率为27.3%,这些科目中噪音烦恼的主要来源是飞机,邻居,道路交通噪音。总的来说,逻辑回归结果表明,由于不同的噪声源引起的烦恼与耳鸣的普遍风险之间存在一致的正相关,在调整性别后,比值比增加了4%至11%。年龄,和社会经济地位。同样,在普遍存在耳鸣的受试者中,观察到耳鸣困扰的比值比持续增加.例如,睡眠期间邻里噪声烦恼与耳鸣困扰增加26%相关(OR1.26,95%CI1.13;1.39).
    结论:这是在一个大的普通人群中调查噪声烦恼与耳鸣和痛苦之间的关联的第一项研究。我们的结果表明,各种噪声烦恼源与耳鸣之间存在一致的正相关关系。这些前所未有的发现非常相关,因为噪音烦恼和耳鸣很普遍。耳鸣的确切病因和部位仍然未知,但是过度的噪声暴露被认为是主要原因之一。这项研究表明,交通和邻里噪声水平仅被认为会引起烦恼和非听觉健康影响,可能足以引起或加剧耳鸣。
    BACKGROUND: The pathophysiology of tinnitus is not yet fully understood. Although there is a large amount of evidence associating traffic noise exposure with non-auditory health outcomes, there is no evidence regarding the impact of noise annoyance on auditory disorders such as tinnitus.
    OBJECTIVE: Thus, we aimed to investigate the association between noise annoyance due to different sources and tinnitus presence and distress in the general population.
    METHODS: Data of 6813 participants from a large German population-based cohort were used (Gutenberg Health Study). Participants were asked about the presence of tinnitus and how much they were bothered by it. In addition, information on annoyance from road traffic, aircraft, railways, industrial, and neighborhood noise during the day and sleep was collected through validated questionnaires.
    RESULTS: The prevalence of tinnitus was 27.3%, and the predominant sources of noise annoyance in these subjects were aircraft, neighborhood, and road traffic noise. Overall, logistic regression results demonstrated consistent positive associations between annoyance due to different noise sources and prevalent risk of tinnitus with increases in odds ratios ranging from 4 to 11% after adjustment for sex, age, and socioeconomic status. Likewise, consistent increases in odds ratios were observed for tinnitus distress in subjects with prevalent tinnitus. For instance, neighborhood noise annoyance during the sleep was associated with a 26% increase in tinnitus distress (OR 1.26, 95% CI 1.13; 1.39).
    CONCLUSIONS: This is the first study investigating the association between noise annoyance and tinnitus presence and distress in a large cohort of the general population. Our results indicate consistent and positive associations between various sources of noise annoyance and tinnitus. These unprecedented findings are highly relevant as noise annoyance and tinnitus are widespread. The precise etiology and locus of tinnitus remain unknown, but excessive noise exposure is thought to be among the major causes. This study suggests that transportation and neighborhood noise levels thought merely to contribute to annoyance and non-auditory health effects may be sufficient to cause or exacerbate tinnitus.
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  • 文章类型: Journal Article
    噪声烦恼与心血管疾病(CVD)风险之间的关系仍需充分阐明。因此,我们在一项基于人群的大型队列研究中研究了噪声烦恼与CVD风险之间的关系.横截面(N=15,010,年龄35-74岁,基线调查期2007-2012)和来自Gutenberg健康研究的前瞻性数据(2012年至2022年的5年和10年随访)用于检查由于不同来源引起的噪声烦恼与包括房颤在内的心血管疾病的流行和事件风险之间的关系。冠状动脉疾病,心肌梗塞,中风,慢性心力衰竭,外周动脉疾病,静脉血栓栓塞.在横截面分析中,噪声烦恼是心血管疾病流行的独立危险因素,与睡眠期间噪声烦恼的最强关联(例如,邻域噪声烦恼:比值比1.20,95%置信区间1.13-1.27,p<0.0001)。在10年的随访中,观察到噪声烦恼与CVD之间的主要正相关(尽管不显著),随访5年后未发现CVD风险增加的迹象.不同来源的噪声烦恼与普遍的CVD有关,而仅发现与心血管事件的弱关联。需要进一步的大规模研究来建立噪声烦恼与CVD风险之间的关系。
    The relationship between noise annoyance and risk of cardiovascular disease (CVD) still needs to be fully elucidated. Thus, we examined the relationship between noise annoyance and CVD risk in a large population-based cohort study. Cross-sectional (N = 15,010, aged 35-74 years, baseline investigation period 2007-2012) and prospective data (5- and 10-year follow-up from 2012 to 2022) from the Gutenberg Health Study were used to examine the relationship between noise annoyance due to different sources and risk of prevalent and incident CVD comprising atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and venous thromboembolism. In cross-sectional analyses, noise annoyance was an independent risk factor for prevalent CVD, with the strongest associations seen for noise annoyance during sleep (e.g., neighborhood noise annoyance: odds ratio 1.20, 95% confidence interval 1.13-1.27, p < 0.0001). While in the 10-year follow-up, mostly positive associations (although not significant) between noise annoyance and incident CVD were observed, no indication of increased CVD risk was observed after 5 years of follow-up. Noise annoyance due to different sources was associated with prevalent CVD, whereas only weak associations with incident CVD were found. Further large-scale studies are needed to establish the relationship between noise annoyance and risk of CVD.
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  • 文章类型: Journal Article
    由于吸入和曲霉属机会性环境霉菌的空气传播孢子的发展,曲霉病是圈养企鹅的主要健康问题。诊断往往是延迟和治疗,基于唑类抗真菌药的使用,并不完全有效。这项研究评估了暴露于曲霉属的风险。并确定巴黎动物园中洪堡企鹅殖民地(Spheniscushumboldti)的直接环境中的环境水库,以及耐药分离株污染的风险。2022年2月至5月,每15天,环境样本(空气和从巢中减去,池塘水,鸽子和企鹅粪便)在企鹅围栏以及临床样本(对雏鸡进行一次性非侵入性采样)中进行,并筛选曲霉属。分生孢子.从191个环境样本中,分离出264株曲霉,其中221株烟曲霉,主要来自环境空气,在巢穴中,池塘水。企鹅环境中没有“危险”区域被强调,也不会因为与城市野鸟的距离而增加风险。然而,随着室外温度的升高,巢中空气曲霉的负荷显着增加。在分离的221株菌株中,我们只鉴定了一株唑耐药菌株,显示cyp51A基因中的TR34/L98H突变。耐药菌株的低流行率可能部分解释为动物园的城市位置,被数公里没有农业活动的城市包围。
    Aspergillosis is a major health problem in captive penguins due to the inhalation and the development of airborne spores of opportunistic environmental molds of the genus Aspergillus. Diagnosis is often delayed and treatments, based on the use of azole antifungals, are not fully effective. This study assesses the risk of exposure to Aspergillus sp. and determines the environmental reservoirs in the direct environment of a colony of Humboldt penguins (Spheniscus humboldti) in a zoological park in Paris, and the risk of contamination with resistant isolates. Every 15 days between February and May 2022, environmental samples (air and subtract from the nests, pond water, pigeon and penguin droppings) were carried out in the penguin enclosure as well as clinical samples (one-time non-invasive sampling on chicks), and screened for Aspergillus sp. conidia. From 191 environmental samples, 264 strains of Aspergillus including 221 strains of A. fumigatus were isolated, mostly from ambient air, in the nests, and pond water. No \"at risk\" areas in the penguin environment have been highlighted, nor an increased risk because of the proximity with urban wild birds. However, the load of airborne Aspergillus in the nests increased significantly with outdoor temperature. Of the 221 strains isolated, we identified only one azole-resistant strain, displaying the TR34/L98H mutation in the cyp51A gene. This low prevalence of resistant strains may probably be partly explained by the urban location of the zoological park, surrounded by kilometers of urban areas without agricultural activities.
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  • 文章类型: Journal Article
    背景:暴露于空气污染物会促进炎症,癌症,和慢性疾病的死亡率。急性呼吸窘迫综合征(ARDS)是重症监护病房患者中的常见病,并与高死亡率相关。ARDS的特征是显著的肺部炎症,可以通过急性暴露于高剂量的各种空气污染物在动物模型中复制。最近,已经在不同国家进行了几项临床研究,以调查慢性或急性空气污染物暴露在增加ARDS发病率和严重程度中的作用.
    结果:慢性暴露研究主要在美国和法国进行。这些研究的结果表明,一些空气污染物,特别是臭氧,二氧化氮,和颗粒物,增加ARDS的易感性和相关死亡率。此外,其影响可能因ARDS的病因而异。在中国城市化地区进行的一项队列研究表明,重症监护病房入院前几天暴露于高水平的空气污染物与ARDS发病率增加有关。关于ARDS的发病率和严重程度,急性暴露的影响更有争议。
    结论:空气污染物暴露与ARDS发生率和严重程度之间可能存在关系。然而,需要进一步的研究来确定哪些污染物受影响最大,哪些患者受影响最大。由于ARDS的患病率,空气污染物暴露可能会产生重大影响,并可能是一个关键的公共卫生问题。
    BACKGROUND: Exposure to air pollutants promotes inflammation, cancer, and mortality in chronic diseases. Acute respiratory distress syndrome (ARDS) is a common condition among intensive care unit patients and is associated with a high mortality rate. ARDS is characterized by significant lung inflammation, which can be replicated in animal models by acute exposure to high doses of various air pollutants. Recently, several clinical studies have been conducted in different countries to investigate the role of chronic or acute air pollutant exposure in enhancing both ARDS incidence and severity.
    RESULTS: Chronic exposure studies have mainly been conducted in the US and France. The results of these studies suggest that some air pollutants, notably ozone, nitrogen dioxide, and particulate matter, increase susceptibility to ARDS and associated mortality. Furthermore, their impact may differ according to the cause of ARDS. A cohort study conducted in an urbanized zone in China showed that exposure to very high levels of air pollutants in the few days preceding intensive care unit admission was associated with an increased incidence of ARDS. The effects of acute exposure are more debatable regarding ARDS incidence and severity.
    CONCLUSIONS: There is a likely relationship between air pollutant exposure and ARDS incidence and severity. However, further studies are required to determine which pollutants are the most involved and which patients are the most affected. Due to the prevalence of ARDS, air pollutant exposure may have a significant impact and could be a key public health issue.
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  • 文章类型: Meta-Analysis
    目的:一系列人体实地研究表明,急性暴露于模拟夜间交通噪声与心血管并发症和睡眠障碍有关,包括内皮功能障碍,血压升高,睡眠质量受损。对这些结果的汇总分析仍有待建立,对巩固科学知识具有极大的兴趣。
    方法:我们分析了四项随机交叉研究的数据(发表于2013年至2021年之间,在美因茨大学医学中心进行,德国)。共有275名受试者(40.4%为女性,平均年龄43.03岁)均在夜间在家中暴露于一种控制情景(常规背景噪音)和至少一种交通噪音情景(60架飞机或火车噪音事件)。每天晚上之后,受试者参观了心血管功能综合评估研究中心,包括测量内皮功能和血液动力学和生化参数,以及与睡眠相关的变量。
    结果:汇总分析显示,当比较两种不同的噪声序列时,内皮功能显着受损(0-60vs.60-0个模拟噪声事件,流量介导的扩张的平均差异-2.00%,95%CI-2.32;-1.68,p<0.0001)。为了和谐,交通噪声暴露后平均动脉压显著升高(平均差2.50mmHg,95%CI0.54;4.45,p=0.013)。自我报告的睡眠质量,睡眠的宁静,交通噪声暴露后,早晨的感觉显着受损(所有p<0.0001)。
    结论:模拟夜间交通噪声的急性暴露与内皮功能障碍有关,平均动脉压升高,和睡眠障碍。
    OBJECTIVE: A series of human field studies demonstrated that acute exposure to simulated nocturnal traffic noise is associated with cardiovascular complications and sleep disturbance, including endothelial dysfunction, increased blood pressure, and impaired sleep quality. A pooled analysis of these results remains to be established and is of tremendous interest to consolidate scientific knowledge.
    METHODS: We analyzed data from four randomized crossover studies (published between 2013 to 2021 and conducted at the University Medical Center Mainz, Germany). A total of 275 subjects (40.4% women, mean age 43.03 years) were each exposed to one control scenario (regular background noise) and at least to one traffic noise scenario (60 aircraft or train noise events) in their homes during nighttime. After each night, the subjects visited the study center for comprehensive cardiovascular function assessment, including the measurement of endothelial function and hemodynamic and biochemical parameters, as well as sleep-related variables.
    RESULTS: The pooled analysis revealed a significantly impaired endothelial function when comparing the two different noise sequences (0-60 vs. 60-0 simulated noise events, mean difference in flow-mediated dilation -2.00%, 95% CI -2.32; -1.68, p < 0.0001). In concordance, mean arterial pressure was significantly increased after traffic noise exposure (mean difference 2.50 mmHg, 95% CI 0.54; 4.45, p = 0.013). Self-reported sleep quality, the restfulness of sleep, and feeling in the morning were significantly impaired after traffic noise exposure (all p < 0.0001).
    CONCLUSIONS: Acute exposure to simulated nocturnal traffic noise is associated with endothelial dysfunction, increased mean arterial pressure, and sleep disturbance.
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  • 文章类型: Journal Article
    在一项具有有限纬度变异性的前瞻性队列研究中,研究女性的积极阳光照射是否会影响发生GCA或PMR的风险。
    我们将瑞典南部黑色素瘤调查(MISS)女性前瞻性队列研究中与阳光照射有关的问题的回答与发生GCA或PMR的风险联系起来。医疗保健数据来自斯科恩医疗保健登记册(SHR),涵盖所有公共医疗咨询。使用基于有向无环图针对协变量调整的Cox比例风险模型评估了主动阳光照射对发生GCA或PMR的风险的直接影响。
    共有14574名女性被纳入研究;601名女性在随访期间被诊断为GCA或PMR(分别为144和457)。与避免阳光照射的女性相比,中度或高度阳光照射的女性发生GCA或PMR的可能性较小[危险比(HR)1.2(CI0.9,1.6)和1.3(0.9,1.9),分别]当调整糖尿病时,高脂血症,高血压,吸烟,肥胖并按年龄分层。在仅研究GCA[HR1.2(CI0.7,2.3)和1.3(0.7,2.6)]和仅研究PMR[HR1.3(CI0.9,1.8)和1.4(0.9,2.0)]时观察到类似的模式。
    在纬度变异性受限的队列中,积极的阳光照射不会影响女性发生GCA或PMR的风险。
    UNASSIGNED: To study if active sun exposure among women affects the risk of developing GCA or PMR in a prospective cohort study with restricted latitudinal variability.
    UNASSIGNED: We linked the response to questions relating to sun exposure from the Melanoma Inquiry in Southern Sweden (MISS) prospective cohort study in women to the risk of developing GCA or PMR. Healthcare data were gathered from the Skåne Healthcare Register (SHR), covering all public healthcare consultations. The direct effect of active sun exposure on the risk of developing GCA or PMR was assessed using Cox proportional hazards models adjusted for covariates based on a directed acyclic graph.
    UNASSIGNED: A total of 14 574 women were included in the study; 601 women were diagnosed with GCA or PMR (144 and 457, respectively) during the follow-up time. Women with moderate or high sun exposure were not less likely to develop GCA or PMR compared with women that indicated they avoided sun exposure [hazard ratio (HR) 1.2 (CI 0.9, 1.6) and 1.3 (0.9, 1.9), respectively] when adjusted for diabetes, hyperlipidaemia, hypertension, smoking, obesity and stratified by age. Similar patterns were observed when studying only GCA [HR 1.2 (CI 0.7, 2.3) and 1.3 (0.7, 2.6)] and only PMR [HR 1.3 (CI 0.9, 1.8) and 1.4 (0.9, 2.0)].
    UNASSIGNED: Active sun exposure did not affect the risk of developing GCA or PMR in women in a cohort with restricted latitudinal variability.
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  • 文章类型: Journal Article
    背景:移动健康(mHealth)服务能够实时测量有关个人\'生物信号和环境风险因素的信息;因此,正在积极开展使用mHealth进行健康管理的研究。
    目的:该研究旨在确定韩国老年人使用mHealth的意愿的预测因子,并验证慢性疾病是否可以调节所确定的预测因子对行为意图的影响。
    方法:对500名60至75岁的参与者进行了横断面问卷调查研究。使用结构方程模型对研究假设进行了检验,并通过自举验证了间接效应。引导进行了10,000次,通过偏倚校正百分位法证实了间接效应的显著性。
    结果:在477名参与者中,278(58.3%)患有至少1种慢性疾病。绩效预期(β=.453;P=.003)和社会影响力(β=.693;P<.001)是行为意向的显著预测因子。自举结果表明,便利条件(β=.325;P=.006;95%CI0.115-0.759)对行为意图具有显着的间接影响。测试是否存在慢性疾病的多组结构方程模型显示,设备信任与预期性能之间存在显着差异(临界比=-2.165)。自举还证实,设备信任(β=.122;P=.039;95%CI0.007-0.346)对慢性病患者的行为意图有显著的间接影响。
    结论:这项研究,通过一项基于网络的老年人调查,探索了使用mHealth的意图的预测因素,提出了与其他将接受和使用技术模型的统一理论应用于接受mHealth的研究相似的结果。预期业绩,社会影响力,和便利条件被揭示为接受mHealth的预测因素。此外,对用于测量生物信号的可穿戴设备的信任作为慢性疾病患者的额外预测因子进行了研究。这表明需要不同的策略,取决于用户的特点。
    BACKGROUND: Mobile health (mHealth) services enable real-time measurement of information on individuals\' biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted.
    OBJECTIVE: The study aims to identify the predictors of older people\'s intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions.
    METHODS: A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method.
    RESULTS: Of 477 participants, 278 (58.3%) had at least 1 chronic disease. Performance expectancy (β=.453; P=.003) and social influence (β=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions (β=.325; P=.006; 95% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=-2.165). Bootstrapping also confirmed that device trust (β=.122; P=.039; 95% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease.
    CONCLUSIONS: This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users.
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