Objective The relative risk of SARS-CoV-2 infection and COVID-19 disease severity among people with rheumatic and musculoskeletal diseases (RMD) compared to those without RMD remains uncertain. We sought to quantify the risk for SARS-CoV-2 infection and describe clinical outcomes of COVID-19 in people with RMD. Methods A systematic literature review was conducted using 14 databases from January 1^st, 2019 to February 13^th, 2021. We included observational studies and experimental trials in RMD patients reporting comparative rates of SARS-CoV-2 infection, hospitalization, oxygen supplementation/ICU admission/mechanical ventilation, or mortality attributed to COVID-19. Methodological quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tools or the Newcastle-Ottawa scale. Risk ratios (RRs) and odds ratios (ORs) were calculated, as applicable for each outcome, using the Mantel-Haenszel formula with random effect models. Results Of 5799 abstracts screened, 100 studies met criteria for inclusion in the systematic review and 54/100 had a low risk-of-bias. Among studies included in the meta-analyses, we found an increased prevalence of SARS-CoV-2 infection in people with RMD (RR 1.53 (95%CI 1.16, 2.01)) compared with the general population. Odds of hospitalization, ICU admission, and mechanical ventilation were similar in patients with and without RMD, whereas odds of mortality was increased (OR 1.74 (95%CI 1.08, 2.80)). A smaller number of studies reported adjusted risk for outcomes and variably demonstrated increased risk for no difference in risk. Conclusion Patients with RMDs had higher rates of SARS-CoV-2 infection and increased odds of mortality.

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Smartphone applications (apps) are a potential mechanism for development of self-management skills in people with persistent pain. However, the inclusion of best practice content items in available pain management apps fostering core self-management skills for self-management support is not known. Objective: To evaluate the contents of smartphone apps for people with persistent pain facilitating self-management support and appraise the app quality. Methods: A systematic search was performed in the New Zealand App Store and Google Play Store. Apps were included if they were designed for people with persistent pain, provided information on pain self-management strategies and were available in English. App contents were evaluated using an a priori 14-item self-management support (SMS-14) checklist. App quality was assessed using the 23-item Mobile Apps Rating Scale. Results: Of the 939 apps screened, 19 apps met inclusion criteria. Meditation and guided relaxation were the most frequently included self-management strategies. Overall, the included apps met a median of 4 (range 1-8) of the SMS-14 checklist. Three apps (Curable, PainScale-Pain Diary and Coach and SuperBetter) met the largest number of items (8 out of 14) to foster self-management of pain. Self-monitoring of symptoms (n=11) and self-tailoring of strategies (n=9) were frequently featured functions, while few apps had features facilitating social support and communicating with clinicians. No apps provided information tailored to cultural needs of the user. The app quality mean scores using Mobile Apps Rating Scale ranged from 2.7 to 4.5 (out of 5.0). While use of two apps (Headspace and SuperBetter) have been shown to improve health outcomes, none of the included apps have been evaluated in people with persistent pain. Conclusions: Of the three apps (Curable, PainScale-Pain Diary and Coach and SuperBetter) that met the largest number of items to support skills in self-management of pain, two apps (PainScale-Pain Diary and Coach and SuperBetter) were free, suggesting the potential for using apps as a scalable, wide-reaching intervention to complement face-to-face care. However, none provided culturally-tailored information. While two apps (Headspace and SuperBetter) were validated to show improved health outcomes, none were tested in people with persistent pain. Both users and clinicians should be aware of such limitations and make informed choices in using or recommending apps as a self-management tool. For better integration of apps in clinical practice, concerted efforts are required among app developers, clinicians and people with persistent pain in developing apps, and evaluating for clinical efficacy. Clinical Trial: Not applicable

This study aimed to explore the beliefs of people with knee osteoarthritis (OA) about the disease, and how these beliefs had formed and what impact these beliefs had on activity participation, health behaviour, and self-management. Semi-structured interviews were conducted with 13 people with knee OA recruited from general practices, community physiotherapy clinics, and public advertisements in two provinces of New Zealand. Data were analysed using Interpretive Description. Two key themes emerged. 1) Knowledge: certainty and uncertainty described participants’ strong beliefs about anatomical changes in their knee. Participants’ beliefs in a biomechanical model of progressive joint degradation often appeared to originate within clinical encounters and from literal interpretation of the term ‘wear and tear’. These beliefs led to uncertainty regarding interpretation of daily symptoms and participants’ ability to influence the rate of decline and certainty that joint replacement surgery represented the only effective solution to fix the damaged knee. 2) Living with OA described broader perspectives of living with OA and the perceived need to balance competing values and risks when making decisions about activity participation, medication, attentional focus, accessing care, and making the most of today without sabotaging tomorrow. Misunderstandings about knee OA negatively impacted on activity participation, health behaviours, and self-management decisions. Biomechanical models of OA reduced participant exploration of management options and underpinned a perceived need to balance competing values. Improved information provision to people with knee OA could help guide positive health behaviour and self-management decisions and ensure these decisions are grounded in current evidence.

Background: People with diabetes mellitus (DM) are using mobile phone apps to support self-management. The numerous apps available to assist with diabetes management have a variety of functions. Some functions, like insulin dose calculators, have significant potential for harm. Objectives: The study aimed to establish (1) whether people with DM in Wellington, New Zealand, use apps for DM self-management and evaluate desirable features of apps and (2) whether health professionals (HPs) in New Zealand treating people with DM recommend apps to patients, the features HPs regard as important, and their confidence with recommending apps. Methods: A survey of patients seen at a hospital diabetes clinic over 12 months (N=539) assessed current app use and desirable features. A second survey of HPs attending a diabetes conference (n=286) assessed their confidence with app recommendations and perceived usefulness. Results: Of the 189 responders (35.0% response rate) to the patient survey, 19.6% (37/189) had used a diabetes app. App users were younger and in comparison to other forms of diabetes mellitus, users prominently had type 1 DM. The most favored feature of the app users was a glucose diary (87%, 32/37), and an insulin calculator was the most desirable function for a future app (46%, 17/37). In non-app users, the most desirable feature for a future app was a glucose diary (64.4%, 98/152). Of the 115 responders (40.2% response rate) to the HPs survey, 60.1% (68/113) had recommended a diabetes app. Diaries for blood glucose levels and carbohydrate counting were considered the most useful app features and the features HPs felt most confident to recommend. HPs were least confident in recommending insulin calculation apps. Conclusions: The use of apps to record blood glucose was the most favored function in apps used by people with diabetes, with interest in insulin dose calculating function. HPs do not feel confident in recommending insulin dose calculators. There is an urgent need for an app assessment process to give confidence in the quality and safety of diabetes management apps to people with diabetes (potential app users) and HPs (potential app prescribers).

Objective: Racial/ethnic minorities experience more severe outcomes of coronavirus disease 2019 (COVID‐19) in the general US population. This study was undertaken to examine the association between race/ethnicity and COVID‐19 hospitalization, ventilation status, and mortality in people with rheumatic disease.Methods: US patients with rheumatic disease and COVID‐19 were entered into the COVID‐19 Global Rheumatology Alliance physician registry between March 24, 2020 and August 26, 2020 were included. Race/ethnicity was defined as White, African American, Latinx, Asian, or other/mixed race. Outcome measures included hospitalization, requirement for ventilatory support, and death. Multivariable regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for age, sex, smoking status, rheumatic disease diagnosis, comorbidities, medication use prior to infection, and rheumatic disease activity.Results: A total of 1,324 patients were included, of whom 36% were hospitalized and 6% died; 26% of hospitalized patients required mechanical ventilation. In multivariable models, African American patients (OR 2.74 [95% CI 1.90–3.95]), Latinx patients (OR 1.71 [95% CI 1.18–2.49]), and Asian patients (OR 2.69 [95% CI 1.16–6.24]) had higher odds of hospitalization compared to White patients. Latinx patients also had 3‐fold increased odds of requiring ventilatory support (OR 3.25 [95% CI 1.75–6.05]). No differences in mortality based on race/ethnicity were found, though power to detect associations may have been limited.Conclusion: Similar to findings in the general US population, racial/ethnic minorities with rheumatic disease and COVID‐19 had increased odds of hospitalization and ventilatory support. These results illustrate significant health disparities related to COVID‐19 in people with rheumatic diseases. The rheumatology community should proactively address the needs of patients currently experiencing inequitable health outcomes during the pandemic.