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 Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn.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: Increasing physical activity (PA) levels in adolescents ages 12-18 is associated with prevention of unhealthy weight gain and improvement in cardiovascular fitness. The widespread availability of mobile health (mHealth) and wearable devices offers self-monitoring and motivational features for increasing PA levels as well as improving adherence to exercise programs. Objective: The aim of this scoping review is to identify the efficacy or effectiveness of mHealth intervention strategies for facilitating PA among adolescents. Methods: We conducted a systematic search for peer-reviewed studies published between 2008 and 2017 in the following electronic databases: PubMed, Google Scholar, PsychINFO, or SportDiscus. The search terms used include (mHealth OR “mobile health” OR apps) AND (“physical activity” OR exercise) AND (children OR adolescents OR teens OR “young adults” OR kids) AND (efficacy OR effectiveness). Articles published outside of the date range (07/10/2008 – 09/01/2017) and non-English articles were removed pre-abstract review. Three reviewers assessed all abstracts against the inclusion and exclusion criteria. Any uncertainty or differences in opinion were discussed as a group. If the disagreement was still unresolved, the abstract was included in the full article review. The inclusion criteria were that the studies shall 1) have a mHealth component, 2) target participants between 12 and 18 years old, 3) have results on efficacy or effectiveness, and 4) assess PA-related outcomes. Reviews, abstracts only, protocols without results, SMS-only interventions were excluded. We also extracted potentially relevant papers from reviews. At least two reviewers examined all full articles for fit with criteria and extracted data for analysis. Data extracted from selected studies included study population, study type, components of PA intervention, and PA outcomes results. Results: 95 articles were initially identified and reviewers pulled 18 additional articles from excluded review papers. Only 15 articles were passed onto full review and 13 were kept for analysis. The included studies differed in the sizes of the study populations (11- 607 participants), locations of the study sites (7 countries), study setting, and study design. The most common measures reported were subjective weekly PA (4/13) and objective daily moderate-to-vigorous physical activity (MVPA, 4/13) of the 19 different PA outcomes assessed. Only 6/13 studies with a control or comparison group showed a significant improvement in PA outcomes between the intervention group and the control or comparison group. Of those 6, 4 permitted isolation of mHealth intervention components in the analysis. Conclusions: Our findings indicate that PA outcomes for adolescents improved over time through mHealth interventions use; however, the lack of consistency in chosen PA outcome measures, paucity of significant outcomes via between group analyses, and the weak study designs that prevent separating the effects of intervention components calls into question their true effect.

OBJECTIVE: Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited.RESEARCH DESIGN AND METHODS: To better understand barriers, focus groups were conducted in Florida and California with adults ≥18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre–focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included 1) provider level (negative provider encounters), 2) system level (financial coverage), and 3) individual level (preferences).RESULTS: Over 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P = 0.02 in FL; P = 0.08 in CA) and race/ethnicity (P = 0.01 in FL; P = 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P = 0.05 in CA; P = 0.56 in FL) and education level (P = 0.02 in CA; P = 0.90 in FL).CONCLUSIONS: These findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes.

Objective To compare healthy late-preterm infants with their full-term counterparts from age 4 through 15 years for numerous standard cognitive, achievement, socioemotional, and behavioral outcomes. Design Prospective cohort study. Setting National Institute of Child Health and Development Study of Early Child Care and Youth Development, 1991-2007. Participants A total of 1298 children (53 born at 34-36 weeks' gestational age), and their families, observed from birth through age 15 years. None of the infants had major health problems before or immediately following birth, and all the infants were discharged from the hospital within 7 days. Main Exposure Preterm status: children born late preterm (34-36 weeks) vs those born full term (37-41 weeks). Main Outcome Measures Eleven standard outcomes measuring cognition, achievement, social skills, and behavioral/emotional problems using the Woodcock-Johnson Psycho-Educational Battery–Revised and the Child Behavior Checklist, administered repeatedly through age 15 years. Results No consistent significant differences were found between late-preterm and full-term children for these standard measures from ages 4 to 15 years. Through age 15 years, the mean difference of most of these outcomes hovered around 0, indicating, along with small confidence intervals around these differences, that it is unlikely that healthy late-preterm infants are at any meaningful disadvantage regarding these measures. Conclusion Late-preterm infants born otherwise healthy seem to have no real burdens regarding cognition, achievement, behavior, and socioemotional development throughout childhood.

OBJECTIVE Pancreas size is reduced in patients at type 1 diabetes onset and in autoantibody (AAB)-positive donors without diabetes. We sought to determine whether pancreas volume (PV) imaging could improve understanding of the loss of pancreas size in first-degree relatives (FDRs) of patients with type 1 diabetes. We also examined relationships among PV, AAB status, and endocrine and exocrine functions. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study that included five groups: AAB⁻ control subjects (no diabetes and no first- or second-degree relatives with type 1 diabetes) (N = 49), AAB⁻ FDRs (N = 61), AAB⁺ FDRs (N = 67 total: n = 31 with a single positive AAB [AAB⁺ single] and n = 36 with multiple positive AABs [AAB⁺ multiple]), and patients with recent-onset type 1 diabetes (<1 year) (N = 52). Fasting subjects underwent 1.5T pancreatic MRI, and PV and relative PV (RPV) (PV-to-BMI ratio) were analyzed between groups and for correlations with HbA_1c,Cc-peptide, glucose, and trypsinogen. RESULTS All FDR groups had significantly lower RPV adjusted for BMI (RPV_BMI) than control subjects (all P < 0.05). Patients with type 1 diabetes had lower RPV_BMI than AAB⁻ FDR (P < 0.0001) and AAB⁺ multiple (P ≤ 0.013) subjects. Transformed data indicated that trypsinogen levels were lowest in patients with type 1 diabetes. CONCLUSIONS This study demonstrates, for the first time, all FDRs having significantly smaller RPV_BMI compared with AAB⁻ control subjects. Furthermore, RPV_BMI was significantly lower in patients with recent-onset type 1 diabetes than in the AAB⁻ FDR and AAB⁺ multiple groups. As such, RPV_BMI may be a novel noninvasive biomarker for predicting progression through stages of type 1 diabetes risk. This study highlights the potential paracrine relationships between the exocrine and endocrine pancreas in progression to type 1 diabetes in subjects at risk.

OBJECTIVE We assessed whether changes in metabolic syndrome (MetS) severity during the treatment of prediabetes are associated with reduced risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS We analyzed data from the Diabetes Prevention Program (DPP) for 2,476 adults in 1996–1999 with prediabetes randomized to receive treatment with lifestyle modification, metformin, or placebo for 2–3 years and followed through 2014 for T2DM and CVD outcomes. We calculated effect sizes from baseline in a MetS severity z score (MetS-Z) and the individual MetS components, and assessed relationships between 1-year effect size and incident T2DM and CVD using hazard ratios (HRs) and mediation analysis. RESULTS Baseline MetS-Z and its components were associated with risk of incident T2DM and CVD. During year 1 of intervention, MetS-Z and its components decreased most with lifestyle modification, followed by treatment with metformin and placebo. Risk of T2DM within 1–5 years was most strongly associated with 1-year changes in MetS-Z and waist circumference (both HRs for a 1 SD increase = 1.80), whereas the risk of CVD was associated with a 1-year change in MetS-Z, glucose, and systolic blood pressure. In mediation analyses, the effect of lifestyle modification on T2DM risk was mediated by 1-year changes in MetS-Z, waist circumference, glucose, and triglycerides, whereas the effect of metformin was mediated by MetS-Z and glucose. CONCLUSIONS Changes in these risk indicators of MetS severity during intervention in the DPP reflect altered disease risk and may help in tracking earlier responses to treatment and in motivating patients.