Digital health-based lifestyle interventions (e.g., mobile applications, short messaging service, wearable devices, social media, and interactive websites) are widely used to manage metabolic syndrome (MetS). This study aimed to confirm the utility of self-care for prevention or management of MetS. We recruited 106 participants with one or more MetS risk factors from December 2019 to September 2020. Participants were provided five healthcare devices and applications. Characteristics were compared at baseline and follow-up to examine changes in risk factors, engagement, persistence, and physical activity (analyzed through device use frequency and lifestyle interventions performed). Participants with 1–2 MetS risk factors showed statistically significant reductions in waist circumference (WC) and blood pressure (BP). Participants with ≥3 MetS risk factors showed statistically significant reductions in risk factors including weight, body mass index, WC, BP, and fasting blood sugar (FBS). The prevention and improvement groups used more healthcare devices than the other groups. Smartwatch was the most frequently used device (5 times/week), and physical activity logged more than 7000 steps/week. WC, BP, and FBS of the improvement group were reduced by more than 40%. Based on engagement, persistence, and physical activity, digital health-based lifestyle interventions could be helpful for MetS prevention and management.

Background Hyperkalemia monitoring is very important in patients with chronic kidney disease (CKD) in emergency medicine. Currently, blood testing is regarded as the standard way to diagnose hyperkalemia (ie, using serum potassium levels). Therefore, an alternative and noninvasive method is required for real-time monitoring of hyperkalemia in the emergency medicine department. Objective This study aimed to propose a novel method for noninvasive screening of hyperkalemia using a single-lead electrocardiogram (ECG) based on a deep learning model. Methods For this study, 2958 patients with hyperkalemia events from July 2009 to June 2019 were enrolled at 1 regional emergency center, of which 1790 were diagnosed with chronic renal failure before hyperkalemic events. Patients who did not have biochemical electrolyte tests corresponding to the original 12-lead ECG signal were excluded. We used data from 855 patients (555 patients with CKD, and 300 patients without CKD). The 12-lead ECG signal was collected at the time of the hyperkalemic event, prior to the event, and after the event for each patient. All 12-lead ECG signals were matched with an electrolyte test within 2 hours of each ECG to form a data set. We then analyzed the ECG signals with a duration of 2 seconds and a segment composed of 1400 samples. The data set was randomly divided into the training set, validation set, and test set according to the ratio of 6:2:2 percent. The proposed noninvasive screening tool used a deep learning model that can express the complex and cyclic rhythm of cardiac activity. The deep learning model consists of convolutional and pooling layers for noninvasive screening of the serum potassium level from an ECG signal. To extract an optimal single-lead ECG, we evaluated the performances of the proposed deep learning model for each lead including lead I, II, and V1-V6. Results The proposed noninvasive screening tool using a single-lead ECG shows high performances with F1 scores of 100%, 96%, and 95% for the training set, validation set, and test set, respectively. The lead II signal was shown to have the highest performance among the ECG leads. Conclusions We developed a novel method for noninvasive screening of hyperkalemia using a single-lead ECG signal, and it can be used as a helpful tool in emergency medicine.

Purpose We propose the Lifelog Bigdata Platform as a sustainable digital healthcare system based on individual-centric lifelog datasets and describe the standardization of lifelog and clinical data in its full-cycle management system. Materials and Methods The Lifelog Bigdata Platform was developed by Yonsei Wonju Health System on the cloud to support digital healthcare and precision medicine. It consists of five core components: data acquisition system, de-identification of individual information, lifelog integration, analyzer, and service. We designed a gathering system into a dedicated virtual machine to save lifelog or clinical outcomes and established standard guidelines for maintaining the quality of gathering procedures. We used standard integration keys to integrate the lifelog and clinical data. Metadata were generated from the data warehouse after loading combined or fragmented data on it. We analyzed the de-identified lifelog and clinical data using the lifelog analyzer to prevent and manage acute and chronic diseases through providing results of statistics on analysis. Results The big data centers were built in four hospitals and seven companies for integrating lifelog and clinical data to develop the Lifelog Bigdata Platform. We integrated and loaded lifelog big data and clinical data for 3 years. In the first year, we uploaded 94 types of data on the platform with a total capacity of 221 GB. Conclusion The Lifelog Bigdata Platform is the first to combine lifelog and clinical data. The proposed standardization guidelines can be used for future platforms to achieve a virtuous cycle structure of lifelogging big data and an industrial ecosystem.

BACKGROUND Research on whether wearable devices and app-based interventions can effectively prevent metabolic syndrome (MetS) by increasing physical activity (PA) among middle-aged people living in the rural areas of South Korea remains insufficient. OBJECTIVE The aim of this study was to determine whether mobile and wearable device interventions can improve health indicators, including PA, in MetS risk groups in rural South Korea. METHODS In this clinical trial, performed from December 2019 to June 2020, participants were asked to use a wearable device (GalaxyWatch Active1) alone (standard intervention) or the wearable device and mobile app (Yonsei Health Korea) (enhanced intervention). Clinical measures and International Physical Activity Questionnaire (IPAQ) scores were evaluated initially and after 6 months. The number of steps was monitored through the website. The primary outcome was the difference in PA and clinical measures between the enhanced intervention and standard intervention groups. The secondary outcome was the decrease in MetS factors related to the change in PA. RESULTS A total of 267 participants were randomly selected, 221 of whom completed the 6-month study. Among the 221 participants, 113 were allocated to the enhanced intervention group and 108 were allocated to the standard intervention group. After 6 months, the body weight and BMI for the enhanced intervention group decreased by 0.6 (SD 1.87) and 0.21 (SD 0.76), respectively (<i>P</i>&lt;.001). In both groups, systolic blood pressure, diastolic blood pressure, waist circumference, and glycated hemoglobin A_1c (HbA_1c) decreased (<i>P</i>&lt;.001). The total PA was approximately 2.8 times lower in the standard intervention group (mean 44.47, SD 224.85) than in the enhanced intervention group (mean 124.36, SD 570.0). Moreover, the enhanced intervention group achieved the recommended level of moderate to vigorous physical activity (MVPA), whereas the standard intervention group did not (188 minutes/week vs 118 minutes/week). Additionally, the number of participants in the enhanced intervention group (n=113) that reached 10,000 daily steps or more after the intervention increased from 9 (8.0%) to 26 (23.1%) (<i>P</i>=.002), whereas this number did not increase significantly in the standard intervention group (n=108), from 8 (7.4%) to 16 (14.8%) (<i>P</i>=.72). The number of participants without any MetS factors increased by 12 (11%) and 8 (7%) in the enhanced and standard intervention group, respectively. CONCLUSIONS PA monitoring and an intervention using wearable devices were effective in preventing MetS in a rural population in Korea. Blood pressure, waist circumference, and HbA_1c were improved in both intervention groups, which were effective in reducing MetS factors. However, only the participants in the enhanced intervention group continuously increased their MVPA and step counts above the recommended level to prevent MetS. Body weight and BMI were further improved, and a higher number of participants with zero MetS factors was attained from the enhanced intervention. CLINICALTRIAL Clinical Research Information Service KCT0005783; https://cris.nih.go.kr/cris/search/detailSearch.do/16123

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