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      Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study

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          Abstract

          Background

          Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child.

          Objective

          The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection.

          Methods

          We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants’ smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction.

          Results

          The gradient boosting and decision tree models predicted maternal social loneliness with weighted F 1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness.

          Conclusions

          Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F 1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness.

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          Most cited references52

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          Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

          Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
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            An Overview of Heart Rate Variability Metrics and Norms

            Healthy biological systems exhibit complex patterns of variability that can be described by mathematical chaos. Heart rate variability (HRV) consists of changes in the time intervals between consecutive heartbeats called interbeat intervals (IBIs). A healthy heart is not a metronome. The oscillations of a healthy heart are complex and constantly changing, which allow the cardiovascular system to rapidly adjust to sudden physical and psychological challenges to homeostasis. This article briefly reviews current perspectives on the mechanisms that generate 24 h, short-term (~5 min), and ultra-short-term (<5 min) HRV, the importance of HRV, and its implications for health and performance. The authors provide an overview of widely-used HRV time-domain, frequency-domain, and non-linear metrics. Time-domain indices quantify the amount of HRV observed during monitoring periods that may range from ~2 min to 24 h. Frequency-domain values calculate the absolute or relative amount of signal energy within component bands. Non-linear measurements quantify the unpredictability and complexity of a series of IBIs. The authors survey published normative values for clinical, healthy, and optimal performance populations. They stress the importance of measurement context, including recording period length, subject age, and sex, on baseline HRV values. They caution that 24 h, short-term, and ultra-short-term normative values are not interchangeable. They encourage professionals to supplement published norms with findings from their own specialized populations. Finally, the authors provide an overview of HRV assessment strategies for clinical and optimal performance interventions.
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              National Sleep Foundation’s sleep time duration recommendations: methodology and results summary

              The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations.
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                Author and article information

                Contributors
                Journal
                JMIR Form Res
                JMIR Form Res
                JFR
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                2561-326X
                2023
                9 August 2023
                : 7
                : e47950
                Affiliations
                [1 ] Department of Computing University of Turku Turku Finland
                [2 ] Department of Computer Science University of California Irvine, CA United States
                [3 ] Institute for Future Health University of California Irvine, CA United States
                [4 ] Department of Nursing Science University of Turku Turku Finland
                [5 ] Department of Obstetrics and Gynaecology Turku University Hospital Turku Finland
                [6 ] Faculty of Medicine University of Turku Turku Finland
                [7 ] School of Nursing University of California Irvine, CA United States
                Author notes
                Corresponding Author: Iman Azimi azimii@ 123456uci.edu
                Author information
                https://orcid.org/0000-0002-5750-5793
                https://orcid.org/0000-0001-5003-299X
                https://orcid.org/0000-0002-8646-6551
                https://orcid.org/0000-0003-2743-3589
                https://orcid.org/0000-0002-9392-3589
                https://orcid.org/0000-0003-0725-1155
                Article
                v7i1e47950
                10.2196/47950
                10448281
                37556183
                7784872a-8933-4993-9f02-640aaa99d1dd
                ©Fatemeh Sarhaddi, Iman Azimi, Hannakaisa Niela-Vilen, Anna Axelin, Pasi Liljeberg, Amir M Rahmani. Originally published in JMIR Formative Research (https://formative.jmir.org), 09.08.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

                History
                : 6 April 2023
                : 10 May 2023
                : 17 June 2023
                : 19 June 2023
                Categories
                Original Paper
                Original Paper

                health monitoring,internet of things,maternal loneliness,passive sensing,wearable device

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