Elizabeth K. Seng

Status and trends of mobile-health applications for iOS devices: A developer's perspective

Modern smart mobile devices offer media-rich and context-aware features that are highly useful for electronic-health (e-health) applications. It is therefore not surprising that these devices have gained acceptance as target devices for e-health applications, turning them into m-health (mobile-health) apps. In particular, many e-health application developers have chosen Apples iOS mobile devices such as iPad, iPhone, or iPod Touch as the target device to provide more convenient and richer user experience, as evidenced by the rapidly increasing number of m-health apps in Apples App Store. In this paper, the top two hundred of such apps from the App Store were examined from a developers perspective to provide a focused overview of the status and trends of iOS m-health apps and an analysis of related technology, architecture, and user interface design issues. The top 200 apps were classified into different groups according to their purposes, functions, and user satisfaction. It was shown that although the biggest group of apps was medical information reference apps that were delivered from or related to medical articles, websites, or journals, mobile users disproportionally favored tracking tools. It was clear that m-health apps still had plenty of room to grow to take full advantage of unique mobile platform features and truly fulfill their potential. In particular, introduction of two- or three-dimensional visualization and context-awareness could further enhance m-health apps usability and utility. This paper aims to serve as a reference point and guide for developers and practitioners interested in using iOS as a platform for m-health applications, particular from the technical point of view.

Neuropsychological functioning in migraine: Clinical and research implications:

Aim: We review the research literature examining neuropsychological performance in migraine. Findings were organized by neuropsychological construct assessed and results were reported using effect size conventions. Factors considered in explaining results included sample characteristics, migraine factors, and control for non-migraine variables. Findings: There is weak evidence for deficits in processing speed, attention, verbal memory, verbal skills, working memory, sustained attention, and inhibition in migraine relative to healthy controls. There are mixed results regarding deficits in visual memory, motor dexterity, visuospatial/constructional skills, visual reasoning, and mental flexibility in migraine relative to healthy controls. Mixed findings do not seem to be consistently related to study characteristics or presence of aura; other important migraine factors (such as migraine severity or presence of neuroradiological findings) remain understudied. Relative to non-healthy control groups, however, there is weak evidence for an effect of migraine in any cognitive domain. Longitudinal studies provide little evidence that neuropsychological functioning worsens over time in migraine or that migraine is a risk factor for Alzheimer’s disease. Research implications: It remains possible that cognitive dysfunction is seen in only a subset of migraine sufferers, perhaps those with more severe illness or neurological involvement; however, more research is needed to examine this issue. Non-migraine differences among migraine sufferers, including medical and psychiatric comorbidities and variables associated with treatment seeking, may partially account for inconsistent findings and should be evaluated for in future research. Clinical implications: Clinicians should refer migraine patients for comprehensive neuropsychological evaluation only when there is sufficient evidence for concern. Such evaluations should include consideration of other psychological, neurological, and medical contributors to both migraine and cognitive status.

Psychiatric comorbidity and response to preventative therapy in the treatment of severe migraine trial

Introduction: Mood and anxiety disorders are comorbid with migraine and commonly assumed to portend a poor response to preventive migraine therapies. However, there is little evidence to support this assumption. Method: We examined impact of a mood and/or anxiety disorder diagnosis using American Psychiatric Association Diagnostic and Statistical Manual criteria on response to the three preventative migraine therapies evaluated in the Treatment of Severe Migraine trial (n = 177): β-blocker, behavioral migraine management, or behavioral migraine management +β-blocker. Daily diaries assessed migraine activity for the 16 months of the trial. The Migraine Specific Quality of Life Questionnaire and Headache Disability Inventory assessed headache-related disability at regular intervals. Mixed models for repeated measures examined changes in these three outcomes with preventative migraine therapy in participants with and without a mood or anxiety disorder diagnosis. Results: Participants with a comorbid mood or anxiety disorder diagnosis recorded larger reductions in migraine days (p < .05) and larger reductions in the Migraine Specific Quality of Life Questionnaire (p < .001) and Headache Disability Inventory (p < .01) than did participants with neither diagnosis. Discussion: Significantly larger reductions in migraine activity and migraine-related disability were observed in participants with a mood and/or anxiety disorder diagnosis than in participants who did not receive either diagnosis.

Optimal Use of Acute Headache Medication: A Qualitative Examination of Behaviors and Barriers to Their Performance

This study aims to qualitatively examine the behaviors required to optimally use acute headache medication and the barriers to successful performance of these behaviors.

Trauma, Social Support, Family Conflict, and Chronic Pain in Recent Service Veterans: Does Gender Matter?

OBJECTIVE Women veterans have a higher prevalence of chronic pain relative to men. One hypothesis is that differential combat and traumatic sexual experiences and attenuated levels of social support between men and women may differentially contribute to the development and perpetuation of pain. This investigation examined [1] gender differences in trauma, social support, and family conflict among veterans with chronic pain, and [2] whether trauma, social support, and family conflict were differentially associated with pain severity, pain interference, and depressive symptom severity as a function of gender. METHODS Participants included 460 veterans (56% female) who served in support of recent conflicts, and who endorsed pain lasting 3 months or longer. Participants completed a baseline survey during participation in a longitudinal investigation. Self-report measures included pain severity, pain interference, depressive symptom severity, exposure to traumatic life events, emotional and tangible support, and family conflict. RESULTS Relative to men, women veterans reporting chronic pain evidenced higher rates of childhood interpersonal trauma (51% vs 34%; P < 0.001) and military sexual trauma (54% vs 3%; P < 0.001), along with lower levels of combat exposure (10.00 vs 16.85, P < 0.001). Gender was found to be a moderator of the association of marital status, combat exposure, childhood interpersonal trauma, and family conflict with pain interference. It also moderated family conflict in the prediction of depressive symptoms. CONCLUSIONS Results underscore the potential importance of developing and testing gender specific models of chronic pain that consider the relative roles of trauma, social support, and family conflict.

Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions

Many unanswered questions remain regarding behavioral and mind/body interventions in the treatment of primary headache disorders in adults.

Prescription headache medication in OEF/OIF veterans: results from the Women Veterans Cohort Study.

To examine differences in male and female veterans of Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) period of service in taking prescription headache medication, and associations between taking prescription headache medication and mental health status, psychiatric symptoms, and rates of traumatic events.

The Importance of Fostering Ownership During Medical Training

There is a need to consider the impact of the new resident-hours regulations on the variety of aspects of medical education and patient care. Most existing literature about this subject has focused on the role of fatigue in resident performance, education, and health care delivery. However, there are other possible consequences of these new regulations, including a negative impact on decision ownership. Our main assumption of is that increased shift work in medicine can decrease ownership of treatment decisions and impact negatively on quality of care. We review some potential components of decision ownership in treatment context and suggest possible ways in which the absence of decision ownership may decrease the quality of medical decision making. The article opens with the definition of decision ownership and the overview of some contextual factors that may contribute to the development of ownership in medical residency. The following section discusses decision ownership in medical care from the perspective of “diffusion of responsibility.” We question the quality of choices made within narrow decisional frames. We also compare isolated and interrelated choices, assuming that residents make more isolated decisions during their shifts. Lastly, we discuss the consequences of decreased decision ownership impacting the delivery of health care.

Psychological Factors Associated With Chronic Migraine and Severe Migraine-Related Disability: An Observational Study in a Tertiary Headache Center

To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine‐related disability in a clinic‐based sample of persons with migraine.

Behavioral Migraine Management Modifies Behavioral and Cognitive Coping in People With Migraine

This is a secondary analysis of a randomized clinical trial which aims to examine changes in cognitive and behavioral responses to migraine with cognitive behavioral treatment for migraine, preventive medication for migraine, and their combination, and the relationship between these changes and reductions in migraine‐related disability.