Kenneth Chui

Communicating the Experience of Chronic Pain and Illness Through Blogging

Background Although more individuals are sharing their experiences with chronic pain or illness through blogging (writing an Internet web log), research on the psychosocial effects and motivating factors for initiating and maintaining a blog is lacking. Objective The objective was to examine via online questionnaire the perceived psychosocial and health benefits of blogging among patients who use this media to communicate their experience of chronic pain or illness. Methods A 34-item online questionnaire was created, tested, and promoted through online health/disease forums. The survey employed convenience sampling and was open from May 5 to July 2, 2011. Respondents provided information regarding demographics, health condition, initiation and upkeep of blogs, and dynamics of online communication. Qualitative data regarding respondents’ blogging experiences, expectations for blogging, and the perceived effects from blogging on the blogger’s health, interpersonal relationships, and quality of life were collected in the form of written narrative. Results Out of 372 respondents who started the survey, 230 completed the entire questionnaire. Demographic data showed survey respondents to be predominantly female (81.8%) and highly educated (97.2% > high school education and 39.6% with graduate school or professional degrees). A wide spectrum of chronic pain and illness diagnoses and comorbidities were represented. Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness. Conclusions Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. Further study involving a larger sample size, a wider range of education levels, and respondents with different types and magnitudes of illnesses will be needed to better elucidate the mechanism of the observed associations in this understudied area.

Vitamin D Deficiency, Adiposity, and Cardiometabolic Risk in Urban Schoolchildren

OBJECTIVE To determine the relationship between serum vitamin D levels and cardiometabolic risk factors independent of adiposity in urban schoolchildren. STUDY DESIGN We assessed the relationships among serum 25-hydroxyvitamin D [25(OH)D], adiposity measured by body mass index (BMI) z-score (BMIz), and 6 cardiometabolic risk factors (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, interleukin-6, and C-reactive protein [CRP]) in a cross-sectional sample of 263 racially and ethnically diverse schoolchildren from the Boston area during late winter. Multivariate regression analyses adjusting for sociodemographic characteristics and BMIz examined associations of 25(OH)D and cardiometabolic risk factors. RESULTS Overall, 74.6% of the children were vitamin D deficient [25(OH)D <50 nmol/L; mean, 41.8 ± 13.7 nmol/L]; 45% were overweight or obese (20% and 25%, respectively; BMIz = 0.75 ± 1.1). The 25(OH)D level was not associated with BMIz, but was positively associated with the cardiometabolic risk factor CRP (β = 0.03; P < .05). BMIz was associated with elevated triglycerides (β = 0.13), CRP (β = 0.58), and interleukin-6 (β= 0.14) and low high-density lipoprotein cholesterol (β = -0.09; all P < .01). CONCLUSIONS Vitamin D deficiency is highly prevalent during the late winter months in urban schoolchildren living in the northeastern United States. This widespread deficiency may contribute to the lack of associations between 25(OH)D and both BMIz and cardiometabolic risk factors. The association between 25(OH)D and CRP warrants further study.

Increasing Infectious Endocarditis Admissions Among Young People Who Inject Drugs

People who inject drugs (PWID) are at risk for infective endocarditis (IE). Hospitalization rates related to misuse of prescription opioids and heroin have increased in recent years, but there are no recent investigations into rates of hospitalizations from injection drug use-related IE (IDU-IE). Using the Health Care and Utilization Project National Inpatient Sample (HCUP-NIS) dataset, we found that the proportion of IE hospitalizations from IDU-IE increased from 7% to 12.1% between 2000 and 2013. Over this time period, we detected a significant increase in the percentages of IDU-IE hospitalizations among 15- to 34-year-olds (27.1%–42.0%; P < .001) and among whites (40.2%–68.9%; P < .001). Female gender was less common when examining all the IDU-IE (40.9%), but it was more common in the 15- to 34-year-old age group (53%). Our findings suggest that the demographics of inpatients hospitalized with IDU-IE are shifting to reflect younger PWID who are more likely to be white and female than previously reported. Future studies to investigate risk behaviors associated with IDU-IE and targeted harm reduction strategies are needed to avoid further increases in morbidity and mortality in this rapidly growing population of young PWID.

Influenza Vaccination in Young Children Reduces Influenza-Associated Hospitalizations in Older Adults, 2002–2006

OBJECTIVES: To assess how influenza vaccination coverage in children is related to pneumonia and influenza (P&I) in older adults and whether sociodemographic factors modify these associations.

Healthy-lifestyle behaviors associated with overweight and obesity in US rural children

BackgroundThere are disproportionately higher rates of overweight and obesity in poor rural communities but studies exploring children’s health-related behaviors that may assist in designing effective interventions are limited. We examined the association between overweight and obesity prevalence of 401 ethnically/racially diverse, rural school-aged children and healthy-lifestyle behaviors: improving diet quality, obtaining adequate sleep, limiting screen-time viewing, and consulting a physician about a child’s weight.MethodsA cross-sectional analysis was conducted on a sample of school-aged children (6–11 years) in rural regions of California, Kentucky, Mississippi, and South Carolina participating in CHANGE (Creating Healthy, Active, and Nurturing Growing-up Environments) Program, created by Save the Children, an independent organization that works with communities to improve overall child health, with the objective to reduce unhealthy weight gain in these school-aged children (grades 1–6) in rural America. After measuring children’s height and weight, we17 assessed overweight and obesity (BMI ≥ 85th percentile) associations with these behaviors: improving diet quality18 (≥ 2 servings of fruits and vegetables/day), reducing whole milk, sweetened beverage consumption/day; obtaining19 adequate night-time sleep on weekdays (≥ 10 hours/night); limiting screen-time (i.e., television, video, computer,20 videogame) viewing on weekdays (≤ 2 hours/day); and consulting a physician about weight. Analyses were adjusted 21 for state of residence, childrens race/ethnicity, gender, age, and government assistance.ResultsOverweight or obesity prevalence was 37 percent in Mississippi and nearly 60 percent in Kentucky. Adjusting for covariates, obese children were twice as likely to eat ≥ 2 servings of vegetables per day (OR=2.0,95% CI 1.1-3.4), less likely to consume whole milk (OR=0.4,95% CI 0.2-0.70), Their parents are more likely to be told by their doctor that their child was obese (OR=108.0,95% CI 21.9-541.6), and less likely to report talking to their child about fruits and vegetables a lot/sometimes vs. not very much/never (OR=0.4, 95%CI 0.2-0.98) compared to the parents of healthy-weight children.ConclusionsRural children are not meeting recommendations to improve diet, reduce screen time and obtain adequate sleep. Although we expected obese children to be more likely to engage in unhealthy behaviors, we found the opposite to be true. It is possible that these groups of respondent parents were highly aware of their weight status and have been advised to change their children’s health behaviors. Perhaps given the opportunity to participate in an intervention study in combination with a physician recommendation could have resulted in actual behavior change.

School-Based Behavioral Assessment Tools Are Reliable and Valid for Measurement of Fruit and Vegetable Intake, Physical Activity, and Television Viewing in Young Children

Interventions aiming to modify the dietary and physical activity behaviors of young children require precise and accurate measurement tools. As part of a larger community-based project, three school-based questionnaires were developed to assess (a) fruit and vegetable intake, (b) physical activity and television (TV) viewing, and (c) perceived parental support for diet and physical activity. Test-retest reliability was performed on all questionnaires and validity was measured for fruit and vegetable intake, physical activity, and TV viewing. Eighty-four school children (8.3+/-1.1 years) were studied. Test-retest reliability was performed by administering questionnaires twice, 1 to 2 hours apart. Validity of the fruit and vegetable questionnaire was measured by direct observation, while the physical activity and TV questionnaire was validated by a parent phone interview. All three questionnaires yielded excellent test-retest reliability (P<0.001). The majority of fruit and vegetable questions and the questions regarding specific physical activities and TV viewing were valid. Low validity scores were found for questions on watching TV during breakfast or dinner. These questionnaires are reliable and valid tools to assess fruit and vegetable intake, physical activity, and TV viewing behaviors in early elementary school-aged children. Methods for assessment of childrens TV viewing during meals should be further investigated because of parent-child discrepancies.

Visual Analytics for Epidemiologists: Understanding the Interactions Between Age, Time, and Disease with Multi-Panel Graphs

Background Visual analytics, a technique aiding data analysis and decision making, is a novel tool that allows for a better understanding of the context of complex systems. Public health professionals can greatly benefit from this technique since context is integral in disease monitoring and biosurveillance. We propose a graphical tool that can reveal the distribution of an outcome by time and age simultaneously. Methodology/Principal Findings We introduce and demonstrate multi-panel (MP) graphs applied in four different settings: U.S. national influenza-associated and salmonellosis-associated hospitalizations among the older adult population (≥65 years old), 1991–2004; confirmed salmonellosis cases reported to the Massachusetts Department of Public Health for the general population, 2004–2005; and asthma-associated hospital visits for children aged 0–18 at Milwaukee Childrens Hospital of Wisconsin, 1997–2006. We illustrate trends and anomalies that otherwise would be obscured by traditional visualization techniques such as case pyramids and time-series plots. Conclusion/Significance MP graphs can weave together two vital dynamics—temporality and demographics—that play important roles in the distribution and spread of diseases, making these graphs a powerful tool for public health and disease biosurveillance efforts.

Dynamic maps: a visual-analytic methodology for exploring spatio-temporal disease patterns

BackgroundEpidemiologic studies are often confounded by the human and environmental interactions that are complex and dynamic spatio-temporal processes. Hence, it is difficult to discover nuances in the data and generate pertinent hypotheses. Dynamic mapping, a method to simultaneously visualize temporal and spatial information, was introduced to elucidate such complexities. A conceptual framework for dynamic mapping regarding principles and implementation methods was proposed.MethodsThe spatio-temporal dynamics of Salmonella infections for 2002 in the U.S. elderly were depicted via dynamic mapping. Hospitalization records were obtained from the Centers of Medicare and Medicaid Services. To visualize the spatial relationship, hospitalization rates were computed and superimposed onto maps of environmental exposure factors including livestock densities and ambient temperatures. To visualize the temporal relationship, the resultant maps were composed into a movie.ResultsThe dynamic maps revealed that the Salmonella infections peaked at specific spatio-temporal loci: more clusters were observed in the summer months and higher density of such clusters in the South. The peaks were reached when the average temperatures were greater than 83.4°F (28.6°C). Although the relationship of salmonellosis rates and occurrence of temperature anomalies was non-uniform, a strong synchronization was found between high broiler chicken sales and dense clusters of cases in the summer.ConclusionsDynamic mapping is a practical visual-analytic technique for public health practitioners and has an outstanding potential in providing insights into spatio-temporal processes such as revealing outbreak origins, percolation and travelling waves of the diseases, peak timing of seasonal outbreaks, and persistence of disease clusters.

Hospitalization of the Elderly in the United States for Nonspecific Gastrointestinal Diseases: A Search for Etiological Clues

The frequency of hospitalization among the elderly in the United States caused by gastrointestinal diseases between 1991 and 2004 increased dramatically, especially hospitalization of elderly individuals with nonspecific diagnoses. We analyzed 6 640 304 gastrointestinal disease-associated hospitalization records in this 14-year period by comparing the peak times of nonspecific gastrointestinal diseases with those of specific diseases. We found that most nonspecific gastrointestinal diseases peak concurrently with viral enteritis, suggesting a lack of diagnostic testing for viruses, which may adversely affect the efficiency of prevention, surveillance, and treatment efforts.

Geographic variations and temporal trends of Salmonella-associated hospitalization in the U.S. elderly, 1991-2004: A time series analysis of the impact of HACCP regulation

BackgroundAbout 1.4 million Salmonella infections, a common food-borne illness, occur in the U.S. annually; the elderly (aged 65 or above) are most susceptible. In 1997, the USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Points Systems (PR/HACCP) which demands regular Salmonella testing in various establishments processing meat products, such as broiler chickens. Impact evaluations of PR/HACCP on hospitalizations related to Salmonella are lacking.MethodsHospitalization records of the U.S. elderly in 1991-2004 were obtained from the Centers of Medicare and Medicaid Services. Harmonic regression analyses were performed to evaluate the long-term trends of Salmonella-related hospitalizations in pre- and post-HACCP periods. Seasonal characteristics of the outcome in the nine Census divisions of the contiguous U.S. were also derived and contrasted.ResultsPredicted rates decreased in most divisions after 1997, except South Atlantic, East South Central, and West South Central. These three divisions also demonstrated higher overall hospitalization rates, pronounced seasonal patterns, and consistent times to peak at about 32nd to 34th week of the year.ConclusionThe impact of HACCP was geographically different. South Atlantic, East South Central, and West South Central divisions should be targeted in further Salmonella preventive programs. Further research is needed to identify the best program type and timing of implementation.