Pronabesh DasMahapatra

Patient-centered activity monitoring in the self-management of chronic health conditions.

BackgroundAs activity tracking devices become smaller, cheaper, and more consumer-accessible, they will be used more extensively across a wide variety of contexts. The expansion of activity tracking and personal data collection offers the potential for patient engagement in the management of chronic diseases. Consumer wearable devices for activity tracking have shown promise in post-surgery recovery in cardiac patients, pulmonary rehabilitation, and activity counseling in diabetic patients, among others. Unfortunately, the data generated by wearable devices is seldom integrated into programmatic self-management chronic disease regimens. In addition, there is lack of evidence supporting sustained use or effects on health outcomes, as studies have primarily focused on establishing the feasibility of monitoring activity and the association of measured activity with short-term benefits.DiscussionMonitoring devices can make a direct and real-time impact on self-management, but the validity and reliability of measurements need to be established. In order for patients to become engaged in wearable data gathering, key patient-centered issues relating to usefulness in care, motivation, the safety and privacy of information, and clinical integration need to be addressed. Because the successful usage of wearables requires an ability to comprehend and utilize personal health data, the user experience should account for individual differences in numeracy skills and apply evidence-based behavioral science principles to promote continued engagement.SummaryActivity monitoring has the potential to engage patients as advocates in their personalized care, as well as offer health care providers real world assessments of their patients’ daily activity patterns. This potential will be realized as the voice of the chronic disease patients is accounted for in the design of devices, measurements are validated against existing clinical assessments, devices become part of the treatment ‘prescription’, behavior change programs are used to engage patients in self-management, and best practices for clinical integration are defined.

Changes in Prevalence of Prescription Opioid Abuse after Introduction of an Abuse-Deterrent Opioid Formulation

OBJECTIVE The reformulation of oxycodone hydrochloride controlled-release (CR) tablets in August 2010 created a natural experiment at a national scale, providing an opportunity to evaluate patterns of abuse of prescription opioids and other drugs before and after introduction of this abuse-deterrent formulation (ADF). DESIGN Observational, cross-sectional study SETTING Sentinel sample of adults assessed for substance abuse treatment within the NAVIPPRO® surveillance system SUBJECTS Two hundred thirty-two thousand and eight hundred seventy-four adults at 437 facilities during January 1, 2008 through December 31, 2011. METHODS Time-series analysis using logistic regression to estimate quarterly prevalence of past 30-day abuse (adjusted for covariates and prescription volume) and changes in abuse pre-and post-ADF introduction. RESULTS Increases in abuse prevalence occurred for all prescription opioids as a class and for extended-release (ER) opioids. Significantly greater abuse of ER oxymorphone and buprenorphine occurred in the post-ADF period (relative risk [RR] = 2.91, 95% confidence interval [CI] = 2.59-3.27 and RR = 1.85, 95% CI = 1.74-1.96). Increases in abuse for these two compounds were significant among groups who reported abuse via preferential routes of administration (oral only, snorting only, injection only) post-ADF introduction. CONCLUSIONS Replacement of a widely prescribed opioid formulation known for its abuse potential alone may have had little impact on overall rates of prescription opioids as a class. However, changes in abuse levels of certain opioids coinciding with ADF introduction suggest possible switching of abuse among this study sample to specific long-acting opioid analgesics. Additional follow-up studies will be important to monitor changing abuse patterns and their public health impact as new opioid formulations are developed and introduced to market.

Risk behaviors and drug use: a latent class analysis of heavy episodic drinking in first-year college students

Examining individual characteristics may not yield an understanding of the complex array of factors that affect college student alcohol use. Utilizing a latent class analysis, the present study investigated an alcohol and drug use database of first-year college students at 89 U.S. colleges and universities (N = 21,945). These data were collected between December, 2010 and September, 2011. This study identified: (1) classes based on alcohol consumption, alcohol-related behaviors, and past-year use of illegal drugs and nonmedical use of prescriptions medications (NMUPM); (2) demographic covariates of these classes; and (3) differential social norms awareness, perceived harmfulness of illegal drugs and NMUPM, and protective strategies. Four classes were identified: (1) Low Risk Drinking/Low Prevalence Drug Use (Class 1); (2) Lower Intake Drinking/Moderate Prevalence Drug Use (Class 2); (3) Moderate Risk Drinking/Moderate Prevalence Drug Use (Class 3); and (4) High Risk Drinking/High Prevalence Drug Use (Class 4). Classes differed in self-reported typical week drinking, estimated peak blood alcohol content over the past 2 weeks, high-risk alcohol use, negative alcohol-related consequences, driving under the influence or riding with drinking drivers, alcohol-related protective behaviors, and past-year substance use. Of particular interest was the identification of a latent class (Class 2) composed primarily of females with a relatively low alcohol intake, but with a high probability of past-year other substance use. This group reported negative alcohol-related consequences despite their relatively low intake. To our knowledge, this is the first latent class analysis of college student alcohol use that includes a drug use indicator and compares social norms awareness, harmfulness perceptions, and alcohol-related protective behaviors between classes.

Participatory Research With an Online Drug Forum: A Survey of User Characteristics, Information Sharing, and Harm Reduction Views

Visitors to a popular online drug forum completed an online survey between November 2011 and January 2012, which covered (1) demographic characteristics, (2) substance use (including nonmedical prescription opioid use), (3) forum activity, and (4) harm reduction beliefs. The study sample (N = 897) primarily included Caucasian males in their twenties from the United States, the United Kingdom, Australia, and Canada. The practice of harm reduction was overwhelmingly endorsed by participants. Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment. The studys implications and limitations are noted and future research is suggested.

Mediators and moderators of chronic pain outcomes in an online self-management program.

Objectives:Little is known about the moderators and mediators of change in online pain interventions based on cognitive-behavior therapy (CBT). We hypothesized that the effects of painACTION.com, an online pain self-management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change. Methods:First, the efficacy of painACTION.com and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes, pain severity, and patient global impression of change (PGIC), was mediated by coping strategies or emotional functioning. Results:Compared with controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time. Discussion:This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors, and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.

Free-Living Physical Activity Monitoring in Adult US Patients with Multiple Sclerosis Using a Consumer Wearable Device

Introduction: Wearable devices have been used to characterize physical activity in multiple sclerosis (MS). The objectives of this study were to advance the literature on the utility of free-living physical activity tracking from secondary analyses of a pilot study in MS patients. Method: The original observational study was conducted in participants with MS at PatientsLikeMe (www.PatientsLikeMe.com), an online network of patients with chronic diseases. Participants completed a baseline self-assessment, and received a Fitbit OneTM wearable device with instructions to upload data. Eligible participants (1) self-reported MS, (2) logged on to the PatientsLikeMe website 90 days prior to enrollment, and (3) consented to participate electronically. Participants (1) < 18 years, (2) living outside the United States, and (3) requiring wheelchair assistance for most daily activities were excluded. The secondary analyses were limited to participants with complete data on MS type, disease duration, and Multiple Sclerosis Rating Scale (MSRS) and at least 7 days of wearable data. Step count was used as a measure of physical activity. Results: The analysis cohort of 114 participants uploaded a mean of 20.1 days of wearable data over the 23-day study (87% adherence); participants averaged 4,393 steps per day. The mean age of participants was 52 years, predominantly female (75%), relapsing-remitting type (79%), with mean disease duration of 16 years. Mean MSRS score within 30-day of baseline was 32; 72% reported mild-moderate walking disability. The reliability of step count measured by intraclass correlation was 0.55 for a single day, ≥0.7 for 2-day average, and ≥0.9 for 7-day average. After controlling for covariates, self-reported disease severity (MSRS quartile) was an independent predictor of step count (p < 0.001). Least square means (LS means) for participants that were least disabled (lowest quartile) was 5,937 steps, which was significantly higher than participants in the second, third, and fourth quartiles (4,570, 3,490, and 3,272, respectively). Similarly, LS means of participants with no ambulatory disability (measured by MSRS walk component) was 6,931 steps, significantly higher than participants with greater disability (4,743, 4,394, 2,727 steps for symptomatic, mild, and moderate disability, respectively, p < 0.001). Discussion: Using an interactive platform, this study captured free-living mobility data in MS patients. Important metrics such as the use of a minimum of 2-day estimates and self-reported disability were found to be robust indicators and correlates, respectively, of participant activity levels. Further triangulation of such metrics may reduce the burden on patients, clinicians, and researchers when monitoring clinical status.

Results of a Pilot Study to Investigate Community College Student Perceptions of the Value of an Online Health-Risk Reduction Program

Health is associated with academic success. Universal, web-based interventions to reduce risks associated with alcohol and other drug use have been found to be effective at changing four-year college students’ health behaviors. An online health program may also be well-suited to a community college population, as it can reach students off campus and can be accessed at times that are convenient for students. The purpose of the current paper is to report the results of a community college student evaluation of a fully-developed, online health risk reduction program. One hundred and thirty four students evaluated the program. Students perceived the program to be successful at addressing college health and wellness issues, and they considered it a tool that could help students make a healthy adjustment to college. A universal, online, health-risk reduction program may have the potential to be a useful component of a community colleges overall prevention strategy.