Sheridan Miyamoto

Healing of nonhymenal genital injuries in prepubertal and adolescent girls : A descriptive study

OBJECTIVE. The objective of this study was to identify the healing process and outcome of nonhymenal injuries in prepubertal and pubertal girls. METHODS. This multicenter, retrospective project used photographs to document the healing process and outcome of nonhymenal genital injuries in 239 prepubertal and pubertal girls whose ages ranged from 4 months to 18 years. RESULTS. The genital injuries sustained by the 113 prepubertal girls consisted of 21 accidental or noninflicted injuries, 73 injuries secondary to abuse, and 19 injuries of unknown cause. All 126 pubertal girls were sexual assault victims. These nonhymenal genital injuries healed at various rates depending on the type and severity. There was no statistical difference in the rate of healing between the 2 groups. Abrasions disappeared by the third day after injury. Edema was no longer present by the fifth day. Ecchymosis (bruising) resolved within 2 to 18 days depending on the severity. One prepubertal girl still had a labial hematoma at 2 weeks. Submucosal hemorrhages of the vestibule and fossa navicularis resolved between 2 days and 2 weeks. Petechiae and blood blisters proved useful for approximating the age of an injury. Petechiae were gone by 24 hours, whereas blood blisters were detected at 30 days in a prepubertal girl and 24 days in a pubertal girl. The depth of a laceration determined the time required for it to heal. Superficial vestibular lacerations seemed healed in 2 days, whereas deep perineal lacerations required up to 20 days. The appearance of new blood vessel formation was detected only in prepubertal girls, whereas scar tissue formation occurred only after a deep laceration in both groups. CONCLUSIONS. The majority of these nonhymenal genital injuries healed with little or no evidence of previous trauma. The time required for resolution varied by type, location, and severity.

Sustained Effects of a Nurse Coaching Intervention via Telehealth to Improve Health Behavior Change in Diabetes

BACKGROUND Diabetes educators and self-management programs are scarce in rural communities, where diabetes is the third highest-ranking health concern. The goal of this study was to evaluate the benefits of nurse telehealth coaching for persons with diabetes living in rural communities through a person-centered approach using motivational interviewing (MI) techniques. MATERIALS AND METHODS A randomized experimental study design was used to assign participants to receive either nurse telehealth coaching for five sessions (intervention group) or usual care (control group). Outcomes were measured in both groups using the Diabetes Empowerment Scale (DES), SF-12, and satisfaction surveys. Mean scores for each outcome were compared at baseline and at the 9-month follow-up for both groups using a Students t test. We also evaluated the change from baseline by estimating the difference in differences (pre- and postintervention) using regression methods. RESULTS Among the 101 participants included in the analysis, 51 received nurse telehealth coaching, and 50 received usual care. We found significantly higher self-efficacy scores in the intervention group compared with the control group based on the DES at 9 months (4.03 versus 3.64, respectively; p<0.05) and the difference in difference estimation (0.42; p<0.05). CONCLUSIONS The nurse MI/telehealth coaching model used in this study shows promise as an effective intervention for diabetes self-management in rural communities. The sustained effect on outcomes observed in the intervention group suggests that this model could be a feasible intervention for long-term behavioral change among persons living with chronic disease in rural communities.

Tracking Health Data Is Not Enough: A Qualitative Exploration of the Role of Healthcare Partnerships and mHealth Technology to Promote Physical Activity and to Sustain Behavior Change.

Background Despite the recent explosion of the mobile health (mHealth) industry and consumer acquisition of mHealth tools such as wearable sensors and applications (apps), limited information is known about how this technology can sustain health behavior change and be integrated into health care. Objective The objective of the study was to understand potential users’ views of mHealth technology, the role this technology may have in promoting individual activity goals aimed at improving health, and the value of integrating mHealth technology with traditional health care. Methods Four focus groups were conducted with adults interested in sharing their views on how mHealth technology could support wellness programs and improve health. Participants (n=30) were enrolled from an employee population at an academic health institution. Qualitative thematic analysis was used to code transcripts and identify overarching themes. Results Our findings suggest that tracking health data alone may result in heightened awareness of daily activity, yet may not be sufficient to sustain use of mHealth technology and apps, which often have low reuse rates. Participants suggested that context, meaning, and health care partnerships need to be incorporated to engage and retain users. In addition to these findings, drivers for mHealth technology previously identified in the literature, including integration and control of health data were confirmed in this study. Conclusions This study explores ways that mHealth technologies may be used to not only track data, but to encourage sustained engagement to achieve individual health goals. Implications of these findings include recommendations for mHealth technology design and health care partnership models to sustain motivation and engagement, allowing individuals to achieve meaningful behavior change.

Evaluating the relationship between plasma and skin carotenoids and reported dietary intake in elementary school children to assess fruit and vegetable intake.

Accurate assessment of dietary intake of children can be challenging due to the limited reliability of current dietary assessment methods. Plasma carotenoid concentration has been used to assess fruit and vegetable intake, but this testing is rarely conducted in school settings in children. Resonance Raman spectroscopy (RRS) is emerging as a useful method to objectively assess fruit and vegetable intake. This methodology has been validated in adults, but limited work has been done in children, particularly in the school setting. The purpose of this research is to further validate the RRS methodology in children. Children (9-12 year) participating in a school-based intervention were recruited. Plasma carotenoids were quantified using HPLC, skin carotenoid status was measured using RRS, and dietary intake of carotenoids was measured with the Block Food Frequency Questionnaire Ages 8-17. Total plasma carotenoid concentrations and skin carotenoid intensities were strongly correlated (r=0.62, p<0.001, n=38). Reported total carotenoid intake correlated with skin carotenoids (r=0.40, p<0.0001, n=128). Skin carotenoid status as measured by RRS can be a strong predictor of plasma carotenoid status and dietary intake of carotenoids in children. RRS may be used as a valid, non-invasive, and useful method to assess fruit and vegetable intakes in this population.

Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities.

To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p<0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p<0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support.

Recruiting Rural Participants for a Telehealth Intervention on Diabetes Self-Management

PURPOSE Recruiting rural and underserved participants in behavioral health interventions is challenging. Community-based recruitment approaches are effective, but they are not always feasible in multisite, diverse community interventions. This study evaluates the feasibility of a rapid, multisite approach that uses rural clinic site coordinators to recruit study participants. The approach allows for rural recruitment in areas where researchers may not have developed long-term collaborative relationships. METHODS Adults with diabetes were recruited from rural Federally Qualified Health Center (FQHC) clinics. Recruitment feasibility was assessed by analyzing field notes by the project manager and health coaches, and 8 in-depth, semistructured interviews with clinic site coordinators and champions, followed by thematic analysis of field notes and interviews. FINDINGS Forty-seven rural sites were contacted to obtain the 6 sites that participated in the study. On average, sites took 14 days to commit to study participation. One hundred and twenty-one participants were acquired from letters mailed to eligible participants and, in some sites, by follow-up phone calls from site coordinators. Facilitators and deterrents affecting study recruitment fell into 4 broad categories--study design, site, site coordinator, and participant factors. CONCLUSION The rapid multisite approach led to quick and efficient recruitment of clinic sites and participants. Recruitment success was achieved in some, but not all, rural sites. The study highlights the opportunities and challenges of recruiting rural clinics and rural, underserved participants in multisite research. Suggestions are provided for improving recruitment for future interventions.

Accurate energy expenditure estimation using smartphone sensors

Accurate and online Energy Expenditure Estimation (EEE) utilizing small wearable sensors is a difficult task with most existing schemes. In this work, we focus on accurate EEE for tracking ambulatory activities of a common smartphone user. We used existing smartphone sensors (accelerometer and barometer sensor), sampled at low frequency, to accurately detect EEE. Using Artificial Neural Networks, a machine learning technique, a generic regression model for EEE is built that yields upto 83% correlation with actual Energy Expenditure (EE). Using barometer data, in addition to accelerometry is found to significantly improve EEE performance (upto 10%). We compare our results against state-of-the-art Calorimetry Equations (CE) and consumer electronics devices (Fitbit and Nike+ Fuel Band).

Risk factors for fatal and non-fatal child maltreatment in families previously investigated by CPS: A case-control study

The objective of this study was to identify individual, family and caregiver risk factors for serious child maltreatment, resulting in hospitalization or death, among children and families investigated by Child Protective Services (CPS). We conducted a matched case-control study of 234 children who sustained fatal or serious nonfatal maltreatment due to physical abuse or neglect and whose mother was named in a CPS investigation between 1999 and 2013. A total of 702 children and their caregivers were included in the study with 234 cases matched 2:1,resulting in 468 controls. Data on potential risk factors were abstracted from three county administrative databases. Differences between cases and controls were calculated and multivariable conditional logistic regression was used to estimate risk models. Variables associated with increased risk for serious maltreatment included male child gender,younger caregivers, three or more children under the age of 5 living in the home, families in which a biologic child was not living with either parent, and scoring moderate or high on the Structured Decision Making Risk Tool®. Caregiver involvement in intimate partner violence (IPV) and child enrollment in public health insurance appears to mitigate the risk of serious maltreatment.

Multiple Aspects of Maltreatment: Moving Toward a Holistic Framework

The ways that researchers define and categorize maltreatment experiences determine both the priorities and scope of scholarly work in the field. In this chapter we review extant literature on maltreatment experiences and consider the benefits and limitations of the current focus on discrete types of maltreatment (i.e., physical abuse, sexual abuse, emotional abuse and neglect). We then offer suggestions for moving prevention efforts beyond the focus on individual maltreatment experiences to more broadly address the complex nature of early adversity. We consider the need for research identifying the meaningful ways in which maltreatment experiences overlap and suggest promising research methodology. We further suggest that the field would benefit from a more holistic preventative framework anchored by a public health model of primary, secondary, and tertiary prevention.

Energy Expenditure Estimation in boys with Duchene muscular dystrophy using accelerometer and heart rate sensors

Accurate Energy Expenditure (EE) Estimation is very important to monitor physical activity of healthy and disabled population. In this work, we examine the limitations of applying existing calorimetry equations and machine learning models based on sensor data collected from healthy adults to estimate EE in disabled population, particularly children with Duchene muscular dystrophy (DMD). We propose a new machine learning-based approach which provides more accurate EE estimation for boys living with DMD. Existing calorimetry equations obtain a correlation of 40% (93% relative error in linear regression) with COSMED indirect calorimeter readings, while the non-linear model derived for normal healthy adults (developed using machine learning) gave 37% correlation. The proposed model for boys with DMD give a 91% correlation with COSMED values (only 38% relative absolute error) and uses ensemble meta-classifier with Reduced Error Pruning Decision Trees methodology.