Uba Backonja

Age and psychological influences on immune responses to trivalent inactivated influenza vaccine in the meditation or exercise for preventing acute respiratory infection (MEPARI) trial.

Background: Strategies to improve influenza vaccine protection among elderly individuals are an important research priority. Mindfulness-based stress reduction (MBSR) and exercise have been shown to affect aspects of immune function in some populations. We hypothesized that influenza vaccine responses may be enhanced with meditation or exercise training as compared with controls. Results: No differences in vaccine responses were found comparing control to MBSR or exercise. Individuals achieving seroprotective levels of influenza antibody ≥160 units had higher optimism, less anxiety, and lower perceived stress than the nonresponders. Age correlated with influenza antibody responses, but not with IFNγ or IL-10 production. Conclusion: The MBSR and exercise training evaluated in this study failed to enhance immune responses to influenza vaccine. However, optimism, perceived stress, and anxiety were correlated in the expected directions with antibody responses to influenza vaccine. Methods: Healthy individuals ≥50 y were randomly assigned to exercise (n = 47) or MBSR (n = 51) training or a waitlist control condition (n = 51). Each participant received trivalent inactivated influenza vaccine after 6 weeks, and had blood draws prior to and 3 and 12 weeks after immunization. Serum influenza antibody, nasal immunoglobulin A, and peripheral blood mononuclear cell interferon-γ (IFNγ) and interleukin-10 (IL-10) concentrations were measured. Measures of optimism, perceived stress, and anxiety were obtained over the course of the study. Seroprotection was defined as an influenza antibody concentration ≥160 units. Vaccine responses were compared using ANOVA, t tests, and Kruskal–Wallis tests. The correlation between vaccine responses and age was examined with the Pearson test.

Closing the Gap: Supporting Patients' Transition to Self-Management after Hospitalization

Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs.

Overall Adiposity, Adipose Tissue Distribution, and Endometriosis: A Systematic Review

BackgroundEndometriosis has been associated with a lean body habitus. However, we do not understand whether endometriosis is also associated with other characteristics of adiposity, including adipose tissue distribution and amount of visceral adipose tissue (VAT; adipose tissue lining inner organs). Having these understandings may provide insights on how endometriosis develops—some of the physiological actions of adipose tissue differ depending on tissue amount and location and are related to proposed mechanisms of endometriosis development. ObjectivesThe aim of this study was to review the literature regarding overall adiposity, adipose tissue distribution and/or VAT, and endometriosis. MethodsWe reviewed and synthesized studies indexed in PubMed and/or Web of Science. We included studies that had one or more measures of overall adiposity, adipose tissue distribution, and/or VAT and women with and without endometriosis for comparison. We summarized the findings and commented on the methods used and potential sources of bias. ResultsOf 366 identified publications, 19 (5.2%) were eligible. Two additional publications were identified from reference lists. Current research included measures of overall adiposity (e.g., body figure drawings) or adipose tissue distribution (e.g., waist-to-hip ratio), but not VAT. The weight of evidence indicated that endometriosis was associated with low overall adiposity and with a preponderance of adipose tissue distributed below the waist (peripheral). DiscussionEndometriosis may be associated with being lean or having peripherally distributed adipose tissue. Well-designed studies with various sampling frameworks and precise measures of adiposity and endometriosis are needed to confirm associations between adiposity measures and endometriosis and delineate potential etiological mechanisms underlying endometriosis.

Biomedical informatics advancing the national health agenda: the AMIA 2015 year-in-review in clinical and consumer informatics

The field of biomedical informatics experienced a productive 2015 in terms of research. In order to highlight the accomplishments of that research, elicit trends, and identify shortcomings at a macro level, a 19-person team conducted an extensive review of the literature in clinical and consumer informatics. The result of this process included a year-in-review presentation at the American Medical Informatics Association Annual Symposium and a written report (see supplemental data). Key findings are detailed in the report and summarized here. This article organizes the clinical and consumer health informatics research from 2015 under 3 themes: the electronic health record (EHR), the learning health system (LHS), and consumer engagement. Key findings include the following: (1) There are significant advances in establishing policies for EHR feature implementation, but increased interoperability is necessary for these to gain traction. (2) Decision support systems improve practice behaviors, but evidence of their impact on clinical outcomes is still lacking. (3) Progress in natural language processing (NLP) suggests that we are approaching but have not yet achieved truly interactive NLP systems. (4) Prediction models are becoming more robust but remain hampered by the lack of interoperable clinical data records. (5) Consumers can and will use mobile applications for improved engagement, yet EHR integration remains elusive.

Sexual and physical abuse and gynecologic disorders

STUDY QUESTION Is sexual and/or physical abuse history associated with incident endometriosis diagnosis or other gynecologic disorders among premenopausal women undergoing diagnostic and/or therapeutic laparoscopy or laparotomy regardless of clinical indication? SUMMARY ANSWER No association was observed between either a history of sexual or physical abuse and risk of endometriosis, ovarian cysts or fibroids; however, a history of physical abuse was associated with a higher likelihood of adhesions after taking into account important confounding and mediating factors. WHAT IS KNOWN ALREADY Sexual and physical abuse may alter neuroendocrine-immune processes leading to a higher risk for endometriosis and other noninfectious gynecologic disorders, but few studies have assessed abuse history prior to diagnosis. STUDY DESIGN, SIZE, DURATION The study population for these analyses includes the ENDO Study (2007-2009) operative cohort: 473 women, ages 18-44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at 1 of the 14 surgical centers located in Salt Lake City, UT, USA or San Francisco, CA, USA. Women with a history of surgically confirmed endometriosis were excluded. PARTICIPANTS/MATERIALS, SETTING AND METHODS Prior to surgery, women completed standardized abuse questionnaires. Relative risk (RR) of incident endometriosis, uterine fibroids, adhesions or ovarian cysts by abuse history were estimated, adjusting for age, race/ethnicity, education, marital status, smoking, gravidity and recruitment site. We assessed whether a history of chronic pelvic pain, depression, or STIs explained any relationships via mediation analyses. MAIN RESULTS AND ROLE OF CHANCE 43 and 39% of women reported experiencing sexual and physical abuse. No association was observed between either a history of sexual or physical abuse, versus no history, and risk of endometriosis (aRR: 1.00 [95% confidence interval (CI): 0.80-1.25]); aRR: 0.83 [95% CI: 0.65-1.06]), ovarian cysts (aRR: 0.67 [95% CI: 0.39-1.15]); aRR: 0.60 [95% CI: 0.34-1.09]) or fibroids (aRR: 1.25 [95% CI: 0.85-1.83]); aRR: 1.36 [95% CI: 0.92-2.01]). Conversely, a history of physical abuse, versus no history, was associated with higher risk of adhesions (aRR: 2.39 [95% CI: 1.18-4.85]). We found no indication that the effect of abuse on womens adhesion risk could be explained by a history of chronic pelvic pain, depression or STIs. LIMITATIONS, REASONS FOR CAUTION Limitations to our study include inquiries on childhood physical but not sexual abuse. Additionally, we did not inquire about childhood or adulthood emotional support systems, found to buffer the negative impact of stress on gynecologic health. WIDER IMPLICATIONS OF THE FINDINGS Abuse may be associated with some but not all gynecologic disorders with neuroendocrine-inflammatory origin. High prevalence of abuse reporting supports the need for care providers to screen for abuse and initiate appropriate follow-up. STUDY FUNDING/COMPETING INTERESTS Supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts NO1-DK-6-3428, NO1-DK-6-3427, and 10001406-02). The authors have no potential competing interests.

Older Adults’ Current and Potential Uses of Information Technologies in a Changing World: A Theoretical Perspective

Technologies have become a major force in people’s lives. They change how people interact with the environment, even as the environment changes. We propose that technology use in the setting of changing environments is motivated by essential needs and tensions experienced by the individual. We apply three developmental and behavioral theories (Erikson’s stages of psychosocial development, Maslow’s hierarchy of needs, and Bronfenbrenner’s ecological model) to explain technology-related behaviors among older adults. We consider how technology use has addressed and can address major ecological changes, in three areas: health promotion, natural disasters, and disparities. We propose that considering these theories can help researchers and developers ensure that technologies will help promote a healthier world for older adults.

Design and Usability of Interactive User Profiles for Online Health Communities

Online health communities provide a rich source of expertise from experienced patients, but uncovering “peer mentors” with shared circumstances is like finding a needle in a haystack—a problem that will escalate as these communities grow and diversify. We investigated interactive health interest profiles (HIPs) that summarize health-related terms extracted from users’ community posts. Through iterative design, we explored practical designs that accommodate differences in users’ community participation in three HIP prototypes: Text, Word Cloud, and Timeline. By comparing prototype usability with patients and design experts, we found that patients accurately used each prototype but completed some tasks faster with the Timeline HIP. Despite this advantage, patients preferred the Text HIP. Design experts and patients agreed that simple data overviews and granular details with salient cues that invite interactivity are key design considerations for HIPs. Findings offer key design considerations for HIPs that patients find most useful when forging critical connections.

Beyond Body Mass Index: Using Anthropometric Measures and Body Composition Indicators to Assess Odds of an Endometriosis Diagnosis

BACKGROUND Body mass index (BMI) and endometriosis have been inversely associated. To address gaps in this research, we examined associations among body composition, endometriosis, and physical activity. MATERIALS AND METHODS Women from 14 clinical sites in the Salt Lake City, Utah and San Francisco, California areas and scheduled for laparoscopy/laparotomy were recruited during 2007-2009. Participants (N = 473) underwent standardized anthropometric assessments to estimate body composition before surgery. Using a cross-sectional design, odds of an endometriosis diagnosis (adjusted odds ratio [aOR]; 95% confidence interval [CI]) were calculated for anthropometric and body composition measures (weight in kg; height in cm; mid upper arm, waist, hip, and chest circumferences in cm; subscapular, suprailiac, and triceps skinfold thicknesses in mm; arm muscle and fat areas in cm2; centripetal fat, chest-to-waist, chest-to-hip, waist-to-hip, and waist-to-height ratios; arm fat index; and BMI in kg/m2). Physical activity (metabolic equivalent of task-minutes/week) and sedentariness (average minutes sitting on a weekday) were assessed using the International Physical Activity Questionnaire-Short Form. Measures were modeled continuously and in quartiles based on sample estimates. Adjusted models were controlled for age (years, continuous), site (Utah/California), smoking history (never, former, or current smoker), and income (below, within 180%, and above of the poverty line). Findings were standardized by dividing variables by their respective standard deviations. We used adjusted models to examine whether odds of an endometriosis diagnosis were moderated by physical activity or sedentariness. RESULTS Inverse relationships were observed between endometriosis and standardized: weight (aOR = 0.71, 95% CI 0.57-0.88); subscapular skinfold thickness (aOR = 0.79, 95% CI 0.65-0.98); waist and hip circumferences (aOR = 0.79, 95% CI 0.64-0.98 and aOR = 0.76, 95% CI 0.61-0.94, respectively); total upper arm and upper arm muscle areas (aOR = 0.76, 95% CI 0.61-0.94 and aOR = 0.74, 95% CI 0.59-0.93, respectively); and BMI (aOR = 0.75, 95% CI 0.60-0.93), despite similar heights. Women in the highest versus lowest quartile had lower adjusted odds of an endometriosis diagnosis for: weight; mid-upper arm, hip, and waist circumferences; total upper arm and upper arm muscle areas; BMI; and centripetal fat ratio. There was no evidence of a main effect or moderation of physical activity or sedentariness. CONCLUSION In a surgical cohort, endometriosis was inversely associated with anthropometric measures and body composition indicators.

How Could Nurse Researchers Apply Theory to Generate Knowledge More Efficiently

BACKGROUND Reports of nursing research often do not provide adequate information about whether, and how, researchers applied theory when conducting their studies. Unfortunately, the lack of adequate application and explication of theory in research impedes development of knowledge to guide nursing practice. OBJECTIVES To clarify and exemplify how to apply theory in research. METHODS First we describe how researchers can apply theory in phases of research. Then we share examples of how three research teams applied one theory to these phases of research in three different studies of preventive behaviors. CONCLUSIONS Nurse researchers can review and refine ways in which they apply theory in guiding research and writing publications. Scholars can appreciate how one theory can guide researchers in building knowledge about a given condition such as preventive behaviors. Clinicians and researchers can collaborate to apply and examine the usefulness of theory. CLINICAL RELEVANCE If nurses had improved understanding of theory-guided research, they could better assess, select, and apply theory-guided interventions in their practices.

Data Visualizations to Support Health Practitioners’ Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study

Background There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. Objective The aim of the study was to assess the health care practitioners’ perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care. Methods Medical doctors (n=4) and registered nurses (n=4) providing cancer care at an academic medical center in the western United States provided feedback on visualization mock-ups. Mock-up designs were guided by current health informatics and visualization literature and the Munzner Nested Model for Visualization Design. User-centered design methods, a mock patient persona, and a scenario were used to elicit insights from participants. Directed content analysis was used to identify themes from session transcripts. Means and SDs were calculated for health care practitioners’ rankings of overview visualizations. Results Themes identified were data elements, supportive elements, confusing elements, interpretation, and use of visualization. Overall, participants found the visualizations useful and with the potential to provide personalized care. Use of color, reference lines, and familiar visual presentations (calendars, line graphs) were noted as helpful in interpreting data. Conclusions Visualizations guided by a framework and literature can support health care practitioners’ understanding of data for individuals with multiple chronic conditions engaged in cancer care. This understanding has the potential to support the provision of personalized care.