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Allen K, Rodriguez S, Hayani L, Rothenberger S, Moses-Kolko E, Simhan HN, Krishnamurti T. Digital phenotyping of depression during pregnancy using self-report data. J Affect Disord 2024; 364:231-239. [PMID: 39137834 DOI: 10.1016/j.jad.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/26/2024] [Accepted: 08/09/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Depression is a common pregnancy complication yet is often under-detected and, subsequently, undertreated. Data collected through mobile health tools may be used to support the identification of depression symptoms in pregnancy. METHODS An observational cohort study of 2062 pregnancies collected self-reports of patient history, mood, pregnancy-specific symptoms, and written language using a prenatal support app. These app inputs were used to model depression risk in subsequent 30- and 60-day periods throughout pregnancy. A selective inference lasso modeling approach examined the individual and additive value of each type of patient-reported app input. RESULTS Depression models ranged in predictive power (AUC value of 0.64-0.83), depending on the type of inputs. The most predictive model included personal history, daily mood, and acute pregnancy-related symptoms (e.g., severe vomiting, cramping). Across models, daily mood was the strongest indicator of depression symptoms in the following month. Models that retained natural language inputs typically improved predictive accuracy and offered insight into the lived context associated with experiencing depression. LIMITATIONS Our findings are not generalizable beyond a digitally literate patient population that is self-motivated to report data during pregnancy. CONCLUSIONS Simple patient reported data, including sparse language, shared directly via digital tools may support earlier depression symptom identification and a more nuanced understanding of depression context.
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Affiliation(s)
- Kristen Allen
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States of America; Allegheny County Department of Human Services, Pittsburgh, PA, United States of America
| | - Samantha Rodriguez
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Laila Hayani
- Naima Health LLC, Pittsburgh, PA, United States of America
| | - Scott Rothenberger
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Eydie Moses-Kolko
- University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA, United States of America
| | - Hyagriv N Simhan
- Department of OB-GYN and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tamar Krishnamurti
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
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Benda NC, Masterson Creber RM, Scheinmann R, Nino de Rivera S, Pimentel EC, Kalish RB, Riley LE, Hermann A, Ancker JS. Sociodemographic Differences in Perspectives on Postpartum Symptom Reporting. Appl Clin Inform 2024; 15:692-699. [PMID: 39168155 PMCID: PMC11338653 DOI: 10.1055/s-0044-1788328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/11/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE The overall goal of this work is to create a patient-reported outcome (PRO) and decision support system to help postpartum patients determine when to seek care for concerning symptoms. In this case study, we assessed differences in perspectives for application design needs based on race, ethnicity, and preferred language. METHODS A sample of 446 participants who reported giving birth in the past 12 months was recruited from an existing survey panel. We sampled participants from four self-reported demographic groups: (1) English-speaking panel, Black/African American race, non-Hispanic ethnicity; (2) Spanish-speaking panel, Hispanic-ethnicity; (3) English-speaking panel, Hispanic ethnicity; (4) English-speaking panel, non-Black race, non-Hispanic ethnicity. Participants provided survey-based feedback regarding interest in using the application, comfort reporting symptoms, desired frequency of reporting, reporting tool features, and preferred outreach pathway for concerning symptoms. RESULTS Fewer Black participants, compared with all other groups, stated that they had used an app for reporting symptoms (p = 0.02), were least interested in downloading the described application (p < 0.05), and found a feature for sharing warning sign information with friends and family least important (p < 0.01). Black and non-Hispanic Black participants also preferred reporting symptoms less frequently as compared with Hispanic participants (English and Spanish-speaking; all p < 0.05). Spanish-speaking Hispanic participants tended to prefer calling their professional regarding urgent warning signs, while Black and English-speaking Hispanic groups tended to express interest in using an online chat or patient portal (all p < 0.05) CONCLUSION: Different participant groups described distinct preferences for postpartum symptom reporting based on race, ethnicity, and preferred languages. Tools used to elicit PROs should consider how to be flexible for different preferences or tailored toward different groups.
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Affiliation(s)
- Natalie C. Benda
- School of Nursing, Columbia University, New York, New York, United States
| | | | - Roberta Scheinmann
- School of Nursing, Columbia University, New York, New York, United States
| | | | - Eric Costa Pimentel
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Robin B. Kalish
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, United States
| | - Laura E. Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, United States
| | - Jessica S. Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Mackenzie ACL, Chung S, Hoppes E, Mickler AK, Cartwright AF. Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials. PLoS One 2024; 19:e0306491. [PMID: 39052601 PMCID: PMC11271926 DOI: 10.1371/journal.pone.0306491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.
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Affiliation(s)
- Amelia C. L. Mackenzie
- Global Health and Population, FHI 360, Washington, District of Columbia, United States of America
| | - Stephanie Chung
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Emily Hoppes
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
| | - Alexandria K Mickler
- Research, Technology and Utilization Division, United States Agency for International Development and the Public Health Institute, Office of Population and Reproductive Health, Bureau for Global Health, Washington, District of Columbia, United States of America
| | - Alice F. Cartwright
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Kazmerski TM, Stransky OM, Wright CE, Albanowski M, Pilewski JM, Talabi MB, Callegari LS, Chang JC, Abebe KZ, Miller E, Deal A, O'Leary R, Borrero S. Feasibility Testing of a Web-Based Reproductive Decision Support Tool for Cystic Fibrosis. J Cyst Fibros 2024; 23:404-411. [PMID: 37833123 DOI: 10.1016/j.jcf.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/22/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND People with cystic fibrosis (CF) are increasingly considering their reproductive goals. We developed MyVoice:CF, a web-based patient-centered reproductive decision support tool and assessed its implementation in CF care. METHODS We conducted a feasibility trial among 18-44-year-old women with CF and multidisciplinary CF providers. Prior to CF clinic visit, patient participants completed a baseline survey, used MyVoice:CF, and assessed acceptability, appropriateness, and usability. After clinic, participants rated impact on reproductive health communication. At 3 months post-use, participants assessed impact on reproductive health outcomes. Provider participants completed a survey and focus group regarding MyVoice:CF feasibility/implementation. We assessed outcomes descriptively. We compared MyVoice:CF's impact on outcomes from baseline to follow-up using McNemar's and Wilcoxon signed rank tests as appropriate. RESULTS Forty-three patient participants completed baseline surveys and 40 rated MyVoice:CF's feasibility; 10 providers participated. Patient participants rated MyVoice:CF's acceptability as 4.48±0.50 out of 5, appropriateness as 4.61±0.48 out of 5, and usability as 82.25±11.02 ('A'/excellent). After MyVoice:CF use, participants reported improved reproductive health communication self-efficacy vs. baseline (3.54±1.17vs.3.95±0.93, p<0.001). At baseline, 36% of participants reported any discussion of reproductive goals/plans with their CF team in the past year compared to 59% after first visit post-MyVoice:CF use (p=0.049). Provider participants similarly rated MyVoice:CF as feasible and reported no negative impacts on clinic flow after implementation. CONCLUSIONS MyVoice:CF is acceptable, appropriate, and usable for those with CF. Preliminary effectiveness evaluation suggests that MyVoice:CF improves self-efficacy in and frequency of reproductive health communication. Future studies should further assess MyVoice:CF's impact on reproductive health communication and outcomes.
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Affiliation(s)
- Traci M Kazmerski
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA.
| | - Olivia M Stransky
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Catherine E Wright
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | | | | | - Mehret Birru Talabi
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Lisa S Callegari
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA; Univ of Washington, Seattle, WA
| | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Kaleab Z Abebe
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
| | - Ashley Deal
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA; Carnegie Mellon University, Pittsburgh, PA
| | - Raelynn O'Leary
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA; Carnegie Mellon University, Pittsburgh, PA
| | - Sonya Borrero
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA
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Mosley EA, Zite N, Dehlendorf C, Deal A, O'Leary R, Achilles S, Barnato AE, Hall D, Borrero S. Development of My Decision/Mi Decisión, a web-based decision aid to support permanent contraception decision making. PEC INNOVATION 2023; 3:100203. [PMID: 37693728 PMCID: PMC10483066 DOI: 10.1016/j.pecinn.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Objective To develop a patient-centered, web-based decision aid to support informed and value-concordant decision making among Medicaid enrollees considering tubal sterilization. Methods We used the Ottawa Decision Support Framework and the International Patient Decision Aids Standards (IPDAS) to guide systematic development of our decision aid. We interviewed 15 obstetrician-gynecologists and 40 women, who had considered or were considering tubal sterilization. A Steering Committee-comprising healthcare providers, social scientists, reproductive health and justice advocates, and people with lived experience-provided feedback and direction. We developed English and Spanish prototypes, which were beta tested with 24 women. Results The resulting web-based My Decision/Mi Decisión tool (English/Spanish) includes written and video information about tubal sterilization procedures; an interactive table of contraception options; values clarification exercises; reflection and deliberation; knowledge checks; and a summary report to share with one's provider. Users found the decision aid to be informative, engaging, easy to use, and helpful in informing contraception decision making. Conclusion My Decision/Mi Decisión is a scalable tool that could be implemented widely to support informed decision making about tubal sterilization. Innovation This is a novel and timely web-based decision tool for tubal sterilization, when demand for permanent contraception is rapidly increasing post-Dobbs. While designed for Medicaid enrollees, further investigation will explore more generalized use.
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Affiliation(s)
- Elizabeth A. Mosley
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Nikki Zite
- Department of Obstetrics and Gynecology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA
| | - Christine Dehlendorf
- Departments of Family & Community Medicine, Obstetrics, Gynecology & Reproductive Sciences, Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Ashley Deal
- Dezudio, Pittsburgh, PA 15221, USA
- Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Raelynn O'Leary
- Dezudio, Pittsburgh, PA 15221, USA
- Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Sharon Achilles
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Bill and Melinda Gates Foundation, Seattle, WA 98102, USA
| | - Amber E. Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Daniel Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
- Department of Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15213, USA
| | - Sonya Borrero
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Center for Innovative Research on Gender Health Equity, University of Pittsburgh, Pittsburgh, PA 15213, USA
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O'Connell M, Gluskin B, Parker S, Burke PJ, Pluhar E, Guss CE, Shrier LA. Adapting a Counseling-Plus-mHealth Intervention for the Virtual Environment to Reduce Sexual and Reproductive Health Risk Among Young Women with Depression. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:196-208. [PMID: 36881344 PMCID: PMC9989584 DOI: 10.1007/s11121-023-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
MARSSI (Momentary Affect Regulation - Safer Sex Intervention) is a counseling-plus-mobile health (mhealth) intervention to reduce sexual and reproductive health (SRH) risks for women with depression and high-risk sexual behavior. Due to the COVID-19 pandemic limiting in-person care, we sought to develop the counseling and mhealth app onboarding for virtual implementation. A team with SRH, adolescent medicine, motivational interviewing, cognitive behavioral therapy, and technology expertise adapted the counseling through an iterative consensus process. We identified essential aspects of the counseling, specified the content so the counseling could be delivered in person or virtually with fidelity, and considered best practices for telehealth for the focus population. Virtual counseling retained key elements from in-person counseling while including enhancements with engaging visual and audio-video aids. Instructions and programming were developed to support virtual counseling delivery and onboarding for the mhealth app component of MARSSI. After testing the virtual format in mock sessions, we implemented a small-scale feasibility study in an adolescent medicine clinic with women with depressive symptoms and high-risk sexual behavior age 18-24 years (N = 9). Participants experienced minimal technical difficulties and expressed satisfaction with the virtual format, and all were able to complete app onboarding successfully. Expanding delivery options for SRH interventions to include virtual can improve access, particularly for populations with psychological and environmental barriers to care.
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Affiliation(s)
- Maddie O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Brittany Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Bouvé College of Health Sciences, School of Nursing, Northeastern University, Boston, MA, USA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Liang J, Ali F, Ramaiyer M, Borahay MA. Determinants and Assessment of Menstrual Blood Flow. CURR EPIDEMIOL REP 2023; 10:210-220. [PMID: 38275001 PMCID: PMC10810143 DOI: 10.1007/s40471-023-00332-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/27/2024]
Abstract
Purpose of review a)The modifiable and non-modifiable determinants and the currently available methods of assessment of menstrual blood flow will be discussed, with the goal of helping healthcare providers, researchers, and those interested in public health. Recent findings b)Several factors can impact menstruation. The determinants include modifiable factors such as smoking, nutrition, exercise, stress, weight fluctuation, and benign gynecologic diseases, and non-modifiable factors such as age, race, and the individual's genes. The intertwined dynamic among these determinants needs more critical attention. Currently, the methods for the assessment of menstruation all have advantages and disadvantages, often with a tradeoff between practicality and accuracy. Summary c)Considered by many as the fifth vital, menstruation provides a window to an individual's general health. The discussion of its determinants and assessment can be more appropriate for individual contexts, especially from a public health perspective as it can improve the reproductive health of the population.
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Affiliation(s)
- Jinxiao Liang
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fiza Ali
- Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Malini Ramaiyer
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
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Nissen M, Barrios Campo N, Flaucher M, Jaeger KM, Titzmann A, Blunck D, Fasching PA, Engelhardt V, Eskofier BM, Leutheuser H. Prevalence and course of pregnancy symptoms using self-reported pregnancy app symptom tracker data. NPJ Digit Med 2023; 6:189. [PMID: 37821584 PMCID: PMC10567694 DOI: 10.1038/s41746-023-00935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
During pregnancy, almost all women experience pregnancy-related symptoms. The relationship between symptoms and their association with pregnancy outcomes is not well understood. Many pregnancy apps allow pregnant women to track their symptoms. To date, the resulting data are primarily used from a commercial rather than a scientific perspective. In this work, we aim to examine symptom occurrence, course, and their correlation throughout pregnancy. Self-reported app data of a pregnancy symptom tracker is used. In this context, we present methods to handle noisy real-world app data from commercial applications to understand the trajectory of user and patient-reported data. We report real-world evidence from patient-reported outcomes that exceeds previous works: 1,549,186 tracked symptoms from 183,732 users of a smartphone pregnancy app symptom tracker are analyzed. The majority of users track symptoms on a single day. These data are generalizable to those users who use the tracker for at least 5 months. Week-by-week symptom report data are presented for each symptom. There are few or conflicting reports in the literature on the course of diarrhea, fatigue, headache, heartburn, and sleep problems. A peak in fatigue in the first trimester, a peak in headache reports around gestation week 15, and a steady increase in the reports of sleeping difficulty throughout pregnancy are found. Our work highlights the potential of secondary use of industry data. It reveals and clarifies several previously unknown or disputed symptom trajectories and relationships. Collaboration between academia and industry can help generate new scientific knowledge.
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Affiliation(s)
- Michael Nissen
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany.
| | - Nuria Barrios Campo
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
| | - Madeleine Flaucher
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
| | - Katharina M Jaeger
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
| | - Adriana Titzmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 21/23, 91054, Erlangen, Bavaria, Germany
| | - Dominik Blunck
- Department of Health Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Bavaria, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 21/23, 91054, Erlangen, Bavaria, Germany
| | - Victoria Engelhardt
- Keleya Digital-Health Solutions GmbH, Max-Beer-Straße 25, 10119, Berlin, Germany
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
- Translational Digital Health Group, Institute of AI for Health, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Bavaria, Germany
| | - Heike Leutheuser
- Machine Learning and Data Analytics (MaD) Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Carl-Thiersch-Straße 2b, 91052, Erlangen, Bavaria, Germany
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Hod M, Divakar H, Kihara AB, Geary M. The femtech revolution-A new approach to pregnancy management: Digital transformation of maternity care-The hybrid e-health perinatal clinic addressing the unmet needs of low- and middle-income countries. Int J Gynaecol Obstet 2023; 163:4-10. [PMID: 37554042 DOI: 10.1002/ijgo.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Prenatal care and infant mortality rates are crucial indicators of healthcare quality. However, millions of women in low-income countries lack access to adequate care. Factors such as high-risk pregnancies and unmanaged diet increase the risk of developing complications during pregnancy, highlighting the need for continuous monitoring of maternal health. The increasing burden of non-communicable diseases represents a significant threat to fragile health systems. The lack of access to appropriate prenatal care and poor maternal and newborn health outcomes are major concerns in low- and middle-income countries (LMICs). It emphasizes the need for innovative, integrative approaches to healthcare delivery, especially in pregnant women. The health services need to be reorganized holistically and effectively, focusing on factors that directly impact maternal, neonatal, and infant mortality, resulting in improved access to maternity services and survival of "at-risk" mothers and their offspring in many LMICs. Based on the FIGO (the International Federation of Gynecology & Obstetrics) recommendations of extending preconception care to the postpartum stage, the authors of this review have developed a new model of care-PregCare-based on the triple-intervention-based holistic and multidisciplinary maternal and fetal medicine model for low-risk pregnancies. This model will help transform the traditional model's high visitation frequency into a safe and reduced office visit, while increasing virtual connections, point of care and self-care with doctors, nurses, and community-based providers of self-care. This shall be based on a sophisticated central PregCare call center powered by innovative technologies combined with experienced personnel in perinatal management (doctors and nurses/midwives).
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Affiliation(s)
- Moshe Hod
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Mor Comprehensive Women's Health Care Center, Tel-Aviv, Israel
| | - Hema Divakar
- Divakars Speciality Hospital, Bengaluru, Karnataka, India
- Karnataka College of Obstetrics and Gynaecology, Bengaluru, Karnataka, India
- Asian Research and Training Institute for Skill Transfer (ARTIST), Bengaluru, Karnataka, India
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
- Federation of Obstetricians and Gynaecologists Societies of India (FOGSI), Mumbai, India
| | - Anne B Kihara
- Federation of Obstetricians and Gynaecologists Societies of India (FOGSI), Mumbai, India
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- African Federation of Obstetricians and Gynaecologists (AFOG), Khartoum, Sudan
- Kenyan Obstetrical and Gynaecological Society (KOGS), Nairobi, Kenya
| | - Michael Geary
- Department of Obstetrics and Gynaecology, The Rotunda Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
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Azizi Z, Adedinsewo D, Rodriguez F, Lewey J, Merchant RM, Brewer LC. Leveraging Digital Health to Improve the Cardiovascular Health of Women. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:205-214. [PMID: 37868625 PMCID: PMC10587029 DOI: 10.1007/s12170-023-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/24/2023]
Abstract
Purpose of Review In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women. Recent Findings Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care. Summary Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.
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Affiliation(s)
- Zahra Azizi
- Center for Digital Health, Stanford University, Stanford, CA USA
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | | | - Fatima Rodriguez
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | - Jennifer Lewey
- Department of Medicine, Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Raina M. Merchant
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN USA
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Jantraporn R, Kian A, Collins M, Baden M, Mendez E, Wehlage J, Wolf E, Austin RR. Evaluation of Mobile Health Cycle Tracking Applications Privacy, Security, and Data Sharing Practices. Comput Inform Nurs 2023; 41:629-634. [PMID: 37683626 DOI: 10.1097/cin.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
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Jain V, Munro MG, Critchley HOD. Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2. Int J Gynaecol Obstet 2023; 162 Suppl 2:29-42. [PMID: 37538019 PMCID: PMC10952771 DOI: 10.1002/ijgo.14946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive-aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM-COEIN. "PALM" refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and "COEI" refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The "N" is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive-aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 "PALM-COEIN" causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally.
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Affiliation(s)
- Varsha Jain
- Centre for Reproductive HealthUniversity of EdinburghEdinburgh, ScotlandUK
| | - Malcolm G. Munro
- Department of Obstetrics and GynecologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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Birru Talabi M, Callegari LS, Kazmerski TM, Krishnamurti T, Mosley EA, Borrero S. A blueprint for a new model of sexual and reproductive health care in subspecialty medicine. Health Serv Res 2023; 58:216-222. [PMID: 36151999 PMCID: PMC9836962 DOI: 10.1111/1475-6773.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mehret Birru Talabi
- Division of Rheumatology and Clinical ImmunologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Lisa S. Callegari
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Obstetrics and GynecologyUniversity of Washington School of MedicineSeattleWashingtonUSA
- Health Services Research and DevelopmentVA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Traci M. Kazmerski
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tamar Krishnamurti
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Elizabeth A. Mosley
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Sonya Borrero
- Center for Innovative Research on Gender Health EquityUniversity of PittsburghPittsburghPennsylvaniaUSA
- Division of General Internal MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
- Center for Health Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
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Harada A, Tateishi S, Ishimaru T, Nagata M, Eguchi H, Tsuji M, Ikegami K, Matsugaki R, Fujino Y. Association Between Types of Chronic Disease and Receiving Workplace Accommodations: A Cross-Sectional Study of Japanese Workers. J Occup Environ Med 2023; 65:93-97. [PMID: 36735620 DOI: 10.1097/jom.0000000000002723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between the type of chronic disease and receiving workplace accommodations. METHODS This online cross-sectional study analyzed a self-reported questionnaire administered in Japan. A total of 6775 full-time workers who reported needing work accommodations were included. RESULTS Workplace accommodations were more likely to be provided for workers with cancer, mental illness, and benign gynecological disorders than for workers with no disease under treatment. In contrast, workplace accommodations were less likely for workers with low back pain and skin diseases. CONCLUSIONS Receiving workplace accommodations depends on the type of chronic disease. Chronic diseases for which workers frequently receive workplace accommodations may be those for which support is encouraged by law. It is necessary to support workers with chronic diseases that do not receive adequate workplace accommodations.
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Affiliation(s)
- Arisa Harada
- From the Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Harada, Dr Nagata); Disaster Occupational Health Center, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Tateishi); Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Ishimaru, Dr Fujino); Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Eguchi); Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Tsuji); Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Ikegami); and Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka, Japan (Dr Matsugaki)
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