Usability and Perception of a Wearable-Integrated Digital Maternity Record App in Germany: User Study

Background

Although digital maternity records (DMRs) have been evaluated in the past, no previous work investigated usability or acceptance through an observational usability study.

Objective

The primary objective was to assess the usability and perception of a DMR smartphone app for pregnant women. The secondary objective was to assess personal preferences and habits related to online information searching, wearable data presentation and interpretation, at-home examination, and sharing data for research purposes during pregnancy.

Methods

A DMR smartphone app was developed. Key features such as wearable device integration, study functionalities (eg, questionnaires), and common pregnancy app functionalities (eg, mood tracker) were included. Women who had previously given birth were invited to participate. Participants completed 10 tasks while asked to think aloud. Sessions were conducted via Zoom. Video, audio, and the shared screen were recorded for analysis. Task completion times, task success, errors, and self-reported (free text) feedback were evaluated. Usability was measured through the System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Semistructured interviews were conducted to explore the secondary objective.

Results

A total of 11 participants (mean age 34.6, SD 2.2 years) were included in the study. A mean SUS score of 79.09 (SD 18.38) was achieved. The app was rated "above average" in 4 of 6 UEQ categories. Sixteen unique features were requested. We found that 5 of 11 participants would only use wearables during pregnancy if requested to by their physician, while 10 of 11 stated they would share their data for research purposes.

Conclusions

Pregnant women rely on their medical caregivers for advice, including on the use of mobile and ubiquitous health technology. Clear benefits must be communicated if issuing wearable devices to pregnant women. Participants that experienced pregnancy complications in the past were overall more open toward the use of wearable devices in pregnancy. Pregnant women have different opinions regarding access to, interpretation of, and reactions to alerts based on wearable data. Future work should investigate personalized concepts covering these aspects.

Optogenetic dissection of RET signaling reveals robust activation of ERK and enhanced filopodia-like protrusions of regenerating axons

RET (REarranged during Transfection) is a receptor tyrosine kinase that transduces various external stimuli into biological functions, such as survival and differentiation, in neurons. In the current study, we developed an optogenetic tool for modulating RET signaling, termed optoRET, combining the cytosolic region of human RET with a blue-light-inducible homo-oligomerizing protein. By varying the duration of photoactivation, we were able to dynamically modulate RET signaling. Activation of optoRET recruited Grb2 (growth factor receptor-bound protein 2) and stimulated AKT and ERK (extracellular signal-regulated kinase) in cultured neurons, evoking robust and efficient ERK activation. By locally activating the distal part of the neuron, we were able to retrogradely transduce the AKT and ERK signal to the soma and trigger formation of filopodia-like F-actin structures at stimulated regions through Cdc42 (cell division control 42) activation. Importantly, we successfully modulated RET signaling in dopaminergic neurons of the substantia nigra in the mouse brain. Collectively, optoRET has the potential to be developed as a future therapeutic intervention, modulating RET downstream signaling with light.

Silencing of SlSPX1 and SlSPX2 promote growth and root mycorrhization in tomato (Solanum lycopersicum L.) seedlings

Owing to the essential requirement of phosphorus (P) for growth and development, plants tightly control inorganic phosphate (Pi) homeostasis. SPX-PHR regulatory circuit not only control phosphate homeostasis responses but also root mycorrhization by arbuscular mycorrhiza (AM) fungi. Besides sensing Pi deficiency, SPX (SYG1/Pho81/XPR1) proteins also control the transcription of P starvation inducible (PSI) genes by blocking the activity of PHR1 (PHOSPHATE STARVATION RESPONSE1) homologs in plants under Pi-sufficient conditions. However, the roles of SPX members in Pi homeostasis and AM fungi colonization remain to be fully recognized in tomato. In this study, we identified 17 SPX-domain containing members in the tomato genome. Transcript profiling revealed the high Pi-specific nature of their activation. Four SlSPX members have also induced in AM colonized roots. Interestingly, we found that SlSPX1 and SlSPX2 are induced by P starvation and AM colonization. Further, SlSPX1 and SlSPX2 exhibited varying degrees of interaction with the PHR homologs in this study. Virus-induced gene silencing-based (VIGS) transcript inhibition of these genes alone or together promoted the accumulation of higher total soluble Pi in tomato seedlings and improved their growth. It also enhanced AM fungi colonization in the roots of SlSPX1 and SlSPX2 silenced seedlings. Overall, the present study provides evidence in support of SlSPX members being good candidates for improving AM fungi colonization potential in tomato.

Plant phosphate status influences root biotic interactions

Phosphorus (P) deficiency stress in combination with biotic stress(es) severely impacts crop yield. Plant responses to P deficiency overlapping with that of other stresses exhibit a high degree of complexity involving different signaling pathways. On the one hand, plants engage with rhizosphere microbiome/arbuscular mycorrhizal fungi for improved phosphate (Pi) acquisition and plant stress response upon Pi deficiency; on the other hand, this association is gets disturbed under Pi sufficiency. This nutrient-dependent response is highly regulated by the phosphate starvation response (PSR) mediated by the master regulator, PHR1, and its homolog, PHL. It is interesting to note that Pi status (deficiency/sufficiency) has a varying response (positive/negative) to different biotic encounters (beneficial microbes/opportunistic pathogens/insect herbivory) through a coupled PSR-PHR1 immune system. This also involves crosstalk among multiple players including transcription factors, defense hormones, miRNAs, and Pi transporters, among others influencing the plant-biotic-phosphate interactions. We provide a comprehensive view of these key players involved in maintaining a delicate balance between Pi homeostasis and plant immunity. Finally, we propose strategies to utilize this information to improve crop resilience to Pi deficiency in combination with biotic stresses.

Cracking the code of plant central phosphate signaling

Phosphate (Pi) is involved in numerous metabolic processes and plays a vital role in plant growth. Green plants have evolved intricate molecular bases of Pi signaling to maintain cellular Pi homeostasis. Here, we summarize recent advances in the molecular and structural bases of central Pi signaling and discuss pending questions.

Significance of platelets to lymphocytes and platelets to haemoglobin ratios in patients with systemic sclerosis

BACKGROUND

Systemic sclerosis (SSc) is a progressive autoimmune connective tissue disease. Platelets to lymphocytes (PLR) and platelets to haemoglobin ratios (PHR) are emerging biomarkers used in the assessment of activity and severity of various autoimmune diseases. This study was designed to clarify the association of PLR and PHR with SSc disease activity and its different manifestations.

METHOD

A cross-sectional study involved sixty SSc patients. Demographic, clinical data and investigations were done.

RESULTS

PLR and PHR were correlated positively with ESR (r=0.351, p=0.003*), (r=0.620, p=0.000**), CRP (r=0.417, p=0.001*), (r=0.305, p=0.018**) and SSc activity index (r=0.292, p=0.024*), (r=0.359, p=0.005*). PLR and PHR were highly significantly related to digital ulcerations, musckeloskeletal, and pulmonary manifestations. Also, they had a significant relation to ground glass abnormalities on HRCT, mild restriction in pulmonary function tests and anti-scleroderma-70 antibodies. The cutoff value for PLR was 107.8 with high sensitivity 97.9% and specifity 92.3%, area under the curve (AUC=0.723, P 0.015) on receiver operating characteristic curve (ROC). PHR AUC (0.799, P .001), cut value was 23.5 at 95.7% sensitivity and 84.6% specifity.

CONCLUSION

PLR and PHR were significantly related to digital ulcerations, musculoskeletal, and pulmonary manifestations and can be considered as predictive biomarkers for the assessment of SSc disease activity and severity.

Overexpression of GmPHR1 Promotes Soybean Yield through Global Regulation of Nutrient Acquisition and Root Development

MYB-CC transcription factors (TFs) are essential for plant growth and development. Members of the MYB-CC subfamily with long N terminal domains, such as phosphate starvation response 1 (PHR1) or PHR1-like TFs, have well documented functions, while those with short N terminal domains remain less understood. In this study, we identified a nodule specific MYB-CC transcription factor 1 (GmPHR1) in soybean that is different from other canonical PHR family genes in that GmPHR1 harbors a short N terminal ahead of its MYB-CC domain and was highly induced by rhizobium infection. The overexpression of GmPHR1 dramatically increased the ratio of deformed root hairs, enhanced subsequent soybean nodulation, and promoted soybean growth in pot experiments. The growth promotion effects of GmPHR1 overexpression were further demonstrated in field trails in which two GmPHR1-OE lines yielded 10.78% and 8.19% more than the wild type line. Transcriptome analysis suggested that GmPHR1 overexpression led to global reprogramming, with 749 genes upregulated and 279 genes downregulated, especially for genes involved in MYB transcription factor activities, root growth, and nutrient acquisition. Taken together, we conclude that GmPHR1 is a key gene involved in the global regulation of nodulation, root growth, and nutrient acquisition in soybeans, and is thus a promising candidate gene to target for soybean yield enhancement.

The RSNA ImageShare - Enabling Secure, Transparent, and Easy Image Exchange

In the early 2000s, the radiology community was awakened to the limitations of electronic media (CDs, DVDs) for exchanging imaging exams. Clinicians frustrated by the time-consuming task of opening discs, while Internet-based exchange of music, photos, and videos were becoming more widespread. The RSNA, which had extensive experience working on interoperability issues in medical imaging, began to look for opportunities to address the issue. In 2007, in the wake of the financial crisis, the National Institute of Biomedical Imaging and Bioengineering (NIBIB) issued an RFP to address Internet-based exchange of medical images. The RFP defined requirements for the network, including that it needed to be patient controlled and standards based. The RSNA was awarded funding for what came to be known as RSNA ImageShare. Over the next 8 years, the RSNA worked in partnership with several vendors and academic institutions to create a network for sharing image-enabled personal health records (PHR). The foundation of interoperability standards used in ImageShare was provided by Integrating the Healthcare Enterprise (IHE), a standards-development organization with which RSNA has had a long association. In 2018 and 2019, the RSNA looked at what had been accomplished and asked if we could take that next step at a national level and promote a solution by which any standards-compliant party could exchange imaging exams through an HIE mechanism.

Genome-Wide Analysis of DoSPX Genes and the Function of DoSPX4 in Low Phosphorus Response in Dendrobium officinale

Dendrobium officinale Kimura et Migo is a famous Chinese herb. D. officinale grows on rocks where the available phosphorus is low. The SPX family plays a critical role in maintaining Pi homeostasis in plants. In this paper, 9 SPX family genes were identified in the genome of D. officinale. Bioinformatics and qRT-PCR analysis showed that DoSPXs were involved in response to -Pi stress and had different expression patterns. DoSPX4, which had a unique expression pattern, was clustered with AtSPX4 and OsSPX4. Under -Pi treatment, the expression level of DoSPX4 reached a peak on 5 d in roots, while showing a downward trend in the aboveground parts. DoSPX4 was located on the cell membrane. Overexpression DoSPX4 promoted Pi content in the stem and the expression level of NtPHT1/2 in Nicotiana tabacum. The results of Yeast two-hybrid showed that DoSPX4 could interact with Phosphate High-Affinity Response factor (DoPHR2). These results highlight the role of DoSPX4 in response to low phosphorus, which provides a theoretical basis for further study on the response mechanism of -Pi in D. officinale.

Factors Associated With Willingness to Share Health Information: Rapid Review

Background

To expand research and strategies to prevent disease, comprehensive and real-time data are essential. Health data are increasingly available from platforms such as pharmaceuticals, genomics, health care imaging, medical procedures, wearable devices, and internet activity. Further, health data are integrated with an individual’s sociodemographic information, medical conditions, genetics, treatments, and health care. Ultimately, health information generation and flow are controlled by the patient or participant; however, there is a lack of understanding about the factors that influence willingness to share health information. A synthesis of the current literature on the multifactorial nature of health information sharing preferences is required to understand health information exchange.

Objective

The objectives of this review are to identify peer-reviewed literature that reported factors associated with health information sharing and to organize factors into cohesive themes and present a narrative synthesis of factors related to willingness to share health information.

Methods

This review uses a rapid review methodology to gather literature regarding willingness to share health information within the context of eHealth, which includes electronic health records, personal health records, mobile health information, general health information, or information on social determinants of health. MEDLINE and Google Scholar were searched using keywords such as electronic health records AND data sharing OR sharing preference OR willingness to share. The search was limited to any population that excluded health care workers or practitioners, and the participants aged ≥18 years within the US or Canadian context. The data abstraction process using thematic analysis where any factors associated with sharing health information were highlighted and coded inductively within each article. On the basis of shared meaning, the coded factors were collated into major themes.

Results

A total of 26 research articles met our inclusion criteria and were included in the qualitative analysis. The inductive thematic coding process revealed multiple major themes related to sharing health information.

Conclusions

This review emphasized the importance of data generators’ viewpoints and the complex systems of factors that shape their decision to share health information. The themes explored in this study emphasize the importance of trust at multiple levels to develop effective information exchange partnerships. In the case of improving precision health care, addressing the factors presented here that influence willingness to share information can improve sharing capacity for individuals and allow researchers to reorient their methods to address hesitation in sharing health information.

Optogenetic Control of Membrane Trafficking Using Light-Activated Reversible Inhibition by Assembly Trap of Intracellular Membranes (IM-LARIAT)

Intracellular membrane trafficking is a dynamic and complex cellular process. To study membrane trafficking with a high spatiotemporal resolution, we present an optogenetic method based on a blue-light inducible oligomerization of Rab GTPases, termed light-activated reversible inhibition by assembly trap of intracellular membranes (IM-LARIAT). In this chapter, we focus on the optical disruption of the dynamics and functions of previously studied intracellular membrane trafficking events, including transferrin recycling and growth cone regulation in relation to specific Rab GTPases. To aid general application, we provide a detailed description of transfection, imaging with a confocal microscope, and analysis of data.

Transcriptome Analysis Reveals Candidate Genes Involved in Light-Induced Primordium Differentiation in Pleurotus eryngii

Pleurotus eryngii, a highly valued edible fungus, is one of the major commercially cultivated mushrooms in China. The development of P. eryngii, especially during the stage of primordium differentiation, is easily affected by light. However, the molecular mechanism underlying the response of primordium differentiation to light remains unknown. In the present study, primordium expression profiles under blue-light stimulation, red-light stimulation, and exposure to darkness were compared using high-throughput sequencing. A total of 16,321 differentially expressed genes (DEGs) were identified from three comparisons. GO enrichment analysis showed that a large number of DEGs were related to light stimulation and amino acid biosynthesis. KEGG analyses demonstrated that the MAPK signaling pathway, oxidative phosphorylation pathway, and RNA transport were most active during primordium differentiation. Furthermore, it was predicted that the blue-light photoreceptor WC-1 and Deoxyribodipyrimidine photolyase PHR play important roles in the primordium differentiation of P. eryngii. Taken together, the results of this study provide a speculative mechanism that light induces primordium differentiation and a foundation for further research on fruiting body development in P. eryngii.

Prerequisites of Personal Health Record for Chronic Kidney Disease: A Scoping Review and Evaluation of the Content Validity

BACKGROUND

It is obvious that the Personal Health Record (PHR) is a major cornerstone for "improving the self-management of patient". However, lack of an effective and comprehensive personal health record system prohibits the widespread use of PHRs. The aim of this study was to identify the core data sets and required functionalities for designing a PHRs for chronic kidney disease (CKD) management and assess their validity.

METHODS

It was a study including two phases. In the initial phase, a scoping review was conducted with the aim of determination the core data sets and required functionalities for designing PHRs. Then in the second phase, the validity of data items and functionalities was determined by 25 multidisciplinary experts.

RESULTS

22 studies were eligible after screening 1335 titles and abstracts and reviewing 88 full texts. We determined 20 core data set and 8 required functionalities of PHRs. From the perspective of experts, 'health maintenance' and 'advance directives' were most often marked as useful but not essential, while 'test and examination', 'medication list' and 'diagnosis and comorbid conditions" were predominantly considered as essential by all experts (n=25,100%).

CONCLUSION

This research is a step that we have taken to identify prerequisites that could be used for the design, development, and implementation of an effective and comprehensive electronic personal health record.

Applicability of Different Electronic Record Types for Use in Patient Recruitment Support Systems: Comparative Analysis

Background

Clinical trials constitute an important pillar in medical research. It is beneficial to support recruitment for clinical trials using software tools, so-called patient recruitment support systems; however, such information technology systems have not been frequently used to date. Because medical information systems' underlying data collection methods strongly influence the benefits of implementing patient recruitment support systems, we investigated patient recruitment support system requirements and corresponding electronic record types such as electronic medical record, electronic health record, electronic medical case record, personal health record, and personal cross-enterprise health record.

Objective

The aim of this study was to (1) define requirements for successful patient recruitment support system deployment and (2) differentiate and compare patient recruitment support system–relevant properties of different electronic record types.

Methods

In a previous study, we gathered requirements for patient recruitment support systems from literature and unstructured interviews with stakeholders (15 patients, 3 physicians, 5 data privacy experts, 4 researchers, and 5 staff members of hospital administration). For this investigation, the requirements were amended and categorized based on input from scientific sessions. Based on literature with a focus on patient recruitment support system–relevant properties, different electronic record types (electronic medical record, electronic health record, electronic medical case record, personal health record and personal cross-enterprise health record) were described in detail. We also evaluated which patient recruitment support system requirements can be achieved for each electronic record type.

Results

Patient recruitment support system requirements (n=16) were grouped into 4 categories (consent management, patient recruitment management, trial management, and general requirements). All 16 requirements could be partially met by at least 1 type of electronic record. Only 1 requirement was fully met by all 5 types. According to our analysis, personal cross-enterprise health records fulfill most requirements for patient recruitment support systems. They demonstrate advantages especially in 2 domains (1) supporting patient empowerment and (2) granting access to the complete medical history of patients.

Conclusions

In combination with patient recruitment support systems, personal cross-enterprise health records prove superior to other electronic record types, and therefore, this integration approach should be further investigated.

Investigating the relationship between the severity of coronary artery disease and inflammatory factors of MHR, PHR, NHR, and IL-25

Background: Coronary artery disease (CAD), as a most common cause of death, is mainly caused by atherosclerosis. Due to the role of inflammation in the process of atherosclerosis, in the present study, the relationship between the severity of coronary artery disease and inflammatory factors of monocyte to HDL-C ratio (MHR), platelet-to-HDL-C ratio (PHR), neutrophil to HDL-C ratio (NHR), and IL-25 was investigated.

Methods: In this cross-sectional study, 64 patients with diagnosis of coronary artery disease who were undergoing angiography in Farshchian heart center in Hamadan were studied. For each patient, the count of monocytes, neutrophils, platelet, and HDL-C, and IL-25 were measured from their blood and serum samples. Also, demographic information, such as age, gender, diabetes, smoking, and history of hypertension, was collected using a checklist. Data were described using frequency, percent, mean, and standard deviation. Statistical analysis was performed using independent t test, Mann-Whitney, Wilcoxon, and Spearman rank correlation tests, and multiple linear regression by SPSS version 25.0 SPSS Inc). P <.05 was considered as significant.

Results: The results of this study showed that IL-25 and MHR index has a significant correlation with coronary artery disease and Gensini score (P ˂.001). The PHR index was associated with coronary artery disease. Also, qualitative variables, such as history of hypertension, history of smoking, and gender, have a significant association with the severity of coronary artery disease (P <.05).

Conclusion: Among the inflammatory markers examined, IL-25 and MHR are stronger markers for assessing the severity of coronary artery disease. Simple and available IL-25 and MHR measurements may be able to, along with common risk factors and lipid profiles, predict the amount of vascular occlusion in treatment centers as an alternative of angiography as well as screening high risk patients prone to cardiovascular disease.

Utility, Value, and Benefits of Contemporary Personal Health Records: Integrative Review and Conceptual Synthesis

Background

Contemporary personal health record (PHR) technologies offer a useful platform for individuals to maintain a lifelong record of personally reported and clinically sourced data from various points of medical care.

Objective

This paper presents an integrative review and synthesis of the extant literature on PHRs. This review draws upon multiple lenses of analysis and deliberates value perspectives of PHRs at the product, consumer, and industry levels.

Methods

Academic databases were searched using multiple keywords related to PHRs for the years 2001-2020. Three research questions were formulated and used as selection criteria in our review of the extant literature relevant to our study.

Results

We offer a high-level functional utility model of PHR features and functions. We also conceptualize a consumer value framework of PHRs, highlighting the applications of these technologies across various health care delivery activities. Finally, we provide a summary of the benefits of PHRs for various health care constituents, including consumers, providers, payors, and public health agencies.

Conclusions

PHR products offer a myriad of content-, connectivity-, and collaboration-based features and functions for their users. Although consumers benefit from the tools provided by PHR technologies, their overall value extends across the constituents of the health care delivery chain. Despite advances in technology, our literature review identifies a shortfall in the research addressing consumer value enabled by PHR tools. In addition to scholars and researchers, our literature review and proposed framework may be especially helpful for value analysis committees in the health care sector that are commissioned for the appraisal of innovative health information technologies such as PHRs.

Bacteriophages as Biocontrol Agents for Flavobacterium psychrophilum Biofilms and Rainbow Trout Infections

Background: Bacteriophages (phages) have been proposed as an alternative to antibiotics and surface disinfectants for treatment of Flavobacterium psychrophilum biofilms and fish infections in aquaculture settings. The aim of the study was to estimate the minimal phage:host ratio (PHR) required for the control of in vitro biofilm formation and mortalities caused by F. psychrophilum in experimentally infected fish. Materials and Methods: F. psychrophilum cells in different stages of biofilm formation were exposed to the lytic phage FPSV-D22 at different PHRs. Results: Our results show that an initial PHR of 0.01 is sufficient for more than an 80% inhibition of attachment and colonization, and disruption of maturated F. psychrophilum biofilms, whereas greater ratios resulted in almost complete interruption of the different biofilm stages. Interestingly, a similar response was observed in a phage therapy trial with live rainbow trout (Oncorhynchus mykiss), where treatment of F. psychrophilum-infected fish by injection of serial bacteriophage doses resulted in significantly (***p ≤ 0.001) higher survival already at a PHR of 0.02. Conclusions: These results indicate that phages have the potential to be effective for control and treatment of F. psychrophilum infections in fish farms even when applied in concentrations lower than previously expected.

Chronic Disease Self Management Using a Social Networking PHR/UHR

This viewpoint paper presents a potential solution to the "information islands" that are holding back PHR/UHR from becoming truly effective diagnostic information care management tools for patients especially those who suffer from chronic diseases. The solution involves integrating patient portal with a diagnostic data interface layer to create a single access point for caregivers and patients.

What are the important design features of personal health records to improve medication adherence for patients with long-term conditions? A systematic literature review

OBJECTIVES

This systematic literature review aims to identify important design features of the electronic personal health record (PHR) that may improve medication adherence in the adult population with long-term conditions.

DATA SOURCES

PubMed (including MEDLINE), CINAHL, Science Direct (including EMBASE), BioMed Central, ACM digital, Emerald Insight, Google Scholar and Research Gate.

METHODS

Studies that were published between 1 January 2002 and 31 May 2018 in English were included if the participants were adults, with at least one long-term condition, were able to self-administer their medication and were treated in primary care settings. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the risk of bias was appraised using the Cochrane risk of bias tool.

RESULTS

From a total of 27 studies that matched the inclusion criteria, 12 were excluded due to low quality of evidence, 10 were rated moderate and 5 were rated high quality. All the included studies had low sample size and limited follow-up duration. Thirteen of the included studies found that the use of a PHR has increased medication adherence. The identified design features are reminders, education, personalisation and tailoring, feedback and alerts, gamification, medication management, medical appointment management, diary and self-monitoring, health condition management, set goals, patient's blog and tethered. It was impossible to draw conclusions as to which feature is important to what group of patients and why. The most frequently identified conditions were HIV and diabetes. This review did not identify any papers with negative results. It was not possible to numerically aggregate the PHR effect due to high heterogeneity of the medication adherence measurement, study type, participants and PHRs used.

CONCLUSION

Although we found recurrent evidence that PHRs can improve medication adherence, there is little evidence to date to indicate which design features facilitate this process.

PROSPERO REGISTRATION NUMBER

CRD42017060542.

Uncovering a Role for Electronic Personal Health Records in Reducing Disparities in Sexually Transmitted Infection Rates Among Students at a Predominantly African American University: Mixed-Methods Study

Background

Black youth continue to bear an overwhelming proportion of the United States sexually transmitted infection (STI) burden, including HIV. Several studies on web-based and mobile health (mHealth) STI interventions have focused on characterizing strategies to improve HIV-related prevention and treatment interventions, risk communication, and stigma among men who have sex with men (MSM), people who use substances, and adolescent populations. The Electronic Sexual Health Information Notification and Education (eSHINE) Study was an exploratory mixed-methods study among students at a historically black university exploring perceptions on facilitating STI testing conversations with partners using electronic personal health records (PHRs).

Objective

The purpose of this paper is to use eSHINE Study results to describe perceived impacts of electronic PHRs on facilitating STI testing discussions between sexual partners.

Methods

Semistructured focus groups and individual in-depth interviews were conducted on a heterogeneous sample of students (n=35) between May and July 2014. Qualitative phase findings guided development of an online survey instrument for quantitative phase data collection. Online surveys were conducted using a convenience sample of students (n=354) between January and May 2015. Online survey items collected demographic information, sexual behaviors, beliefs and practices surrounding STI testing communication between partners, and beliefs about the impact of electronic PHR access on facilitating these discussions with partners. Chi-square analysis was performed to assess gender differences across quantitative measures. A Wilcoxon signed rank sum test was used to test the null hypothesis that electronic PHRs are believed to have no effect on the timing of dyadic STI health communication.

Results

Participants described multiple individual and dyadic-level factors that inhibit initiating discussions about STI testing and test results with partners. Electronic PHRs were believed to improve ability to initiate conversations and confidence in STI screening information shared by partners. Among online survey participants, men were more likely to believe electronic PHRs make it easier to facilitate STI talks with potential partners (59.9% vs 51.9%; χ²=3.93, P=.05). The Wilcoxon signed-rank test results indicate significant increases in perceived discussion timing before sex with electronic PHR access (61.0% vs 40.4%; P<.001).

Conclusions

Findings suggest that electronic PHR access in STI screening settings among similar populations of Black youth may improve both motivation and personal agency for initiating dyadic STI health communication. Results from this study will likely inform novel interventions that use access to electronic PHRs to stimulate important health-related discussions between sexual partners. Moving forward requires studying strategies for implementing interventions that leverage electronic PHRs to create new sexual health communication channels with providers, peers, and family among black youth.

The health literacy demands of electronic personal health records (e-PHRs): An integrative review to inform future inclusive research

OBJECTIVE

To integrate the findings of research on electronic personal health records (e-PHRs) for an understanding of their health literacy demands on both patients and providers.

METHODS

We sought peer-reviewed primary research in English addressing the health literacy demands of e-PHRs that are online and allow patients any degree of control or input to the record. A synthesis of three theoretical models was used to frame the analysis of 24 studies.

RESULTS

e-PHRs pose a wide range of health literacy demands on both patients and health service providers. Patient participation in e-PHRs relies not only on their level of education and computer literacy, and attitudes to sharing health information, but also upon their executive function, verbal expression, and understanding of spoken and written language.

CONCLUSION

The multiple health literacy demands of e-PHRs must be considered when implementing population-wide initiatives for storing and sharing health information using these systems.

PRACTICE IMPLICATIONS

The health literacy demands of e-PHRs are high and could potentially exclude many patients unless strategies are adopted to support their use of these systems. Developing strategies for all patients to meet or reduce the high health literacy demands of e-PHRs will be important in population-wide implementation.

Consumer Adoption of Future MyData-Based Preventive eHealth Services: An Acceptance Model and Survey Study

Background

Constantly increasing health care costs have led countries and health care providers to the point where health care systems must be reinvented. Consequently, electronic health (eHealth) has recently received a great deal of attention in social sciences in the domain of Internet studies. However, only a fraction of these studies focuses on the acceptability of eHealth, making consumers’ subjective evaluation an understudied field. This study will address this gap by focusing on the acceptance of MyData-based preventive eHealth services from the consumer point of view. We are adopting the term "MyData", which according to a White Paper of the Finnish Ministry of Transport and Communication refers to "1) a new approach, a paradigm shift in personal data management and processing that seeks to transform the current organization centric system to a human centric system, 2) to personal data as a resource that the individual can access and control."

Objective

The aim of this study was to investigate what factors influence consumers’ intentions to use a MyData-based preventive eHealth service before use.

Methods

We applied a new adoption model combining Venkatesh’s unified theory of acceptance and use of technology 2 (UTAUT2) in a consumer context and three constructs from health behavior theories, namely threat appraisals, self-efficacy, and perceived barriers. To test the research model, we applied structural equation modeling (SEM) with Mplus software, version 7.4. A Web-based survey was administered. We collected 855 responses.

Results

We first applied traditional SEM for the research model, which was not statistically significant. We then tested for possible heterogeneity in the data by running a mixture analysis. We found that heterogeneity was not the cause for the poor performance of the research model. Thus, we moved on to model-generating SEM and ended up with a statistically significant empirical model (root mean square error of approximation [RMSEA] 0.051, Tucker-Lewis index [TLI] 0.906, comparative fit index [CFI] 0.915, and standardized root mean square residual 0.062). According to our empirical model, the statistically significant drivers for behavioral intention were effort expectancy (beta=.191, P<.001), self-efficacy (beta=.449, P<.001), threat appraisals (beta=.416, P<.001), and perceived barriers (beta=−.212, P=.009).

Conclusions

Our research highlighted the importance of health-related factors when it comes to eHealth technology adoption in the consumer context. Emphasis should especially be placed on efforts to increase consumers’ self-efficacy in eHealth technology use and in supporting healthy behavior.

GmPHR25, a GmPHR member up-regulated by phosphate starvation, controls phosphate homeostasis in soybean

As an essential nutrient element, phosphorus (P) plays an important role in plant growth and development. Low P availability is a limiting factor for crop production, especially for legume crops (e.g. soybean), which require additional P to sustain nitrogen fixation through symbiotic associations with rhizobia. Although PHOSPHATE STARVATION RESPONSE 1 (PHR1) or PHR1-like is considered as a central regulator of phosphate (Pi) homeostasis in several plant species, it remains undefined in soybean. In this study, 35 GmPHR members were cloned from the soybean genome and expression patterns in soybean were assayed under nitrogen (N) and P deficiency conditions. GmPHR25, which is up-regulated in response to Pi starvation, was then overexpressed in soybean hairy roots in vitro and in vivo to investigate its functions. The results showed that overexpressing GmPHR25 increased Pi concentration in transgenic soybean hairy roots under normal conditions, accompanied with a significant decrease in hairy root growth. Furthermore, transcripts of 11 out of 14 high-affinity Pi transporter (GmPT) members as well as five other Pi starvation-responsive genes were significantly increased in soybean hairy roots with GmPHR25 overexpression. Taken together, this study suggests that GmPHR25 is a vital regulator in the P signaling network, and controls Pi homeostasis in soybean.

OmniPHR: A distributed architecture model to integrate personal health records

The advances in the Information and Communications Technology (ICT) brought many benefits to the healthcare area, specially to digital storage of patients' health records. However, it is still a challenge to have a unified viewpoint of patients' health history, because typically health data is scattered among different health organizations. Furthermore, there are several standards for these records, some of them open and others proprietary. Usually health records are stored in databases within health organizations and rarely have external access. This situation applies mainly to cases where patients' data are maintained by healthcare providers, known as EHRs (Electronic Health Records). In case of PHRs (Personal Health Records), in which patients by definition can manage their health records, they usually have no control over their data stored in healthcare providers' databases. Thereby, we envision two main challenges regarding PHR context: first, how patients could have a unified view of their scattered health records, and second, how healthcare providers can access up-to-date data regarding their patients, even though changes occurred elsewhere. For addressing these issues, this work proposes a model named OmniPHR, a distributed model to integrate PHRs, for patients and healthcare providers use. The scientific contribution is to propose an architecture model to support a distributed PHR, where patients can maintain their health history in an unified viewpoint, from any device anywhere. Likewise, for healthcare providers, the possibility of having their patients data interconnected among health organizations. The evaluation demonstrates the feasibility of the model in maintaining health records distributed in an architecture model that promotes a unified view of PHR with elasticity and scalability of the solution.

Perceived challenges for adopting the Personal Health Record (PHR) at Ministry of National Guard Health Affairs (MNGHA)- Riyadh

BACKGROUND

The Personal Health Record (PHR) is an electronic record that allows patients to maintain, manage and access their health information in one secure location. However, despite these potential capabilities, the adoption rate of the PHR has been slow due to various challenges.

OBJECTIVES

This study, being the first of its kind in Saudi Arabia, investigates the perceived barriers and /or challenges for PHR adoption in the Ministry of National Guard Health Affairs (MNGHA). The study explored perceived barriers and /or challenges from two different perspectives; a technical perspective and a social perspective.

METHODS

The study was conducted using a mixed methods approach. A cross-sectional study design using a questionnaire was used to measure patients' perceptions of the PHR and a qualitative approach through focus groups was used to capture comments and opinions from technical personnel for perceived technical barriers to PHR adoption.

RESULT

Results from 424 patients revealed a positive perception for PHR adoption with almost all of the participants (96.7%) indicating interest in using the PHR and the majority (73.3%) expressing no confidentiality concerns for the online accessibility of their health information. Patients with higher levels of education indicated higher interest in using the PHR and expressed more concern with confidentiality than patients with lower levels of education. However, the majority of patients (78.3%) expressed their lack of awareness of existing patient e-services on the MNGHA website. The themes that emerged from the focus groups reinforced lack of awareness of e-services as a potential barrier for PHR adoption as well as the role of policy in the regulation and business process for PHR adoption.

CONCLUSION

This study has highlighted the perceived challenges and barriers for adoption of the PHR in MNGHA-Riyadh. In order to ensure an efficient PHR with a strong adoption rate, effective steps need to be undertaken by building PHR awareness as well as setting clear guidelines and regulations from policy makers.

Personal health records: Consumer attitudes toward privacy and security of their personal health information

Personal health record (PHR) systems are a subject of intense interest in the move to improve healthcare accessibility and quality. Although a number of vendors continue to put forward PHR systems, user-centered design research has lagged, and it has not been clear what features are important to prospective PHR users. Here, we report on a user-centered design study that combines qualitative and quantitative approaches to investigate several dimensions relevant to PHR design, and to look at the effect of health status on user needs. The results indicate that health status, especially disability and chronic illness, is relevant to PHR design. Further, the results provide empirical evidence about the role of privacy and security in users' attitudes toward PHR use. The exact nature of these attitudes differs from widely held perceptions about consumer values in healthcare information management.

Patients with chronic kidney disease and their intent to use electronic personal health records

Background

Electronic personal health records (ePHRs) provide patients with access to their personal health information, aiming to inform them about their health, enhance self-management, and improve outcomes. Although they have been associated with improved health outcomes in several chronic diseases, the potential impact of ePHR use in chronic kidney disease (CKD) is unknown.

Objectives

We sought to understand perceptions of CKD patients about ePHRs, and describe characteristics associated with their expressed intent to use an ePHR.

Design

Self-administered paper based survey.

Setting

The study was conducted in Calgary, Alberta, Canada at a multidisciplinary CKD clinic from November 2013 to January 2014.

Participants

Patients with non-dialysis-dependent CKD.

Measurements

Demographics, perceived benefits, and drawbacks of ePHRs were obtained. A univariate analysis was used to assess for an association with the expressed intention to use an ePHR.

Methods

A patient survey was used to determine perceptions of ePHRs, and to identify factors that were associated with intention to use an ePHR.

Results

Overall 63 patients with CKD (76.2 % male, 55.6 % ≥65 years old) completed the survey. The majority (69.8 %) expressed their intent to use an ePHR. CKD patients over the age of 65 were less likely to intend to use an ePHR as compared to those aged <65 years (OR 0.22, 95 % CI: [0.06, 0.78]). Those with post-secondary education (OR 3.31, 95 % CI: [1.06, 10.41]) and Internet access (OR 5.70, 95 % CI: [1.64, 19.81]) were more likely to express their intent to use an ePHR. Perceived benefits of ePHR use included greater involvement in their own care (50.0 % indicated this), better access to lab results (75.8 %), and access to health information (56.5 %). Although 41.9 % reported concerns about privacy of health information, there was no association between these concerns and the intent to use an ePHR.

Limitations

Our results are limited by small study size and single centre location.

Conclusions

We found that patients with CKD expressed their intention to use ePHRs, and perceive benefits such as personal involvement in their health care and better access to lab results. Studies of CKD patients using ePHRs are needed to determine whether ePHR use improves patient outcomes.

SPX proteins regulate Pi homeostasis and signaling in different subcellular level

To cope with low phosphate (Pi) availability, plants have to adjust its gene expression profile to facilitate Pi acquisition and remobilization. Sensing the levels of Pi is essential for reprogramming the gene expression profile to adapt to the fluctuating Pi environment. AtPHR1 in Arabidopsis and OsPHR2 in rice are central regulators of Pi signaling, which regulates the expression of phosphate starvation-induced (PSI) genes by binding to the P1BS elements in the promoter of PSI genes. However, how the Pi level affects the central regulator to regulate the PSI genes have puzzled us for a decade. Recent progress in SPX proteins indicated that the SPX proteins play important role in regulating the activity of central regulator AtPHR1/OsPHR2 in a Pi dependent manner at different subcellular levels.

Personal health record use and association with immunizations and well-child care visits recommendations

OBJECTIVE

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations.

STUDY DESIGN

For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs <all) and number of WCC visits through 15 months old (≥ 6 vs <6). We conducted multivariate logistic, propensity score-matched regression adjusting for parents' education and child's continuity of care.

RESULTS

Children whose parents used ≥ 1 PHR feature (vs none) had higher odds of adhering to the recommended immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P < .05). PHR use was associated with better adherence to WCC visit recommendations for both KP Hawaii (OR 1.9, 95% CI 1.3-2.9, P < .001) and KP Northwest (OR 2.5, 95% CI 2.1-2.9, P < .001).

CONCLUSIONS

Young children whose parents used a PHR were more likely to adhere to the recommended WCC visits in both regions but immunizations in only 1 region.

Improving self-care of patients with chronic disease using online personal health record

BACKGROUND

Effective management of chronic diseases such as prostate cancer is important. Research suggests a tendency to use self-care treatment options such as over-the-counter (OTC) complementary medications among prostate cancer patients. The current trend in patient-driven recording of health data in an online Personal Health Record (PHR) presents an opportunity to develop new data-driven approaches for improving prostate cancer patient care. However, the ability of current online solutions to share patients' data for better decision support is limited. An informatics approach may improve online sharing of self-care interventions among these patients. It can also provide better evidence to support decisions made during their self-managed care.

AIMS

To identify requirements for an online system and describe a new case-based reasoning (CBR) method for improving self-care of advanced prostate cancer patients in an online PHR environment.

METHOD

A non-identifying online survey was conducted to understand self-care patterns among prostate cancer patients and to identify requirements for an online information system. The pilot study was carried out between August 2010 and December 2010. A case-base of 52 patients was developed.

RESULTS

The data analysis showed self-care patterns among the prostate cancer patients. Selenium (55%) was the common complementary supplement used by the patients. Paracetamol (about 45%) was the commonly used OTC by the patients.

CONCLUSION

The results of this study specified requirements for an online case-based reasoning information system. The outcomes of this study are being incorporated in design of the proposed Artificial Intelligence (Al) driven patient journey browser system. A basic version of the proposed system is currently being considered for implementation.