Self-monitoring diabetes with multiple mobile health devices

OBJECTIVE

The purpose of this study was to examine the use of multiple mobile health technologies to generate and transmit data from diverse patients with type 2 diabetes mellitus (T2DM) in between clinic visits. We examined the data to identify patterns that describe characteristics of patients for clinical insights.

METHODS

We enrolled 60 adults with T2DM from a US healthcare system to participate in a 6-month longitudinal feasibility trial. Patient weight, physical activity, and blood glucose were self-monitored via devices provided at baseline. Patients also responded to biweekly medication adherence text message surveys. Data were aggregated in near real-time. Measures of feasibility assessing total engagement in device submissions and survey completion over the 6 months of observation were calculated.

RESULTS

It was feasible for participants from different socioeconomic, educational, and racial backgrounds to use and track relevant diabetes-related data from multiple mobile health devices for at least 6 months. Both the transmission and engagement of the data revealed notable patterns and varied by patient characteristics.

DISCUSSION

Using multiple mobile health tools allowed us to derive clinical insights from diverse patients with diabetes. The ubiquitous adoption of smartphones across racial, educational, and socioeconomic populations and the integration of data from mobile health devices into electronic health records present an opportunity to develop new models of care delivery for patients with T2DM that may promote equity as well.

Brain responses to biological motion predict treatment outcome in young children with autism

Autism spectrum disorders (ASDs) are common yet complex neurodevelopmental disorders, characterized by social, communication and behavioral deficits. Behavioral interventions have shown favorable results-however, the promise of precision medicine in ASD is hampered by a lack of sensitive, objective neurobiological markers (neurobiomarkers) to identify subgroups of young children likely to respond to specific treatments. Such neurobiomarkers are essential because early childhood provides a sensitive window of opportunity for intervention, while unsuccessful intervention is costly to children, families and society. In young children with ASD, we show that functional magnetic resonance imaging-based stratification neurobiomarkers accurately predict responses to an evidence-based behavioral treatment-pivotal response treatment. Neural predictors were identified in the pretreatment levels of activity in response to biological vs scrambled motion in the neural circuits that support social information processing (superior temporal sulcus, fusiform gyrus, amygdala, inferior parietal cortex and superior parietal lobule) and social motivation/reward (orbitofrontal cortex, insula, putamen, pallidum and ventral striatum). The predictive value of our findings for individual children with ASD was supported by a multivariate pattern analysis with cross validation. Predicting who will respond to a particular treatment for ASD, we believe the current findings mark the very first evidence of prediction/stratification biomarkers in young children with ASD. The implications of the findings are far reaching and should greatly accelerate progress toward more precise and effective treatments for core deficits in ASD.

A mere exposure effect for transformed three-dimensional objects: effects of reflection, size, or color changes on affect and recognition

If the mere exposure effect is based on implicit memory, recognition and affect judgments should be dissociated by experimental variables in the same manner as other explicit and implicit measures. Consistent with results from recognition and picture naming or object decision priming tasks (e.g., Biederman & E.E. Cooper, 1991, 1992; L.A. Cooper, Schacter, Ballesteros, & Moore, 1992), the present research showed that recognition memory but not affective preference was impaired by reflection or size transformations of three-dimensional objects between study and test. Stimulus color transformations had no effect on either measure. These results indicate that representations that support recognition memory code spatial information about an object's left-right orientation and size, whereas representations that underlie affective preference do not. Insensitivity to surface feature changes that do not alter object form appears to be a general characteristic of implicit memory measures, including the affective preference task.

The influence of some perinatal variables on neonatal blood pressure

Adult hypertension has been linked to fetal growth. This study investigates whether this link is evident in the newborn. We measured blood pressure by oscillometry in 248 healthy neonates on day 3/4 of life. Antenatal data and neonatal measurements were obtained from hospital records. Elevated neonatal blood pressure correlated with higher birthweight. There was no correlation between placental weight and blood pressure. Babies born by caesarean section had lower systolic blood pressure. Babies of maternal smokers had higher diastolic blood pressure, but their mothers (45% of this study) had lower blood pressure than non-smokers. Thus, smoking was associated with a significant change in both maternal and neonatal blood pressure, and may be an important influence on the developing cardiovascular system.

Suicide levels in Cork City 1987/1991

This study investigates the level of suicide in Cork City during the 5-year period 1987/1991. Both male and female crude rates were higher than the corresponding national levels. The male/female ratio was 2.3:1, which is consistent with established findings. Vulnerability to suicide is most pronounced in 20-39 year old males and females in the 40-59 age category. There was some evidence of an increased risk of suicide among single elderly males; otherwise marital status was not a significant factor. A positive association was noted between unemployment and suicide rate for males. Drowning was used as the method of suicide by approximately half the male and female sub-groups; this was followed by hanging in the case of males and overdosing among females. However all suicide cases under 20 years of age used hanging.

Deliberate self-poisoning, unemployment and public health

The purpose of the present investigation was to explore further the known relationship between deliberate self-poisoning and social deprivation. Each individual who attended one of Cork city's three casualty departments following an act of deliberate self-poisoning in 1988 was examined. The place of residence (ward) of each city resident patient was established. The social status of the city's 34 wards was estimated using a number of indices obtained from the 1981 and 1986 census reports and social service records. A comparison was made between the 1988 self-poisoning rate for each ward and the rate found in a 1982 study of the city. Correlations between self-poisoning rate and seven social deprivation indices were found to be significant. Multiple regression, factor, and partial correlation analyses were carried out to examine more closely the interrelationships between the social deprivation indices. With respect to explaining the variation in the self-poisoning rate, unemployment alone performed almost as well as all of the indices together and as well as the factors derived using factor analysis. The correlation between unemployment and self-poisoning rate remained highly significant when the other related variables were controlled for. However, at fixed levels of unemployment, these variables were found to be independent of the self-poisoning rate. It is suggested that whereas clinical intervention may benefit the individual, deliberate self-poisoning as an issue requires a public health approach for its resolution.

Value of wearing head protection gear while playing hurling

One of the three national games of Ireland, hurling is a contact team sport (15 a side) played with a metre long ash stick and a small hard leather ball. Over a 12 month period, 413 players were treated for hurling-related injuries at Cork Regional Hospital. While hand and facial trauma predominate, the proportion between the two sites has changed substantially from previous reports with a reduction in the level of facial injuries. The wearing of a helmet, and optionally a supplementary faceguard, is seen to have contributed to this trend. Despite this welcome reduction of facial injuries, a certain resistance to the use of protective headgear is evident, particularly among older players.

Patient throughput in an acute geriatric unit

This report presents findings from a 3-year investigation of patient turnover, morbidity and mortality in the department of geriatric medicine based at Cork University and St. Finbarr's Hospitals, Cork. A total of 3,977 patients were admitted during the study period. The majority were 70 years or over (89%), referred by a general practitioner (83%) and female (56%). Seventy-one percent of admissions were discharged home, a further 18% died within the unit while 11% were transferred to continuing care. The median duration of stay was ten days. Age, diagnosis and source of referral significantly influenced both patient outcome and duration of stay. Forty-seven percent of discharged patients were followed-up at either the day hospital or outpatient clinic. A morbidity profile was constructed for a representative sample of 318 patients. 52% of this sample had two or more significant diagnoses. Neurological disorders carried a particularly poor prognosis. The median duration of stay for patients transferred to an on-site long stay facility was approximately one year.

Epidemiology of tumours of the central nervous system in Ireland

The incidence of cancer of the central nervous system (CNS) was established for the counties of Cork and Kerry using the Southern Tumour Registry data base. A total of 191 newly-diagnosed patients were identified over the five year period 1984-1988. This represents a crude annual incidence rate of 7.3 per 100,000 for males and 6.8 for females. When the incidence rates were adjusted using the accepted theoretical World Population, the annual rates were 6.7 and 6.4 for males and females respectively. These levels are higher than those reported for England and Wales (5.2 for males and 3.6 for females) and Scotland (5.9 for males and 4.2 for females). However the Irish rates are much lower than the most recent published statistics for Denmark which report rates of 12.9 for males and 11.8 for females. The risk of being affected by a CNS tumour increases substantially from 50 years onwards for a male and from 40 years on for females. The risk is seen to diminish for those aged 80 years or more. The most common locations of CNS tumours were the frontal, parietal and temporal lobes. Gliomas were by far the most common type of tumour.

The continuing dental education (CDE) activities of a regional cohort of Irish dentists--a baseline study

The need for continuing dental education (CDE) throughout one's career is becoming increasingly accepted by the modern practitioner. The current paper is part of a longitudinal investigation of the various conceptual, practical and attitudinal aspects of CDE. (Based on the responses of a representative sample of 146 dentists, it documents the level of participation in CDE among practitioners in the South and Mid-West regions of Ireland, at a baseline examination). Only 41% of respondents belonged to more than one professional association, while 55% subscribed to more than one journal. The Irish Dental Association and the present journal dominated these statistics. There was a generally low level of involvement in elements of CDE, such as attendance at scientific conferences, professional courses and occasional meetings. There was a high degree of consistency in the respondents' participation in CDE-related activities. Thus dentists who belonged to a number of organisations and subscribed to various journals, also tended to more frequently attend relevant conferences, courses and meetings. With some exceptions, specialist and hospital-based dentists were more likely to be involved in CDE activities.

Investigation of the possible effect of the Chernobyl accident on Irish mortality rates

RADIOACTIVE fallout from the Chernobyl accident reached Ireland in May 1986 and caused serious concern with regard to its possible effects on health. Reports of a large scale American study claim an almost immediate effect of Chernobyl fallout in terms of increased mortality rates. A study of Irish mortality rates reported a substantial increase in numbers of deaths during the three months immediately post-Chernobyl. The present study investigates whether there is a statistically significant basis for the reported increase in mortality in Ireland. No discernible evidence was found for increased mortality rates in Ireland during 1986, following the Chernobyl accident. The initial report of increased mortality rates was based on provisional mortality registration statistics and not on actual day by day data.

A longitudinal study of untreated periodontal disease

1016 textile workers were examined during a baseline study in 1969/70. A follow-up examination in 1979/80 identified 82 subjects who had not been treated for periodontal disease in the intervening period. There were 39 male and 43 female subjects; the average age at the initial examination was 27.0 years. There was an average tooth loss of 2.5 (SEM 0.6) teeth per subject over the 10-year period. While periodontal disease was significantly related to oral hygiene at the outset, neither factor was significantly related to the degree of tooth loss. A detailed analysis of the dynamics of the periodontal condition was undertaken. The subsequent results are presented in the form of transition matrices and clearly illustrate both the progression of periodontal disease and the degree of tooth loss associated with each level of periodontal disease at the initial examination. The main findings are as follows. (a) Overall 6% of teeth initially free of periodontal disease (P.I.O.) were lost compared to 14% with destructive periodontal disease (P.I.6). (b) Progression of periodontal disease was slow for teeth initially free of periodontal disease and with mild gingivitis (P.I.0 and P.I.1) for all age groups. However severe gingivitis (P.I.2), resulted in more rapid deterioration of the supporting tissues in subjects over 35 years old at the final examination; 35% of such teeth changed to destructive periodontal disease (P.I.6) compared to 17% of corresponding teeth for the under 35-year age group. In contrast, a poorer prognosis was found for the teeth with destructive periodontal disease (P.I.6) in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Factors in the exfoliation syndrome

The study cohort consists of 459 subjects over 60 years of age. Intraocular pressure and degrees of exfoliation, lens changes, and pigment were recorded and their interrelationships investigated. A raised intraocular pressure was found to be associated with exfoliation, as also was increased pigmentation and the development of lens changes. An original observation is that the exfoliated males had a significantly higher IOP than their female counterparts.

Detailed examination of caries progression in 4-year-old children in a non-fluoridated area in Ireland

314 4-year-old children were examined in Mallow, Ireland (a non-fluoridated area). 30.6% were found to be caries free. Investigation of the pattern of decay in the dentitions of these children showed the primary secondary molar as the tooth most commonly affected by caries irrespective of def score. The distribution of the disease is examined on a surface by surface basis. Decay occurring on the occlusal surface is predominant and no homogeneous pattern is found among the other surfaces. A statistical method for examining possible patterns of surface involvement is introduced.

Plasma angiotensin II concentrations in diabetic ketoacidosis and in hyperosmolar non-ketotic hyperglycemia

Plasma angiotensin II concentrations were measured in 14 patients in diabetic ketoacidosis and in two patients with hyperosmolar non-ketotic hyperglycemia, before treatment and again when blood glucose control was restored. In the ketoacidosis group plasma angiotensin II before treatment was markedly raised in all patients with otherwise uncomplicated diabetes, but was within the normal range in some patients with long-term complications such as neuropathy, retinopathy and nephropathy. Mean angiotensin II before treatment was significantly higher in otherwise uncomplicated patients than in those with long-term complications. However, plasma angiotensin II decreased with improved control in all. Angiotensin II levels did not correlate with indices of rehydration such as changes in blood urea, packed cell volume and calculated changes in plasma volume. There was, however, a significant negative association between pre-treatment angiotensin II and pH. Two patients with hyperosmolar non-ketotic hyperglycemia were more dehydrated but less acidotic. Pre-treatment angiotensin II in each was well below the mean of the ketoacidosis group. These data are further evidence that the renin-angiotensin system may be imparied in diabetics with long-term complications. In addition, they suggest that factors other than fluid depletion are also important in activating the renin-angiotensin system in uncontrolled diabetes.

Plasma angiotensin II and the control of diabetes mellitus

Plasma angiotensin II was measured in twenty patients with poorly controlled non-ketotic diabetes mellitus, and again when blood glucose control improved. Plasma angiotensin II fell significantly improved control, both when patients were supine and fasting overnight, and when studied after 4 h ambulation. The change occurred with improved short-term and longer-term control. It is concluded that the degree of blood glucose control is important when assessing the renin-angiotensin system in diabetic patients.