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- All Subjects: Health Sciences
- All Subjects: Digital Health
- Creators: Buman, Matthew P
- Creators: Wardenaar, Floris
- Member of: Theses and Dissertations
- Member of: Barrett, The Honors College Thesis/Creative Project Collection
Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
Initial FB and HS were assessed in NCAA-DI female soccer athletes (n=10) of a single team in temperate, dry conditions (55-68°F, 18-48% humidity) who were monitored during 3 practices of equal estimated energy expenditure (EE): two outdoors in direct SUR (cold/moderate temperatures) and one indoors without SUR (moderate temperatures). Humidity, temperature, and wet bulb globe temperature (WBGT – a measurement partly based on SUR, including ambient temperature/relative humidity) were recorded using Heat Stress Meters placed in the direct sun or in the shade. Each athlete’s semi-nude dry body weight was recorded before and after exercise. Urine samples were taken before, after, and the morning after. Urine specific gravity (USG) was tested to assess HS. Athletes wore combined heart rate and activity monitors to estimate EE and were provided ad libitum water and/or a zero-calorie sports drink. Their total intake included weights of consumed food and drink. Sweat rate was calculated using body weight change and intakes of liquids minus urine losses/hour.
Two-way repeated measures ANOVA analyzed group-level differences. No significance was found in total FB (1.01±0.32 L/hr) or EE/hr (444±97.1 kcal/hr) across all days (p>0.05). In analyzing individual athlete results, 40% had consistent USG >1.025 (p=0.001) suggesting potential dehydration. These 4 athletes selected water as their beverage, of which is known that consuming only water does not stimulate drinking behavior as does electrolyte drinks. The remaining 60% were overall not dehydrated (USG <1.025) but must be aware of incidental dehydration in hotter temperatures.
The conclusion is that in low-moderate temperatures, athletes self-regulate drinking habits and achieve fluid balance during exercise with or without sun radiation. However, athletes with average USG >1.025 are likely to remain dehydrated in moderate temperatures. The findings suggest that more education would benefit these athletes by ensuring hydration in any environment.
One approach to support such personalization is via self-experimentation using single-case designs. ‘Hack Your Health’ is a tool that guides individuals through an 18-day self-experiment to test if an intervention they choose (e.g., meditation, gratitude journaling) improves their own psychological well-being (e.g., stress, happiness), whether it fits in their routine, and whether they enjoy it.
The purpose of this work was to conduct a formative evaluation of Hack Your Health to examine user burden, adherence, and to evaluate its usefulness in supporting decision-making about a health intervention. A mixed-methods approach was used, and two versions of the tool were tested via two waves of participants (Wave 1, N=20; Wave 2, N=8). Participants completed their self-experiments and provided feedback via follow-up surveys (n=26) and interviews (n=20).
Findings indicated that the tool had high usability and low burden overall. Average survey completion rate was 91%, and compliance to protocol was 72%. Overall, participants found the experience useful to test if their chosen intervention helped them. However, there were discrepancies between participants’ intuition about intervention effect and results from analyses. Participants often relied on intuition/lived experience over results for decision-making. This suggested that the usefulness of Hack Your Health in its current form might be through the structure, accountability, and means for self-reflection it provided rather than the specific experimental design/results. Additionally, situations where performing interventions within a rigorous/restrictive experimental set-up may not be appropriate (e.g., when goal is to assess intervention enjoyment) were uncovered. Plausible design implications include: longer experimental and phase durations, accounting for non-compliance, missingness, and proximal/acute effects, and exploring strategies to complement quantitative data with participants’ lived experiences with interventions to effectively support decision-making. Future work should explore ways to balance scientific rigor with participants’ needs for such decision-making.
This study investigated the effect of environmental heat stress on physiological and performance measures during a ~4 mi time trial (TT) mountain hike in the Phoenix metropolitan area. Participants (n = 12; 7M/5F; age 21.6 ± 2.47 [SD]) climbed ‘A’ mountain (~1 mi) four times on a hot day (HOT; wet bulb globe temperature [WBGT] = 31.6°C) and again on a moderate day (MOD; WBGT = 19.0°C). Physiological and performance measures were made before and throughout the course of each hike. Mean pre-hike hydration status (urine specific gravity [USG]) indicated that participants began both HOT and MOD trials in a euhydrated state (1.016 ± 0.010 and 1.010 ± 0.008, respectively) and means did not differ significantly between trials (p = .085). Time trial performance was impaired by -11% (11.1 minutes) in the HOT trial (105 ± 21.7 min), compared to MOD (93.9 ± 13.1 min) (p = .013). Peak core temperatures were significantly higher in HOT (38.5 ± 0.36°C) versus MOD (38.0 ± 0.30°C) with progressively increasing differences between trials over time (p < .001). Peak ratings of perceived exertion were significantly higher in HOT (14.2 ± 2.38) compared to MOD (11.9 ± 2.02) (p = .007). Relative intensity (percent of age-predicted maximal heart rate [HR]), estimated absolute intensity (metabolic equivalents [METs]), and estimated energy expenditure (MET-h) were all increased in HOT, but not significantly so. The HOT condition reduced predicted maximal aerobic capacity (CRFp) by 6% (p = .026). Sweat rates differed significantly between HOT (1.38 ± 0.53 L/h) and MOD (0.84 ± 0.27 L/h) (p = .01). Percent body mass loss (PBML) did not differ significantly between HOT (1.06 ± 0.95%) and MOD (0.98 ± 0.84%) (p = .869). All repeated measures variables showed significant between-subjects effects (p < .05), indicating individual differences in response to test conditions. Heat stress was shown to negatively affect physiological and performance measures in recreational mountain hikers. However, considerable variation exists between individuals, and the degree of physiological and performance impairment is probably due, in part, to differences in aerobic fitness and acclimatization status rather than pre- or during-performance hydration status.
Eleven women (46.9±7.0 years) not participating in regular exercise and self-reporting insomnia completed a graded maximal exercise test followed by a crossover trial of three randomly assigned conditions separated by a 1-week washout. Participants performed moderate-intensity [MIC, 30 minutes, 65-70% maximum heart rate (HRmax)] or high-intensity (HIT, 20 minutes, 1-minute bouts at 90-95% HRmax alternating with 1-minute active recovery) treadmill walking or a no-exercise control (NEC) on two consecutive weekdays 4-6 hours prior to typical bed time. A dual-function wrist-worn accelerometer/temperature monitor recorded movement and skin temperature from which sleep-onset latency (SOL), sleep maintenance, sleep efficiency, total sleep time (TST), and peripheral skin temperature changes were calculated. Participants self-reported sleep outcomes weekly, enjoyment of exercise the morning after HIT and MIC, and exercise intensity preference upon completing all conditions. Mixed models analysis of variance examined differences between and within conditions controlling for demographic characteristics and habitual physical activity.
HIT resulted in up to a 90-minute TST increase on night four (448 minutes, 95% CI 422.4-474.2) compared to nights one-three. MIC nights three (43.5 minutes, 95% CI 30.4-56.6) and four (42.1 minutes 95% CI 29.0-55.2) showed nearly a 30-minute SOL worsening compared to nights one-two. No other actigraphy-measured sleep parameters differenced within or between conditions. Self-reported sleep outcomes, peripheral skin temperature change, and exercise enjoyment between conditions were similar (p>0.05). More participants preferred lower (n=3) to higher (n=1) intensity activities.
Early evening high-intensity and moderate-intensity exercise had no effect on sleep outcomes compared to a control in non-exercising adults reporting sleep complaints. Sleep benefits from HIT may require exercise on successive days. Participants indicated partiality for lower intensity exercise. More information on timing and mode of physical activity to improve sleep in this population is warranted.
Purpose: This qualitative research aimed to create a developmentally and gender-appropriate game-based intervention to promote Human Papillomavirus (HPV) vaccination in adolescents. <br/>Background: Ranking as the most common sexually transmitted infection, about 80 million Americans are currently infected by HPV, and it continues to increase with an estimated 14 million new cases yearly. Certain types of HPV have been significantly associated with cervical, vaginal, and vulvar cancers in women; penile cancers in men; and oropharyngeal and anal cancers in both men and women. Despite HPV vaccination being one of the most effective methods in preventing HPV-associated cancers, vaccination rates remain suboptimal in adolescents. Game-based intervention, a novel medium that is popular with adolescents, has been shown to be effective in promoting health behaviors. <br/>Methods: Sample/Sampling. We used purposeful sampling to recruit eight adolescent-parent dyads (N = 16) which represented both sexes (4 boys, 4 girls) and different racial/ethnic groups (White, Black, Latino, Asian American) in the United States. The inclusion criteria for the dyads were: (1) a child aged 11-14 years and his/her parent, and (2) ability to speak, read, write, and understand English. Procedure. After eligible families consented to their participation, semi-structured interviews (each 60-90 minutes long) were conducted with each adolescent-parent dyad in a quiet and private room. Each dyad received $50 to acknowledge their time and effort. Measure. The interview questions consisted of two parts: (a) those related to game design, functioning, and feasibility of implementation; (b) those related to theoretical constructs of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Data analysis. The interviews were audio-recorded with permission and manually transcribed into textual data. Two researchers confirmed the verbatim transcription. We use pre-developed codes to identify each participant’s responses and organize data and develop themes based on the HBM and TPB constructs. After the analysis was completed, three researchers in the team reviewed the results and discussed the discrepancies until a consensus is reached.<br/>Results: The findings suggested that the most common motivating factors for adolescents’ HPV vaccination were its effectiveness, benefits, convenience, affordable cost, reminders via text, and recommendation by a health care provider. Regarding the content included in the HPV game, participants suggested including information about who and when should receive the vaccine, what is HPV and the vaccination, what are the consequences if infected, the side effects of the vaccine, and where to receive the vaccine. The preferred game design elements were: 15 minutes long, stories about fighting or action, option to choose characters/avatars, motivating factors (i.e., rewards such as allowing users to advance levels and receive coins when correctly answering questions), use of a portable electronic device (e.g., tablet) to deliver the education. Participants were open to multiplayer function which assists in a facilitated conversation about HPV and the HPV vaccine. Overall, the participants concluded enthusiasm for an interactive yet engaging game-based intervention to learn about the HPV vaccine with the goal to increase HPV vaccination in adolescents. <br/>Implications: Tailored educational games have the potential to decrease the stigma of HPV and HPV vaccination, increasing communication between the adolescent, parent, and healthcare provider, as well as increase the overall HPV vaccination rate.