Age-Sensitive Design of Online Health Information: Comparative Usability Study

Background

Older adults’ health maintenance may be enhanced by having access to online health information. However, usability issues may prevent older adults from easily accessing such information. Prior research has shown that aging is associated with a unique pattern of cognitive changes, and knowledge of these changes may be used in the design of health websites for older adults.

Objective

The goal of the current study was to examine whether older adults use of a health information website was affected by an alternative information architecture and access interface (hierarchical versus tag-based).

Methods

Fifty younger adults (aged 18-23) and 50 older adults (aged 60-80) navigated a health information website, which was organized hierarchically or used tags/keywords, to find answers to health-related questions while their performance was tracked. We hypothesized that older adults would perform better in the tag-based health information website because it placed greater demands on abilities that remain intact with aging (verbal ability and vocabulary).

Results

The pattern of age-related differences in computer use was consistent with prior research with older adults. We found that older adults had been using computers for less time (F _1,98= 10.6, P= .002) and used them less often (F _1,98= 11.3, P= .001) than younger adults. Also consistent with the cognitive aging literature, younger adults had greater spatial visualization and orientation abilities (F _1,98= 34.6, P< .001 and F _1,98= 6.8, P= .01) and a larger memory span (F _1,98= 5.7, P= .02) than older adults, but older adults had greater vocabulary (F _1,98= 11.4, P= .001). Older adults also took significantly more medications than younger adults (F _1,98= 57.7, P< .001). In the information search task, older adults performed worse than younger adults (F _1,96= 18.0, P< .001). However, there was a significant age × condition interaction indicating that while younger adults outperformed older adults in the hierarchical condition (F _1,96= 25.2, P< .001), there were no significant age-related differences in the tag-based condition, indicating that older adults performed as well as younger adults in this condition.

Conclusions

Access to online health information is increasing in popularity and can lead to a more informed health consumer. However, usability barriers may differentially affect older adults. The results of the current study suggest that the design of health information websites that take into account age-related changes in cognition can enhance older adults’ access to such information.     

Hospice utilization in advanced cervical malignancies: An analysis of the National Inpatient Sample

ObjectiveHospice services improve quality of life and outcomes for patients and caretakers, compared to inpatient mortality. This study identifies factors that exert the strongest influence on end-of-life care modalities in patients with cervical cancer.MethodsAdmissions with a diagnosis of cervical cancer that were discharged to hospice or died in-hospital were identified in the National Inpatient Sample years 2007–2011, excluding admissions coded for hysterectomy. Logistic regression models were used to examine differences in age, race, length of stay, primary payer, hospital region, admission type, hospital bedsize, hospital teaching status, income quartile, and Elixhauser comorbidity index score between the groups.Results2073 admissions with a diagnosis of cervical cancer resulting in hospice discharge (n = 1290) or inpatient death (n = 783) were identified. Age (P = 0.01), hospital region (P = 0.01), length of hospitalization (P < 0.01), Elixhauser comorbidity index score (P = 0.03), and urban vs. rural location (P = 0.01) had a significant impact on disposition in univariate analysis. Admissions of patients categorized as Asian/Pacific Islander (OR = 2.24, 95% CI 1.11–4.49), hospitalizations lasting 0–3 days (OR = 1.57, 95% CI 1.21–2.03), and admissions in rural areas (OR = 1.62, 95% CI 1.12–2.36) had higher rates of in-hospital death compared to the reference groups. Patients aged 18–45 years (OR = 0.69, 95% CI 0.52–0.90) and those treated in the South (OR 0.59, 95% CI 0.45–0.77) and West (OR = 0.50, 95% CI 0.30–0.81) had lower odds ratios of inpatient mortality.ConclusionModalities of care in terminal cervical cancer vary among sociodemographic and clinical factors. This data underscores the continued push for improved end-of-life care among cervical cancer patients and can guide clinicians in appropriate targeted counseling to increase utilization of hospice resources.     

Policy of high-dose tranexamic acid for treating postpartum hemorrhage after vaginal delivery

Objective: To assess whether a policy of routine administration of high-dose tranexamic acid (TA) at the diagnosis of postpartum hemorrhage (PPH) reduces blood loss after vaginal birth.

Methods: This controlled single-center before-and-after study of all women with PPH?≥?500?ml after vaginal birth took place from January 2011 through March 2012; the control group included those seen from January 2011 through August 2011, and the case patients those from September 2011 through March 2012. Our protocol for the management of PPH was modified effective September 2011 to include administration of high-dose TA (4?g of TA intravenously then 1?g/h for 6?h) once blood loss reached 800?ml. Our primary objective was to assess the efficacy of this policy in reducing blood loss in PPH.

Results: Maternal characteristics did not differ between the two groups. Mean estimated blood loss was not significantly lower in the TA group (n?=?138) than in the control group (n?=?151) (respectively, 915.7?±?321?ml versus 944.8?±?313.8?ml; p?=?0.47). The difference between pre- and post-delivery hemoglobin levels were lower in the TA group (?2.6?g/dl?±?1.2 versus ?2.9?g/dl?±?1.3; p?=?0.09), but it was not significant. Postpartum iron sucrose injections were significantly less frequent in the TA than the control group (2.2% versus 9.9%; p?<?0.05).

Conclusions: A policy of high-dose TA in PPH after vaginal deliveries was not associated with a significant reduction of blood loss.     

Age-dependent effects of chronic fluoxetine treatment on the serotonergic system one week following treatment

Rationale  

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine are increasingly used for the treatment of depression in children. Limited data are, however, available on their effects on brain development and their efficacy remains debated. Moreover, previous experimental studies are seriously hampered in their clinical relevance.     

Quantitative structural imaging of keratoconic corneas using polarization-resolved SHG microscopy

The human cornea is mainly composed of collagen fibrils aligned together within stacked lamellae. This lamellar structure can be affected in pathologies such as keratoconus, which is characterized by progressive corneal thinning and local steepening. In this study, we use polarization-resolved second harmonic generation (P-SHG) microscopy to characterize 8 control and 6 keratoconic human corneas. Automated processing of P-SHG images of transverse sections provides the collagen orientation in every pixel with sub-micrometer resolution. Series of P-SHG images recorded in the most anterior region of the stroma evidence sutural lamellae inclined at 22° ± 5° to the corneal surface, but show no significant difference between control and keratoconic corneas. In contrast, series of P-SHG images acquired along the full thickness of the stroma show a loss of order in the lamellar structure of keratoconic corneas, in agreement with their defective mechanical properties. This structural difference is analyzed quantitatively by computing the entropy and the orientation index of the collagen orientation distribution and significant differences are obtained along the full thickness of the stroma. This study shows that P-SHG is an effective tool for automatic quantitative analysis of structural defects of human corneas and should be applied to other collagen-rich tissues.     

Towards source volume estimation of interictal spikes in focal epilepsy using magnetoencephalography

Interictal spikes are a hallmark of cortical epileptogenicity; their spatial distribution in the cortex defines the so-called ‘irritative’ zone or spiking volume (SV). Delineating the SV precisely is a challenge during the presurgical evaluation of patients with epilepsy. Magnetoencephalography (MEG) recordings enable determination of the brain sources of epileptic spikes using source localization procedures. Most previous clinical MEG studies have relied on dipole modeling of epileptic spikes, which does not permit a volumetric estimation of the spiking cortex.In the present study, we propose a new source modeling procedure, Volumetric Imaging of Epileptic Spikes (VIES). In VIES, the SV is identified as the 3D region where sources of the high frequency activities (> 20 Hz) associated with epileptic spikes are distributed. We localized these sources using a beamforming approach (DICS, Dynamic Imaging of Coherent Neural Sources). To determine the optimal parameters and accuracy of the method, we compared the SV obtained by VIES with the SV defined by the invasive gold standard, intracranial stereotactic EEG recordings (SEEG), in 21 patients with focal epilepsy. Using rigorous validation criteria based on the exact anatomical location of SEEG contacts, we found that the overall sensitivity of VIES for detecting spiking SEEG contacts was 76% and its specificity for correctly identifying non-spiking SEEG contacts was 67%, indicating a good agreement between VIES and SEEG. Moreover, we found that classical dipole clustering was not informative in 9/21 patients, while VIES enable to delineate the SV in all patients. For the 12 patients having a SV delineated both with VIES and dipole clustering, VIES method had higher sensitivity and lower specificity. This proof-of-concept study shows that VIES is a promising approach to non-invasive estimation of the SV in focal epilepsy.     

Interacting effects of vision and attention in perceiving spontaneous sensations arising on the hands

Visual input and attention enhance tactile perception. But do they influence the perception of spontaneous sensations (SPS) arising in the absence of any external stimulus? We have investigated this by requiring subject to focus attention on each hand while orienting overtly toward it (convergent focusing) or away (divergent focusing) and to subsequently describe the properties of the SPS they felt. Subjects performed this task under free viewing conditions or while blindfolded. Enhanced perception of SPS was found under convergent focusing and also under free viewing conditions. However, the effects of focusing were different whether visual input was available or not. When visual input was available, SPS were enhanced in the fingers but suppressed in the palm, suggesting that enhancement and suppression operated to refine perception of SPS. When visual input was unavailable, only enhancement was observed, even in areas of the hand where suppressing effects were found under free viewing conditions. These interacting effects between vision and attention were observed exclusively in the left hand. A control experiment failed to evidence whether looking at different parts of the hand modulates SPS. We suggest that vision facilitates perception and, when interacting with attention, it enables better perception by promoting suppression of SPS arising in areas of lower sensitivity that may interfere with processing in more sensitive zones. The results are discussed with respect to mechanisms lateralized in the right cerebral hemisphere, and a role of SPS in the maintenance of a conscious image of the body is suggested.     

Maternal hypertension during pregnancy modifies the response of the immature brain to hypoxia-ischemia: sequential MRI and behavioral investigations

Hypoxic-ischemic (HI) brain injury occurring during the perinatal period is still a major cause of mortality and morbidity. We assessed the impact of maternal hypertension, the most common medical disorder of pregnancy, on the anatomical and functional consequences of HI insult in the immature brain. Rat pups from spontaneously hypertensive (SHR) and normotensive (Wistar Kyoto - WKY) dams were subjected to HI brain damage at post-natal day 7 (P7). Brain lesion and functional deficits were analyzed from 10 min to 35 days after HI, using magnetic resonance imaging (MRI), sensorimotor and cognitive tests. MRI data revealed that SHR pups displayed less brain damage than WKY, attested by an initial smaller lesion followed by a reduced tissue loss at chronic stage (57.1±21.6 and 31.1±27% ipsilateral hemisphere atrophy in WKY and SHR, respectively). Behavioral analyses showed less HI-induced behavioral deficits in motor coordination (rotarod test) and spatial learning (Morris water maze test) in pups from hypertensive dams compared to those from normotensive ones. The data suggest that maternal hypertension causes prenatal stress that may render the immature brain more resistant to subsequent hypoxia-ischemia, related to a preconditioning phenomenon.     

Flt3 ligand improves the innate response to respiratory syncytial virus and limits lung disease upon RSV reexposure in neonate mice

Respiratory syncytial virus (RSV) causes severe bronchiolitis in infants worldwide. The immunological factors responsible for RSV susceptibility in infants are poorly understood. Here, we used the BALB/c mouse model of neonatal RSV infection to study the mechanisms leading to severe disease upon reexposure to the virus when adults. Two major deficiencies in neonatal lung innate responses were found: a poor DCs mobilization, and a weak engagement of the IFN_I pathway. The administration of Flt3 ligand (Flt3‐L), a growth factor that stimulates the proliferation of hematopoietic cells, to neonates before RSV‐infection, resulted in increased lung DC number, and reconditioned the IFN_I pathway upon RSV neonatal infection. Besides, neonates treated with Flt3‐L were protected against exacerbated airway disease upon adult reexposure to RSV. This was associated with a reorientation of RSV‐specific responses toward Th1‐mediated immunity. Thus, the poor lung DCs and IFN_I responses to RSV in neonates may be partly responsible for the deleterious long‐term consequences revealed upon adult reexposure to RSV, which could be prevented by Flt3‐L treatment. These results open new perspectives for developing neonatal immuno‐modulating strategies to reduce the burden of bronchiolitis.     

Allosteric transitions of the acetylcholine receptor probed at the amino acid level with a photolabile cholinergic ligand.

Structural changes occurring upon desensitization of the Torpedo marmorata acetylcholine receptor were monitored with tritiated p-(N,N-dimethyl)aminobenzenediazonium fluoroborate, a reversible competitive antagonist in the dark, which may serve as a photoaffinity probe of the area of the receptor molecule with which cholinergic ligands interact. Addition of meproadifen, an allosteric effector that stabilizes the high-affinity desensitized state of the receptor upon binding to a site topographically distinct from the cholinergic ligand-binding domains, caused a major increase in labeling of the alpha subunit, a smaller increase in the delta subunit, and decreased labeling in the gamma subunit, thus revealing changes in the alpha and non-alpha subunits' contribution to cholinergic ligand binding. Also, in agreement with the tighter binding of cholinergic ligands to the desensitized receptor, differential labeling of three peptide loops of the alpha subunit was detected: while Tyr-190, Cys-192, and Cys-193 were labeled in a roughly identical manner in both resting and desensitized conformations, the labeling of Tyr-93 and Trp-149 increased up to 6-fold in the desensitized state. Tyr-93 and Trp-149 belong to separate regions containing strictly conserved "canonical" amino acids, common to all nicotinic, gamma-aminobutyrate, and glycine receptor subunits. These regions are thus likely to play a critical role in the regulation of ligand-gated ion channels.