Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data

Associations between EEG and cognition in Parkinson's disease.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder that is accompanied by a range of both motor and non-motor symptoms. Cognitive impairment in PD is particularly common, with a high incidence of conversion to dementia (PDD). Elec- troencephalogram (EEG) brain activity may provide a cost-effective and relatively quick technique to determine neural correlates of cognitive status in PD. We used EEG to measure spontaneous brain activity during eyes-closed resting wakefulness and evoked response potentials (ERPs) during a three-stimulus visual oddball task. The oddball task was initially used to compare easy and hard options in a group of 19 cognitively ‘normal’ PD participants (PD-N) compared to 19 healthy controls (HC). PD-N status was established by not meeting Movement Disorder Society Task Force (MDS-TF) level II criteria for PD with mild cognitive impairment (PD-MCI). Overall, reaction time was longer for the hard task, and longer in the PD-N group than the HC group, but no group differences were found for amplitude or latency, for either the P3a or P3b ERPs. The easy oddball task was then used to compare participants in four groups: 23 HC, 31 PD-N, 26 PD-MCI, and 8 PDD. New Zealand Brain Research Institute PD-MCI criteria were used that are consistent with the MDS-TF Level II criteria, but specifically based on two tests in each of five cognitive tests that predict a high risk of conversion to PDD once impairment is evident on any two tests. The median reaction time was longer in the PD-N group compared to the HC group, longer again for the PD-MCI group, and longest in the PDD group. However, no significant differences among any groups were found for ERP amplitude or latency, for either the P3a or P3b. Individual alpha frequency (IAF), spectral power (delta, theta, alpha, and beta) and debiased weighted phase lag index (dwPLI) functional connectivity (for each band) were derived from 10-minutes of resting-state EEG in 29 HC, 44 PD-N, 40 PD-MCI, and 12 PDD participants. Group differences were evident for the peak alpha frequency (Individual Alpha Frequency; IAF) between all groups except between the HC and PD- N groups. IAF was lower in the PD-MCI group and decreased further in the PDD group. Spectral power was highest in the theta band and lowest in the alpha band for the PDD group. Group differences in alpha power were evident in the posterior brain region, smaller in the central region, but not evident the anterior brain region. For the posterior region, alpha power was highest in the HC group and decreased linearly across PD-N, PD-MCI and PDD groups. Spectral power in the theta band was intermediate in the PD- MCI group compared to the PDD group and the PD-N and HC groups; the latter two groups had similar theta power. Across groups, functional connectivity was also highest in the alpha band, and lowest in the theta band, for the PDD group. This was apparent for both the within- region and cross-region connectivity analyses. For the theta band, the PD-MCI group had intermediate functional connectivity values, for both types of region analysis. For the alpha band, the PD-MCI group showed intermediate values for the within-region analysis but was similar to the PD-N and HC groups for the cross-region analysis. Overall, resting-state measures proved to be good discriminators of cognitive status on EEG, unlike oddball ERP measures. For resting-state, spectral power measures produced clearer group differences for PD-MCI and PDD than functional connectivity measures. Spectral power in the alpha band, especially in the posterior region, showed the largest effect sizes for between-group comparisons. Longitudinal work is needed to establish whether EEG measures are good predictors of future cognitive decline in PD. In this project, we were the first to look at task difficulty in a sample of cognitively unimpaired PD patients who did not meet criteria for PD-MCI. Overall task difficulty did not produce any significant ERP differences between tasks or groups. We then used the ‘easy’ task to investigate group differences in HC, PD-N, PD-MCI, and PDD groups, but no significant group differences were found for either P3a or P3b. For resting-state, we were the first to look at IAF across the four groups, namely HC, PD- N, PD-MCI, and PDD. IAF decreased linearly from the HC group to the PDD group in the posterior brain region. We were also the first to use dwPLI to calculate functional connectivity in the resting-state. We have shown that alpha band functional connectivity was lowest, and theta band functional connectivity highest in the PDD group; the other three groups tended to be similar, with only weak evidence that the PD-MCI group showed intermediate values for connectivity. These studies provided a promising endeavour into resting-state and task-related EEG measures across the full spectrum of cognition. The findings have implications of developing markers for future cognitive decline in PD

The Impact of Prefrontal Cortex Warm Up on Immediate Cognitive Reappraisal Ability in Older Adolescents with Elevated Symptoms of Depression

Cognitive Reappraisal (CR) is a central component of Cognitive Behavioral Therapy for adolescent depression. Yet, previous research indicates that a brain region highly associated with successful CR in adults, the Prefrontal Cortex (PFC), is not fully developed until early adulthood. Thus, there is growing concern that CBT interventions directed at building CR abilities in depressed teens might be constrained by PFC immaturity. However, CR is an effective strategy for regulating affect. The current study evaluated an intervention aimed at enhancing CR performance through PFC “warm up” with a working memory task. Additionally, the study examined moderators of intervention response, as well as cognitive correlates of self-reported CR use. Participants included 48 older adolescents (mean age=19.1, 89% female) with elevated symptoms of depression who were randomly assigned to a lab-based WM or control activity followed by a CR task. Overall, results failed to support the effectiveness of “warm up” to augment CR performance. However, current level of depression predicted negative bias and sadness ratings after CR instructions, and this effect was qualified by an interaction with condition. The moderator analysis showed that depressive symptoms interacted with condition such that in the control condition, participants with higher depressive symptoms had significantly lower negative bias scores than individuals with lower depressive symptoms, but this pattern was not found in the experimental condition. Contrary to hypotheses, history of depression did not moderate treatment response. Additional analyses explored alternative explanations for the lack of intervention effects. There was some evidence to suggest that the WM task was frustrating and cognitively taxing. However, irritation scores and overall WM task accuracy did not predict subsequent CR performance. Lastly, multiple cognitive variables emerged as correlates of self-reported CR use, with cognitive flexibility contributing unique variance to self-reported CR use. Results pointed to new directions for improving CR performance among youth with elevated symptoms of depression

Characterizing Prenatal Maternal Distress with Unique Prenatal Cortisol Trajectories

Objective: It is widely assumed that glucocorticoids represent a primary mechanism through which exposure to adversity and maternal psychological distress shape prenatal developmental trajectories of both mother and fetus. However, despite repeated investigations and the fact that prenatal cortisol has been reliably linked to developmental outcomes, the empirical evidence supporting an association between prenatal cortisol and maternal distress is scarce. In this study, a novel approach to assessing links between maternal prenatal psychological distress and gestational cortisol profiles, general growth mixture modeling (GGMM), was applied. Method: Measures of pregnancy anxiety, perceived stress, and state anxiety and depressive symptoms as well as plasma samples (for determination of cortisol) were collected from 250 women 4 times during pregnancy. Results: Using GGMM, 3 cortisol trajectory groups were identified, including a typical group (n = 199) that exhibited the expected steady increase in cortisol throughout gestation, a steep group (n = 31) displaying an accelerated increase in cortisol over the course of pregnancy relative to the typical group, and a flat group (n = 20) with relatively higher cortisol levels early in pregnancy that plateaued in midgestation. Women reporting the highest distress scores exhibited trajectories expected to be associated with the least optimal developmental outcomes (flatter trajectories characterized by relatively higher levels early in gestation and lower levels late in gestation). Conclusions: These findings suggest that psychological distress during pregnancy is associated with unique prenatal cortisol profiles and support further examination of this link, to enable continued evaluation of a plausible biological pathway by which maternal psychological distress programs fetal development

A survey of psychological support provision for people with inflammatory arthritis in secondary care in England

© 2014 The Authors. Objectives: The consequences of inflammatory arthritis can include depression, anxiety and low mood, reducing patients' quality of life and increasing pressure on the healthcare system. Treatment guidelines recommend psychological support, but data are lacking on the provision available. Methods: A postal survey concerning psychological support provision was sent to rheumatology units in 143 acute trusts across England. Nurses from 73 rheumatology units (51%) responded. Results: Overall, 73% rated their unit's psychological support provision as 'inadequate' and only 4% rated it as 'good'. Few units believed that psychological support did not fall within their remit (12%), yet only 8% had a psychologist in the team. Most units (68%) did not routinely screen patients to identify psychological difficulties. Referral to other service providers was reported in 42% of units, with 3% very satisfied with this provision. Within units, services containing elements of psychological support ranged from occupational therapy (81%) to psychology/counselling (14%). Psychological approaches used by team members ranged from shared decision making (77%) to cognitive-behavioural approaches (26%). The current barriers to providing psychological support were lack of clinical time and available training (86% and 74%, respectively), and delivery costs (74%). Future facilitators included management support (74%) and availability of skills training (74%). Conclusions: Rheumatology units viewed psychological support provision as part of their remit but rated their overall provision as inadequate, despite some team members using psychological skills. To improve provision, clinicians' training needs must be addressed and organizational support generated, and further research needs to define adequate psychological support provision from the patient perspective

The Iowa Homemaker vol.16, no.3

Cover by Dorothy Coe The Way to His Heart by Win Hanssen, page 2 “Don’ts” for the Rushee by Stella Mae Brinkman, page 3 Sally Says, “Swinging Shoulders – Swirling Skirts” by Katherine Hoffman, page 4 Travel With Richard Halliburton by Emma Jean Scudder, page 6 Have a Treasure-Hunt Spread by Louise Peterson, page 7 Vocational Possibilitites, page 8 Our 1936 Graduates at Work by Gay Starrak, page 9 Behind Bright Jackets, page 10 Is Your Room “You”? by Betty Shoemaker, page 11 What’s New in Home Economics, page 12 Do You Keep a Diary?, page 15 Books to Read, page 16 Catt Gown Is Historic, page 18 Dr. Nickell at Iowa State, page 18 Facts on Child Health, page 20 Want to Remember Names?, page 22 Vitamin A Deficiency Test, page 2

Patients’ Perspectives on the Psychological Impact of Inflammatory Arthritis and Meeting the Associated Support Needs: Open-Ended Responses in a Multi-Centre Survey

Copyright © 2016 John Wiley & Sons, Ltd. Objectives: Psychological support for inflammatory arthritis is recommended in rheumatology treatment guidelines. Previous research found that high numbers of patients would access such support but that provision is often inconsistent and inadequate. The present study explored patients’ perspectives on the nature of the psychological impact of inflammatory arthritis and how to meet the associated support needs. Methods: A cross-sectional survey was conducted, using questionnaires which included three open-ended questions about helpful and unhelpful psychological support. The questionnaires were administered to 1,080 patients at six regional rheumatology units across England, and 1,200 members of a national patient charity. Results: A total of 1,210 (53%) patients completed the questionnaire, with 779 (64%) responding to the open-ended questions: 80% female; mean age 59 years (12.6); disease duration 10 years (40%). Data were analysed using a hybrid content analysis. Four categories emerged: challenges of an altered life course (negative emotions, isolation and loneliness, a dysfunctional body, loss, strained relationships, and fears for the future); poor communication (feeling unheard, clinicians’ reluctance to address psychological issues, a lack of help to manage pain and fatigue, and struggling to ask for help); understood by others (sharing with people who have arthritis, supportive family and friends, whole team support, and understanding from clinicians); and acquiring strategies (ways of coping). Conclusions: Psychological distress was commonplace, and often attributed to fatigue and pain. In addition to peers and family, patients looked to the rheumatology team for validation and support. Further research will address the skills training needs of rheumatology teams to meet patients’ psychological support requirements