Listening to Patients and Talking to Doctors: A Case for Design in Medicine, & A Call to Action

This paper describes how design can work at a fundamental level to improve health in the United States. It argues for a design application that levels the playing field between the doctor and the patient in a way that re-establishes the person as the center of medical advancement. It uses the inclusion of a design research oriented Patient Engagement Core within a current study at the Indiana University School of Medicine as a way to demonstrate the relevance of design to health research. We touch upon the research environment established by the National Institutes of Health as a driver for the relevance of design in medicine, and finally, we suggest that designers use their visual communication and design research skills within health research to increase its relevancy to patients and the population, and ‘make the science stick’ through better understanding of patient perspectives. We assert that by entering discourse in health at this foundational stage we contribute to a new understanding of what health is, who might contribute to its improvement, who determines the relevancy of research, and how such research is used

Untersuchung zum Sprachverständnis im Störgeräusch mit dem Oldenburger Satztest mit und ohne FM-Anlage

Die auditive Verarbeitungs- und Wahrnehmungsstörung (AVWS) ist durch normale periphere Hörleistungen und Funktionsbeeinträchtigungen auf zentraler Ebene charakterisiert. Häufig ist die binaurale Hörverarbeitung beeinträchtigt, was sich durch vermindertes Sprachverständnis in nebengeräuschreichen Situationen äußert. Im Umfeld Schule finden sich häufig schlechte akustische Verhältnisse, die durch Störgeräusche, lange Nachhallzeiten und ungünstige Reflexionseigenschaften zustande kommen und in der Folge zu niedrige Signal-Rausch-Abständen (SRA, Verhältnis zwischen Nutzschall und Störschall) aufweisen. AVWS-erkrankte Kinder können solche Situationen besonders schlecht kompensieren, so dass sie in der Sprachentwicklung und in weiteren Lernprozessen benachteiligt sind, was sich negativ auf die Schulkarriere auswirken kann. Neben den üblichen kompensatorischen und übenden Verfahren kommt der FM-Anlage in der Therapie der AVWS eine zunehmend bedeutende Rolle zu. In dieser Studie sollte die Wirksamkeit einer FM-Anlage anhand einer Vergleichsmessung mittels des Oldenburger Satztests untersucht werden. Dabei wurde dieser zunächst ohne und, im direkten Anschluss, mit FM-Anlage durchgeführt und so die Verbesserung der Sprachverständlichkeitsschwelle L50 (SRA bei 50% Sprachverständnis) detektiert. 20 Kinder (mittleres Alter 9,13 ± 1,44 Jahre), die zur Erstdiagnostik in die Abteilung kamen, aber ein unauffälliges OLSA-Ergebnis aufwiesen, dienten als Kontrollgruppe (Gruppe 1). Weitere 34 Kinder derselben Altersspanne durchliefen den OLSA bereits im Vorjahr im Rahmen der Erstdiagnostik und erzielten ein auffälliges Testergebnis; der im Rahmen dieser Studie stattfindende Retest war bei der Hälfte dieser Gruppe unauffällig (Gruppe 2a, mittleres Alter 8,67 ± 1,33 Jahre) und bei der anderen Hälfte abermals auffällig (Gruppe 2b, mittleres Alter 8,95 ± 1,54 Jahre). Die Wertepaare OLSA ohne FM und OLSA mit FM unterschieden sich höchst-signifikant voneinander (p=0,001). Im Mittel verbesserte sich die Sprachverständlichkeitsschwelle L50 im Gesamtkollektiv (n=54) um 8,77 ± 2,68 dB S/N (Gruppe 1: 8,86 ± 2,18 dB S/N; Gruppe 2a: 7,89 ± 3,10 dB S/N; Gruppe 2b: 9,53 ± 2,66 dB S/N). Auf einem Signifikanzniveau von 0,05 ließen sich keine signifikanten Altersabhängigkeiten detektieren – weder für den OLSA ohne Hilfsmittel noch für das Ergebnis mit FM-Anlage noch für die Verbesserung durch FM. Die o. g. Unterschiede zwischen den Gruppen sind ebenfalls nicht signifikant, so dass man durch Nutzung einer FM-Anlage von einer Verbesserung der Sprachverständlichkeitsschwelle L50 von 8-9 dB ausgehen kann, die unabhängig vom erreichten Wert ohne Hilfsmittel ist. Erreicht wird diese Verbesserung durch die Überwindung der Distanz zum Sprecher und die Verstärkung seiner Stimme. Es resultiert ein verbessertes Sprachverständnis und eine Erleichterung der Kommunikation. Dies ist besonders für die Kinder der Gruppe 2b und darüber hinaus für sämtliche AVWS-erkrankte Kinder mit Selektionsschwäche klinisch relevant, so dass die Anschaffung einer FM-Anlage für sie zu erwägen ist. In Folge dieser Beobachtungen lässt sich ein positiver Einfluss der FM-Anlage auf das (Kommunikations-)Verhalten des betroffenen Kindes im Schulunterricht und auf seine schulischen Erfolge vermuten. Einige Studien scheinen diese Annahme zu belegen. Gleichwohl sind aber gerade Langzeitstudien notwendig, um die Veränderung von Verhalten und schulischen Leistungen durch FM-Nutzung zu untersuchen

Photo-Elicitation as an Adjunct to Structured Interviews When Assessing Ideal Romantic and Sexual Relationships

Structured interviews have been used as an assessment tool in clinical and research settings for many years. However, such interviews have limitations, especially when questions are abstract from the daily life experiences of adolescents and young adults (e.g., “What are all the qualities you desire in a romantic partner?”). Accordingly, photo-elicitation was incorporated as a tool into how young women perceive ideal romantic and sexual relationships

Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment

poster abstractUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program

The IUPUI Center for Urban Health Enhancing Community Wellness Through Research

poster abstractUrban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. The central theme of the IUPUI Center for Urban Health is Environment, Community, and Health. Each of these “spheres” is connected by the built and social environment from a contextual standpoint and by geospatial referencing from an integration standpoint. The goal of the Center for Urban Health is to enhance health and sustainability for urban populations, with an eye toward both environmental legacies (i.e., reduced contamination, removing social and economic disparities) and emerging threats (i.e., climate change, water quality and quantity). The Center is currently recruiting Investigators across campus and across the community to provide research linkages, is funding several Urban Health Graduate Fellows, is developing a Seed Funding program for investigators through a Protocol Development Team, and is funding a Visiting Scholars program to enhance research at IUPUI

Associations between child and sibling levels of vigorous physical activity in low-income minority families

AbstractBackground and objectivesA child's level of habitual physical activity is partly determined by a familial component, but the literature is limited regarding sibling influences. Multiple studies suggest that targeting siblings is an effective strategy for improving child health behaviors.Patients and methodsWe analyze Moving to Opportunity for Fair Housing (MTO) data to study associations between the odds of a child attaining 20 min or more of vigorous physical activity at least 3 days every week and parallel measures from an older sibling and a parent. We include covariates representing the social environment such as household income and neighborhood safety.ResultsThere were 1347 study units that consisted of a child (age 11.2 y ± 2.6), an older sibling (age 14.8 y ± 2.8), and a parent (age 38.3 y ± 7.5). A child's odds of vigorous physical activity for 20 min or more was increased if the older sibling (OR 1.67; 95% CI 1.32–2.11) or parent (OR 1.36; 95% CI 1.08–1.72) had a comparable activity level compared to children whose older siblings or parents did not exhibit a comparable level of activity.ConclusionsA younger sibling's level of physical activity is positively associated with an older sibling's and/or parent's level of physical activity. Family-based approaches, especially those incorporating siblings, may be effective at increasing physical activity in children

Creation of a Decision Support Tool for Expectant Parents Facing Threatened Periviable Delivery: Application of a User-Centered Design Approach

Background Shared decision-making (SDM) is optimal in the context of periviable delivery, where the decision to pursue life-support measures or palliation is both preference sensitive and value laden. We sought to develop a decision support tool (DST) prototype to facilitate SDM by utilizing a user-centered design research approach. Methods We convened four patient and provider advisory boards with women and their partners who had experienced a surviving or non-surviving periviable delivery, pregnant women who had not experienced a prior preterm birth, and obstetric providers. Each 2-h session involved design research activities to generate ideas and facilitate sharing of values, goals, and attitudes. Participant feedback shaped the design of three prototypes (a tablet application, family story videos, and a virtual reality experience) to be tested in a final session. Results Ninety-five individuals (48 mothers/partners; 47 providers) from two hospitals participated. Most participants agreed that the prototypes should include factual, unbiased outcomes and probabilities. Mothers and support partners also desired comprehensive explanations of delivery and care options, while providers wanted a tool to ease communication, help elicit values, and share patient experiences. Participants ultimately favored the tablet application and suggested that it include family testimonial videos. Conclusion Our results suggest that a DST that combines unbiased information and understandable outcomes with family testimonials would be meaningful for periviable SDM. User-centered design was found to be a useful method for creating a DST prototype that may lead to improved effectiveness, usability, uptake, and dissemination in the future, by leveraging the expertise of a wide range of stakeholders

Health Equity Starts with Us: Recommendations from the IN-CTSI Racial Justice and Health Equity Task Force

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Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment

Urban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, conducting workshops on cutting-edge developments in urban health, and bridging campus and community efforts in public health, including the Reconnecting to Our Waterways (RWO) initiative

Adolescent Burmese Refugees Perspectives on Determinants of Health

Over 70,000 Burmese refugees have resettled in the United States in the past decade. While Burmese adolescents quickly acculturate into American society, their perspectives on health are not well-known. The purpose of this study was to identify adolescent Burmese refugee perspectives on determinants of health and health-related experiences after resettlement. In this qualitative study, Burmese adolescents took photographs depicting health-related experiences that were used as elicitation tools during focus groups. These discussions were recorded, transcribed, and analyzed for themes. Participants described positive determinants of health, including family and church. Rampant tobacco use was identified by the participants as a determinant of poor health within the Burmese community. Notably, the participants were proud to serve as liaisons within their community, despite the stressful nature of this role. Our results highlight the need to screen this population for anxiety, secondary to serving as a liaison for their community, as well as tobacco use