More than just tracking time: Complex measures of user engagement with an internet-based health promotion intervention

BACKGROUND: There has been a rise in internet-based health interventions without a concomitant focus on new methods to measure user engagement and its effect on outcomes. We describe current user tracking methods for internet-based health interventions and offer suggestions for improvement based on the design and pilot testing of healthMpowerment.org (HMP). METHODS: HMP is a multi-component online intervention for young Black men and transgender women who have sex with men (YBMSM/TW) to reduce risky sexual behaviors, promote healthy living and build social support. The intervention is non-directive, incorporates interactive features, and utilizes a point-based reward system. Fifteen YBMSM/TW (age 20-30) participated in a one-month pilot study to test the usability and efficacy of HMP. Engagement with the intervention was tracked using a customized data capture system and validated with Google Analytics. Usage was measured in time spent (total and across sections) and points earned. RESULTS: Average total time spent on HMP was five hours per person (range 0-13). Total time spent was correlated with total points earned and overall site satisfaction. CONCLUSION: Measuring engagement in internet-based interventions is crucial to determining efficacy. Multiple methods of tracking helped derive more comprehensive user profiles. Results highlighted the limitations of measures to capture user activity and the elusiveness of the concept of engagement

A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden’s index. The lactate/albumin ratio was elevated in non-survivors (p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01). Regarding long- term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes (p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill. View Full- Tex

If you build it will they come? Addressing social isolation within a technology-based HIV intervention for young black men who have sex with men

The rate of HIV infections among young black men who have sex with men (YBMSM) continues to rise at an alarming pace. YBMSM are particularly vulnerable to social isolation and a lack of social support due to experiences with racism and homophobia, which may have implications for sexual risk behaviors. The purpose of this study was to explore perceptions of social isolation and sense of community among YBMSM, the need for and receptivity to social networking features designed to reduce social isolation and build community within an internet and mobile phone-based primary and secondary HIV prevention intervention for YBMSM and to identify strategies to develop these features. Focus groups were conducted with 22 YBMSM ages 20–30 at three sites in North Carolina. Data from the focus groups were thematically analyzed using NVivo. Feelings of social isolation and lack of a sense of community were strongly endorsed by participants with homophobia, lack of opportunities for social engagement, and a focus on sex rather than friendship in interpersonal relationships with other YBMSM cited as contributing factors. Participants were receptive to a social networking intervention designed to reduce social isolation and build community. Recommendations offered by participants to increase acceptability and usability of such features included: availability of information about healthy relationships, the ability to connect with other YBMSM and health care providers, and ensuring the site had ongoing facilitation by the study team as well as monitoring for inappropriate content. The development of a social networking feature of an HIV prevention intervention may present an opportunity to reduce social isolation, build community and reduce risky sexual behaviors among YBMSM. The findings from this study are being used to inform the development of a social networking feature for an existing internet and mobile phone-based primary and secondary HIV prevention intervention for YBMSM

Meal-derived glucagon responses are related to lower hepatic phosphate concentrations in obesity and type 2 diabetes

Aim. - Type 2 diabetes (T2D) alters glucagon, glucagon-like peptide (GLP)-1, glucose-dependent insulinotropic polypeptide (GIP) and hepatic energy metabolism, yet the possible relationships remain unclear.Methods. - In this observational study, lean insulin-sensitive control subjects (BMI: 23.2 +/- 1.5 kg/m(2)), age-matched insulin-resistant obese subjects (BMI: 34.3 +/- 1.7 kg/m(2)) and similarly obese elderly T2D patients (BMI: 32.0 +/- 2.4 kg/m(2)) underwent mixed-meal tolerance tests (MMTTs), and assessment of hepatic gamma ATP, inorganic phosphate (P-i) and lipids using P-31/H-1 magnetic resonance spectroscopy. Meal-induced secretion of glucagon and incretins was calculated from incremental areas under the concentration-time curves (iAUCs). Peripheral and adipose tissue insulin sensitivity were assessed from time courses of circulating glucose, insulin and free fatty acids.Results. - MMTT-derived peripheral insulin sensitivity was lowest in T2D patients (P &lt;0.001), while glucagon concentrations were comparable across all three groups. At 260 min, GLP-1 was lower in T2D patients than in controls, whereas GIP was lowest in obese individuals. Fasting glucagon concentrations correlated positively with fasting (r = 0.60) and postprandial hepatocellular lipid levels (160 min: r= 0.51, 240 min: r = 0.59), and negatively with adipose tissue insulin sensitivity (r = -0.73). Higher meal-induced glucagon release (iAUC(0)(-260) (min)) correlated with lower fasting (r = -0.62) and postprandial P(i )levels (160 min: r = -0.43, 240 min: r = -0.42; all P &lt;0.05). Higher meal-induced release of GIP (iAUC(0-260) (min)) correlated positively with fasting (r = 0.54) and postprandial serum triglyceride concentrations (iAUC(0-260 min, )r = 0.54; all P &lt;0.01).Conclusion. - Correlations between fasting glucagon and hepatic lipids and between meal-induced glucagon and hepatic P-i suggest a role for glucagon in hepatic energy metabolism. (C) 2018 Elsevier Masson SAS. All rights reserved.</p

Examining how health navigation affects mental health among gay, bisexual, and other men who have sex with men living with human immunodeficiency virus in Guatemala

Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by mental health problems and human immunodeficiency virus (HIV). Health navigation has the potential to improve both HIV and mental health outcomes; however, few studies have measured the impact of navigation on mental health among people living with HIV. We analyzed longitudinal data from a sociobehavioral survey and navigation monitoring system with GBMSM living with HIV in Guatemala (n = 346) that participated in a 12-month differentiated care intervention. We examined relationships between navigation characteristics (frequency, duration, mode of interactions, and level of emotional, instrumental, and informational navigation support) and anxiety and depression using fixed-effects regression. We also examined if these relationships were moderated by baseline social support. We found that as navigation interactions increased, anxiety significantly improved [B = -0.03, standard error (SE) = 0.01 p = 0.05]. Participants who received high levels of informational navigator support also experienced a significant improvement in anxiety compared with those receiving low levels of informational support (B = -0.81, SE = 0.40, p = 0.04). Unexpectedly, we found that as the proportion of in-person navigation interactions increased, anxiety worsened (B = 1.12, SE = 0.54, p = 0.04). No aspects of navigation were significantly associated with depression and baseline social support did not moderate the relationship between navigation and anxiety and depression. To improve the mental health of key populations affected by HIV, health navigation programs should prioritize frequent interaction and informational navigation support for clients with anxiety while considering other strategies that specifically target reducing depressive symptoms, including other cost-effective modalities, such as mobile apps

HIV Treatment as Prevention: The Utility and Limitations of Ecological Observation

Results from several observational studies of HIV-discordant couples and a randomized controlled trial (HIV Prevention Trials Network 052) show that antiretroviral therapy (ART) can greatly reduce heterosexual HIV transmission in stable HIV-discordant couples. However, such data do not prove that ART will reduce HIV incidence at the population level. Observational investigations using ecological measures have been used to support the implementation of HIV treatment for the specific purpose of preventing transmission at the population level. Many of these studies note ecological associations between measures of increased ART uptake and decreased HIV transmission. Given the urgency of implementing HIV prevention measures, ecological studies must de facto be used to inform current strategies. However, the hypothesis that widespread ART can eliminate HIV infection may have raised expectations beyond what we may be able to achieve. Here we review and discuss the construct of the exposure and outcome measures and analysis methods used in ecological studies. By examining the strengths and weaknesses of ecological analyses, we aim to aid understanding of the findings from these studies to inform future policy decisions regarding the use of ART for HIV prevention

HealthMpowerment.org: Building Community Through a Mobile-Optimized, Online Health Promotion Intervention

Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships

Alcohol use as a mediator of the effect of two alcohol reduction interventions on mental health symptoms of ART clients in Vietnam

We aimed to examine the mediating role of alcohol use in the pathway from the interventions to depression and anxiety symptoms using data from a randomized controlled trial among people living with HIV (PWH) with hazardous alcohol use (n = 440) in Thai Nguyen, Vietnam. Participants were randomized into either a combined intervention (CoI), a brief intervention (BI) and a standard of care arm. Both interventions were based on cognitive behavioral therapy and motivational enhancement therapy. Alcohol use was measured as the percentage of days abstinent from alcohol in the last 30 days. Symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. Alcohol use was a significant mediator of the effects of two alcohol interventions on depression symptoms, but not anxiety symptoms. There were significant indirect effects via alcohol use of both interventions on depression symptoms at 12 months (CoI: mean difference (MD) = −0.134; 95%CI: −0.251, −0.035); (BI: MD = −0.141; 95%CI: −0.261, −0.038). There were no significant direct or total effects of the interventions on either symptoms at 12 months. Interventions with a dual focus on mental health and alcohol disorders are needed to determine optimal ways to tackle these common comorbidities among PWH

Effects of Two Alcohol Reduction Interventions on Depression and Anxiety Symptoms of ART Clients in Vietnam

Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use

Putting Prevention in Their Pockets: Developing Mobile Phone-Based HIV Interventions for Black Men Who Have Sex with Men

Young black men who have sex with men (MSM) bear a disproportionate burden of HIV. Rapid expansion of mobile technologies, including smartphone applications (apps), provides a unique opportunity for outreach and tailored health messaging. We collected electronic daily journals and conducted surveys and focus groups with 22 black MSM (age 18–30) at three sites in North Carolina to inform the development of a mobile phone-based intervention. Qualitative data was analyzed thematically using NVivo. Half of the sample earned under $11,000 annually. All participants owned smartphones and had unlimited texting and many had unlimited data plans. Phones were integral to participants' lives and were a primary means of Internet access. Communication was primarily through text messaging and Internet (on-line chatting, social networking sites) rather than calls. Apps were used daily for entertainment, information, productivity, and social networking. Half of participants used their phones to find sex partners; over half used phones to find health information. For an HIV-related app, participants requested user-friendly content about test site locators, sexually transmitted diseases, symptom evaluation, drug and alcohol risk, safe sex, sexuality and relationships, gay-friendly health providers, and connection to other gay/HIV-positive men. For young black MSM in this qualitative study, mobile technologies were a widely used, acceptable means for HIV intervention. Future research is needed to measure patterns and preferences of mobile technology use among broader samples