Viewing mHealth Technology Design through the Lens of Amplification Theory (Preprint)

2021 ◽  
Author(s):  
Beza Merid ◽  
Maria Cielito Robles ◽  
Brahmajee K. Nallamothu ◽  
Mark K. Newman ◽  
Lesli E. Skolarus
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Health Services ◽  
Research Design ◽  
Technology Use ◽  
The United States ◽  
Structural Barriers ◽  
Community Partners ◽  
Technological Interventions ◽  
Mhealth Technology

BACKGROUND Heart disease is a leading cause of death in the United States (U.S.), killing roughly 655,000 Americans each year. It also represents a disproportionate harm to minoritized people, who often face structural barriers to health including poor access to emergency medical services and treatment, insurance coverage, healthy foods, and safe environments for physical activity. Researchers and providers studying racial health disparities in cardiovascular disease treatment and outcomes use SMS text messaging to facilitate communication between providers and patients, electronic home blood pressure monitors to enable the tracking of trends in blood pressure readings over time, and wearable devices like the Fitbit and Apple Watch to monitor health metrics like heart rate, exercise, and cardiac electrical activity. This viewpoint argues that access to these technologies does not guarantee the ability to afford or sustainably use them; it is merely one precondition of technology use that providers and researchers should consider when designing technological interventions to address patient needs. OBJECTIVE This paper provides a model that interventionist health services researchers can follow in order to think about facilitators of and barriers to technology use among patients whose resource constraints may shape their capacity to address the modifiable cardiovascular disease risk factors that these technologies target. METHODS This Viewpoint offers reflections on an ongoing community-based participatory research design process in developing an mHealth intervention into hypertension management. RESULTS Results presented included a model that interventionist health services researchers can follow to improve research design. CONCLUSIONS Structural barriers to mHealth technology use must be addressed at every stage of the research process, and must guide decision-making about how providers and researchers can work with community partners to ensure that patients and community partners have the capability to use technological interventions as designed.

scholarly journals mHealth Technology Use and Implications in Historically Underserved and Minority Populations in the United States: Systematic Literature Review

2018 ◽  
Vol 6 (6) ◽  
pp. e128 ◽  
Author(s):  
Charkarra Anderson-Lewis ◽  
Gabrielle Darville ◽  
Rebeccah Eve Mercado ◽  
Savannah Howell ◽  
Samantha Di Maggio
Keyword(s):  
United States ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Technology Use ◽  
The United States ◽  
Minority Populations ◽  
Mhealth Technology

scholarly journals Extracellular vesicles as a novel diagnostic and research tool for patients with HTN and kidney disease

2019 ◽  
Vol 317 (3) ◽  
pp. F641-F647 ◽  
Author(s):  
Uta Erdbrügger ◽  
Thu H. Le
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Extracellular Vesicles ◽  
Organ Damage ◽  
The United States ◽  
End Organ Damage ◽  
Pressure Threshold ◽  
Stage Renal Disease ◽  
Blood Pressure Threshold

Hypertension (HTN) affects one in three adults in the United States and is a major risk factor for cardiovascular disease and kidney failure. There is emerging evidence that more intense blood pressure lowering reduces mortality in patients with kidney disease who are at risk of cardiovascular disease and progression to end-stage renal disease. However, the ideal blood pressure threshold for patients with kidney disease remains a question of debate. Novel tools to more precisely diagnose HTN, tailor treatment, and predict the risk of end-organ damage such as kidney disease are needed. Analysis of circulating and urinary extracellular vesicles (EVs) and their cargo (protein and RNA) has the potential to identify novel noninvasive biomarkers that can also reflect a specific pathological mechanism of different HTN phenotypes. We will discuss the use of extracellular vesicles as markers of HTN severity and explain their profile change with antihypertensive medicine and potential to detect early end-organ damage. However, more studies with enhanced rigor in this field are needed to define the blood pressure threshold to prevent or delay kidney disease progression and decrease cardiovascular risk.

Identifying Properties for an Aortic Stent-Graft That Counteracts Hypertension

2018 ◽  
Author(s):  
Shannen B. Kizilski ◽  
Omid Amili ◽  
Filippo Coletti ◽  
Rumi Faizer ◽  
Victor H. Barocas
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Stent Graft ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Aortic Stent Graft

In 2017, the American Heart Association reported that one third of deaths in the United States, and 31% of deaths worldwide, are attributed to cardiovascular disease (CVD) [1]. A risk factor pervasive across most types of CVD is chronic high blood pressure, or hypertension [2].

scholarly journals Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Hypertension ◽  
2021 ◽  
Author(s):  
Vesna D. Garovic ◽  
Ralf Dechend ◽  
Thomas Easterling ◽  
S. Ananth Karumanchi ◽  
Suzanne McMurtry Baird ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
The United States ◽  
In Utero ◽  
Pressure Treatment ◽  
Placental Perfusion ◽  
Blood Pressure Treatment ◽  
Disease Risks ◽  
In Pregnancy

Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.

Abstract P151: Primary ASCVD Risk Associated With Undiagnosed Conditions Decreased Over NHANES 1999-2014

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
David R Nelson ◽  
Jessica A Davis
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
High Blood Pressure ◽  
The United States ◽  
High Cholesterol ◽  
Diabetes Status ◽  
Ascvd Risk ◽  
Over Time

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a general term for a group of diseases characterized by atherosclerosis that affect the heart and blood vessels. ASCVD is the leading cause of death in the United States contributing to at least 200,000 preventable deaths from heart disease and stroke each year. Cardiovascular disease, heart disease, and stroke mortality has declined since the year 2000, due to broader use of evidence-based therapies and changes to risk factors and lifestyle modifications, but the decline began to slow after 2011. Two main risk factors contributing to ASCVD are high blood pressure and high cholesterol. Efforts have been made to increase control of these factors at the population-level, however, only those who are diagnosed can be treated. While awareness has increased over time, there is still a significant contribution to ASCVD events from those who were undiagnosed but have high blood pressure, high cholesterol, and/or diabetes. Hypothesis: To assess how much of the total U.S. population ASCVD risk is undiagnosed from 1999-2014. Methods: The Pooled Cohort Equations assessed 10-year ASCVD risk, based on age, sex, race, total cholesterol, HDL level, systolic blood pressure, use of blood pressure medication, smoking status, and diabetes status. The undiagnosed risk of the primary risk population (age 40-79 years, without missing values for necessary cholesterol, blood pressure, and glucose measures) from 1999-2014 Continuous National Health and Nutrition Examination Survey (NHANES) was calculated based on self-report questions and clinical measures, after age, sex, race, smoking, and diagnosed risks were accounted for. Linear regression for complex survey data tested whether undiagnosed risk was changing over time. Results: Applying the ASCVD risk equation to the NHANES subset (n=8,763; weighted n=104,421,757), undiagnosed conditions were associated with 10% of the projected ASCVD events. That is, per 100,000 Americans in this subset, 7,747 ASCVD events were estimated over 10-years, and 800 were based on risk from undiagnosed diabetes, hypercholesterolemia, or hypertension. However, ASCVD risk associated with undiagnosed conditions over time decreased (p<0.001), from 1,169 per 100,000 in 1999-2000, to 642 per 100,000 in 2013-2014. Conclusions: NHANES creates a unique opportunity to quantify undiagnosed ASCVD risk in a nationally representative sample. Since 1999, a sizeable portion of the US primary ASCVD risk was based on undiagnosed conditions, however, this proportion of undiagnosed risk decreased over time.

The Effects of Teachers’ Social and Human Capital on Urban Science Reform Initiatives: Considerations for Professional Development

2017 ◽  
Vol 119 (4) ◽  
pp. 1-32
Author(s):  
Susan Yoon ◽  
Jessica Koehler Yom ◽  
Zhitong Yang ◽  
Lei Liu
Keyword(s):  
Professional Development ◽  
Social Capital ◽  
Human Capital ◽  
African American ◽  
Research Design ◽  
Science Teachers ◽  
Technology Use ◽  
The United States ◽  
Successful Implementation ◽  
Science Reform

Background Recent research investigating the conditions under which science teachers can successfully implement science education reforms suggests that focusing only on professional development to improve content knowledge and teaching skills—often referred to as human capital—may not be enough. Increasingly, possessing social capital, defined as capacities acquired through direct and indirect relationships in social networks, has become an important teaching characteristic to develop, however, more empirical research needs to be conducted. Purpose This article details our efforts to examine the relative influence of teachers’ social and human capital on instruction in the science classroom. The following research question guided our analysis: “What is the impact of teachers’ social and human capital on their classroom enactments, and what implications does this have for implementing science reform projects?” Setting This research was conducted in a large urban public school district in the northeast region of the United States. Teachers participated in professional development activities focused on learning about, constructing, and implementing nanoscale content through problem-based and inquiry-based units, integrated with technology applications such as computer simulations. Population The teacher group was comprised of 10 males and 11 females, eight of whom identified as African American and 13 as White. Teaching experience ranged from 1 to 33 years, with a mean of 11.18 years. Data were collected from 545 students in their classes, of whom 52.19% were African American and 65.03% received free or reduced-priced lunch. Students ranged in level between eighth and 12th grade in the subject areas of biology, chemistry, and physical science. Research Design The research design entailed a within group comparison assessing variables that quantified teacher's social and human capital as discreet measures. They were then compared to survey outcomes collected from their students that indicated change in instructional enactments as they were related to the nanoscale units. Data Collection and Analysis A regression analysis was used in the study. Student surveys of perceptions of instructional enactments in two factors—cognitively-rich pedagogies and computer-related technology use–were used as the predicted variables. The social and human capital measures were established from application surveys and year-end interviews of teachers and used as predictor variables. Results With both predictors in the model, only social capital was found to be predictive of teachers’ successful implementation, indicating that social capital was a stronger predictor than human capital. Conclusions The study shows that focusing on the development of a teacher's social capital may be an important feature of professional development activities alongside the development of human capital particularly in urban populations where access to resources is limited.

Carotid Artery Stiffness Mechanisms Associated With Cardiovascular Disease Events and Incident Hypertension: the MESA

Hypertension ◽  
2022 ◽  
Author(s):  
Ryan J. Pewowaruk ◽  
Claudia Korcarz ◽  
Yacob Tedla ◽  
Gregory Burke ◽  
Philip Greenland ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Elastic Modulus ◽  
Arterial Stiffness ◽  
The United States ◽  
Hazard Ratio ◽  
Structural Stiffness ◽  
Cox Models ◽  
Artery Stiffness ◽  
The Difference

Background: Elastic arteries stiffen via 2 main mechanisms: (1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to changes in the vessel wall. It is unknown how these different mechanisms contribute to incident cardiovascular disease (CVD) events. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6814 men and women without CVD at enrollment, from 6 communities in the United States. MESA participants with B-mode carotid ultrasound and brachial blood pressure at baseline Exam in (2000–2002) and CVD surveillance (mean follow-up 14.3 years through 2018) were included (n=5873). Peterson’s elastic modulus was calculated to represent total arterial stiffness. Structural stiffness was calculated by adjusting Peterson’s elastic modulus to a standard blood pressure of 120/80 mm Hg with participant-specific models. Load-dependent stiffness was the difference between total and structural stiffness. Results: In Cox models adjusted for traditional risk factors, load-dependent stiffness was significantly associated with higher incidence of CVD events (hazard ratio/100 mm Hg, 1.21 [95% CI, 1.09–1.34] P <0.001) events while higher structural stiffness was not (hazard ratio, 1.03 [95% CI, 0.99–1.07] P =0.10). Analysis of participants who were normotensive (blood pressure <130/80, no antihypertensives) at baseline exam (n=2122) found higher load-dependent stiffness was also associated with significantly higher incidence of hypertension (hazard ratio, 1.53 [95% CI, 1.35–1.75] P <0.001) while higher structural stiffness was not (hazard ratio, 1.03 [95% CI, 0.99–1.07] P =0.16). Conclusions: These results provide valuable new insights into mechanisms underlying the association between arterial stiffness and CVD. Load-dependent stiffness was significantly associated with CVD events but structural stiffness was not.

scholarly journals Dietary Sodium Intake: Scientific Basis for Public Policy

2015 ◽  
Vol 39 (1-3) ◽  
pp. 16-20 ◽  
Author(s):  
Paul K. Whelton
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Observational Studies ◽  
Direct Relationship ◽  
Sodium Intake ◽  
Large Body ◽  
The United States ◽  
Dietary Sodium

Background/Aims: National and international agencies recommend a reduction in dietary sodium intake. However, some have questioned the wisdom of these policies. The goal of this report was to assess the findings and quality of studies that have examined the relationship between dietary sodium and both blood pressure and cardiovascular disease. Methods: Literature review of the available observational studies and randomized controlled trials, including systematic reviews and meta-analyses. Results: A large body of evidence from observational studies and clinical trials documents a direct relationship between dietary sodium intake and the level of blood pressure, especially in persons with a higher level of blood pressure, African-Americans, and those who are older or have comorbidity, including chronic kidney disease. A majority of the available observational reports support the presence of a direct relationship between dietary sodium intake and cardiovascular disease but the quality of the evidence according to most studies is poor. The limited information available from clinical trials is consistent with a beneficial effect of reduced sodium intake on incidence of cardiovascular disease. Conclusions: The scientific underpinning for policies to reduce the usual intake of dietary sodium is strong. In the United States and many other countries, addition of sodium during food processing has led to a very high average intake of dietary sodium, with almost everyone exceeding the recommended goals. National programs utilizing voluntary and mandatory approaches have resulted in a successful reduction in sodium intake. Even a small reduction in sodium consumption is likely to yield sizable improvement in population health. Video Journal Club ‘Cappuccino with Claudio Ronco' at www.karger.com/?doi=368975.

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