National Center for Telehealth and Technology

Seattle, United States

National Center for Telehealth and Technology

Seattle, United States

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Yellowlees P.M.,University of California at Davis | Holloway K.M.,National Center for Telehealth and Technology | Parish M.B.,University of California at Davis
Telemedicine and e-Health | Year: 2012

Background: As virtual reality and computer-assisted therapy strategies are increasingly implemented for the treatment of psychological disorders, ethical standards and guidelines must be considered. This study determined a set of ethical and legal guidelines for treatment of post-traumatic stress disorder (PTSD)/traumatic brain injury (TBI) in a virtual environment incorporating the rights of an individual who is represented by an avatar. Materials and Methods: A comprehensive literature review was undertaken. An example of a case study of therapy in Second Life (a popular online virtual world developed by Linden Labs) was described. Results: Ethical and legal considerations regarding psychiatric treatment of PTSD/TBI in a virtual environment were examined. The following issues were described and discussed: authentication of providers and patients, informed consent, patient confidentiality, patient well-being, clinician competence (licensing and credentialing), training of providers, insurance for providers, the therapeutic environment, and emergencies. Ethical and legal guidelines relevant to these issues in a virtual environment were proposed. Conclusions: Ethical and legal issues in virtual environments are similar to those that occur in the in-person world. Individuals represented by an avatar have the rights equivalent to the individual and should be treated as such. © 2012, Mary Ann Liebert, Inc.


Luxton D.D.,National Center for Telehealth and Technology | Trofimovich L.,Armed Forces Health Surveillance Center | Clark L.L.,Armed Forces Health Surveillance Center
Psychiatric Services | Year: 2013

Objective: The rising rate of suicide and the increase in psychiatric hospitalizations in the U.S. military underscore the need to determine risk among service members in psychiatric care so that targeted interventions and prevention programs are implemented. The purpose of this study was to determine the suicide rates of active-duty U.S. service members after discharge from a psychiatric hospitalization. Methods: Data from 68,947 patients who had psychiatric hospitalizations at military treatment facilities between 2001 and 2011 were obtained from the Defense Medical Surveillance System. Rates of suicide were compared between the cohort group and the general active-duty U.S. military population. Survival analysis was used to determine time-dependent patterns of suicide after hospital discharge. Results: A total of 153 suicides occurred among the 68,947 service members. The overall suicide rate in the cohort was 71.6 per 100,000 person-years, compared with the rate of 14.2 per 100,000 person-years in the general active-duty U.S. military population. Personnel released from a psychiatric hospitalization were therefore five times more likely to die from suicide. The risk of dying from suicide within the first 30 days after a psychiatric hospitalization was 8.2 times higher than the risk at more than one year after hospitalization. Conclusions: Active-duty U.S. service members who are released from a psychiatric hospitalization are a group at high risk of suicide. Aggressive safety planning and targeted interventions during and after hospitalization are recommended.


Logan J.,Centers for Disease Control and Prevention | Skopp N.A.,National Center for Telehealth and Technology | Karch D.,Centers for Disease Control and Prevention | Reger M.A.,National Center for Telehealth and Technology | Gahm G.A.,National Center for Telehealth and Technology
American Journal of Public Health | Year: 2012

Suicides are increasing among active duty US Army soldiers. To help focus prevention strategies, we characterized 56 US Army suicides that occurred from 2005 to 2007 in 17 US states using 2 large-scale surveillance systems. We found that intimate partner problems and military-related stress, particularly job stress, were common among decedents. Many decedents were also identified as having suicidal ideation, a sad or depressed mood, or a recent crisis before death. Focusing efforts to prevent these forms of stress might reduce suicides among soldiers.


Johnson C.M.,Duke University | Wei C.,Anderson University, South Carolina | Ensor J.E.,Anderson University, South Carolina | Smolenski D.J.,National Center for Telehealth and Technology | And 3 more authors.
Cancer Causes and Control | Year: 2013

Purpose Demographic, behavioral, and environmental factors have been associated with increased risk of colorectal cancer (CRC). We reviewed the published evidence and explored associations between risk factors and CRC incidence. Methods We identified 12 established non-screening CRC risk factors and performed a comprehensive review and meta-Analyses to quantify each factor's impact on CRC risk. We used random-effects models of the logarithms of risks across studies: inverse-variance weighted averages for dichotomous factors and generalized least squares for dose-response for multi-level factors. Results Significant risk factors include inflammatory bowel disease (RR = 2.93, 95 % CI 1.79-4.81); CRC history in first-degree relative (RR = 1.80, 95 % CI 1.61-2.02); body mass index (BMI)to overall population (RR = 1.10 per 8 kg/m2 increase, 95 % CI 1.08-1.12); physical activity (RR = 0.88, 95 % CI 0.86-0.91 for 2 standard deviations increased physical activity score); cigarette smoking (RR = 1.06, 95 % CI 1.03-1.08 for 5 pack-years); and consumption of red meat (RR = 1.13, 95 % CI 1.09-1.16 for 5 servings/week), fruit (RR = 0.85, 95 % CI 0.75-0.96 for 3 servings/day), and vegetables (RR = 0.86, 95 % CI 0.78-0.94 for 5 servings/day). Conclusions We developed a comprehensive risk modeling strategy that incorporates multiple effects to predict an individual's risk of developing CRC. Inflammatory bowel disease and history of CRC in first-degree relatives are associated with much higher risk of CRC. Increased BMI, red meat intake, cigarette smoking, low physical activity, low vegetable consumption, and low fruit consumption were associated with moderately increased risk of CRC © Springer Science+Business Media Dordrecht 2013.


Novaco R.W.,University of California at Irvine | Swanson R.D.,National Center for Telehealth and Technology | Gonzalez O.I.,University of California at Irvine | Gahm G.A.,National Center for Telehealth and Technology | Reger M.D.,National Center for Telehealth and Technology
Psychological Assessment | Year: 2012

The involvement of anger in the psychological adjustment of current war veterans, particularly in conjunction with combat-related posttraumatic stress disorder (PTSD), warrants greater research focus than it has received. The present study concerns a brief anger measure, Dimensions of Anger Reactions (DAR), intended for use in large sample studies and as a screening tool. The concurrent validity, discriminant validity, and incremental validity of the instrument were examined in conjunction with behavioral health data for 3,528 treatment-seeking soldiers who had been in combat in Iraq and Afghanistan. Criterion indices included multiple self-rated measures of psychological distress (including PTSD, depression, and anxiety), functional difficulties (relationships, daily activities, work problems, and substance use), and violence risk. Concurrent validity was established by strong correlations with single anger items on 4 other scales, and discriminant validity was found against anxiety and depression measures. Pertinent to the construct of anger, the DAR was significantly associated with psychosocial functional difficulties and with several indices of harm to self and to others. Hierarchical regression performed on a self/others harm index found incremental validity for the DAR, controlling for age, education, military component, officer rank, combat exposure, PTSD, and depression. The ability to efficiently assess anger in at-risk military populations can provide an indicator of many undesirable behavioral health outcomes. © 2012 American Psychological Association.


Bush N.E.,National Center for Telehealth and Technology
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2012

Personal technologies such as smartphones, computers, and gaming devices, are ubiquitous in the civilian world. Consequently they represent ideal vehicles for disseminating psychological and other health resources and interventions. However, almost nothing is known about personal technology use in the U.S. military. We conducted the most comprehensive survey to date of the use, availability, and need for personal technologies by U.S. military service members. Our survey asked detailed questions about computers and the Internet, phones and smartphones, other mobile or portable technologies, gaming devices, and TV and video media used during deployment and at permanent duty station or home. We collected data by paper-and-pencil survey in 2010 and 2011 from 331 active Army service members at a processing and registration center in a large military installation in the western United States. Two cohorts were surveyed: Soldiers who had previously been deployed to a warzone and soldiers who had never been deployed. We measured high rates of personal technology use by service members at home across all popular electronic media. Soldiers at home essentially resembled civilian consumers in their use of popular technologies. Some technologies, including the Internet, gaming, and TV, were widespread on deployment. Others, most notably cellphones, were more restricted by availability, connectivity, opportunity, and military regulation in the warzone. Results will enable researchers and technology developers target their efforts on the most promising and popular technologies for psychological health in the military.


Luxton D.D.,National Center for Telehealth and Technology
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2012

The rise in the use of mobile devices, such as smartphones, tablet personal computers, and wireless medical devices, as well as the wireless networks that enable their use, has raised new concerns for data security and integrity. Standardized Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant electronic data security that will allow ubiquitous use of mobile health technologies is needed. The lack of standardized data security to assure privacy, to allow interoperability, and to maximize the full capabilities of mobile devices presents a significant barrier to care. The purpose of this article is to provide an overview of the issue and to encourage discussion of this important topic. Current security needs, standards, limitations, and recommendations for how to address this barrier to care are discussed.


Kramer G.M.,National Center for Telehealth and Technology
Telemedicine journal and e-health : the official journal of the American Telemedicine Association | Year: 2012

The telehealth field has advanced historic promises to improve access, cost, and quality of care. However, the extent to which it is delivering on its promises is unclear as the scientific evidence needed to justify success is still emerging. Many have identified the need to advance the scientific knowledge base to better quantify success. One method for advancing that knowledge base is a standard telemental health evaluation model. Telemental health is defined here as the provision of mental health services using live, interactive video-teleconferencing technology. Evaluation in the telemental health field largely consists of descriptive and small pilot studies, is often defined by the individual goals of the specific programs, and is typically focused on only one outcome. The field should adopt new evaluation methods that consider the co-adaptive interaction between users (patients and providers), healthcare costs and savings, and the rapid evolution in communication technologies. Acceptance of a standard evaluation model will improve perceptions of telemental health as an established field, promote development of a sounder empirical base, promote interagency collaboration, and provide a framework for more multidisciplinary research that integrates measuring the impact of the technology and the overall healthcare aspect. We suggest that consideration of a standard model is timely given where telemental health is at in terms of its stage of scientific progress. We will broadly recommend some elements of what such a standard evaluation model might include for telemental health and suggest a way forward for adopting such a model.


Osenbach J.E.,National Center for Telehealth and Technology | O'Brien K.M.,National Center for Telehealth and Technology | Mishkind M.,National Center for Telehealth and Technology | Smolenski D.J.,National Center for Telehealth and Technology
Depression and Anxiety | Year: 2013

Background Many patients suffering from depression lack immediate access to care. The use of synchronous telehealth modalities to deliver psychotherapy is one solution to this problem. This meta-analysis examined differences in treatment efficacy for psychotherapy administered via synchronous telehealth as compared to standard nontelehealth approaches. Method We located 14 articles that met inclusion criteria of the use of a synchronous telehealth modality for treatment compared to a standard nontelehealth modality comparison group. Results Overall, a statistically significant systematic difference between modes of delivery was not identified (g = 0.14, SE = 0.08, 95% CI = [-0.03, 0.30], P =.098, I2 = 49.74%). Stratification methods and metaregression were used to analyze the contributions of type of comparison group, intervention modality, and targeted mental health outcome to moderation of effect size (ES) estimates and heterogeneity. Type of comparison group (face-to-face versus care-as-usual) had the strongest influence on observed heterogeneity and moderated the summary ES. The only detectable difference in efficacy was restricted to studies that used care-as-usual as the comparison group (g = 0.29, SE = 0.06, 95% CI = [0.16, 0.41], P <.001, I2 = 5.14%). Conclusions Overall, we found no evidence to suggest that the delivery of psychotherapy via synchronous telehealth modalities is less effective than nontelehealth means in reducing depression symptoms. © Published 2013. This article is a U.S. Government work and is in the public domain in the USA.


Luxton D.D.,National Center for Telehealth and Technology | Kayl R.A.,National Center for Telehealth and Technology | Mishkind M.C.,National Center for Telehealth and Technology
Telemedicine and e-Health | Year: 2012

The rise in the use of mobile devices, such as smartphones, tablet personal computers, and wireless medical devices, as well as the wireless networks that enable their use, has raised new concerns for data security and integrity. Standardized Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant electronic data security that will allow ubiquitous use of mobile health technologies is needed. The lack of standardized data security to assure privacy, to allow interoperability, and to maximize the full capabilities of mobile devices presents a significant barrier to care. The purpose of this article is to provide an overview of the issue and to encourage discussion of this important topic. Current security needs, standards, limitations, and recommendations for how to address this barrier to care are discussed. © Copyright 2012, Mary Ann Liebert, Inc.

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