Multi-purpose HealthCare Telemedicine Systems with mobile communication link support

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3–12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.     

Vaccination and the prevention problem

This paper seeks to critically review a traditional objection to preventive medicine (which I call here the 'prevention problem'). The prevention problem is a concern about the supposedly inequitable distribution of benefits and risks of harm resulting from preventive medicine's focus on population-based interventions. This objection is potentially applicable to preventive vaccination programmes and could be used to argue that such programmes are unethical. I explore the structure of the prevention problem by focusing upon two different types of vaccination (therapeutic vaccination and preventive vaccination). I argue that the 'prevention problem' cannot be fairly applied to the case of preventive vaccination because such programmes do not just focus upon benefits at the level of populations (as is claimed by the prevention problem). Most such preventive vaccination programmes explicitly seek to create and maintain herd protection. I argue that herd protection is an important public good which is a benefit shared by all individuals in the relevant population. This fact can then be used to block the 'prevention problem' argument in relation to preventive vaccination programmes. I conclude by suggesting that whilst the future development and use of therapeutic vaccines does raise some interesting ethical issues, any ethical objections to prophylactic vaccination on the basis of the 'prevention problem' will not be overcome through the substitution of therapeutic vaccines for preventive vaccines; indeed, the 'prevention problem' fails on its own terms in relation to preventive vaccination programmes.     

First real-world experience with mobile health telemonitoring in adult patients with congenital heart disease

Background

Arrhythmias and heart failure are common and invalidating sequelae in adult patients with congenital heart disease (CHD). Mobile health (m-Health) enables daily monitoring and a timely response that might prevent deterioration. We present an observational prospective registry to evaluate feasibility of an m‑Health telemonitoring program for managing arrhythmia, heart failure and blood pressure in symptomatic adults with CHD.

Methods

Symptomatic adult patients with CHD are enrolled in an m‑Health telemonitoring program, which evaluates single-lead ECG, blood pressure and weight measurements. In case of symptoms extra measurements could be performed. Data are collected by mobile apps, matched with individualised thresholds. Patients are contacted if thresholds were exceeded or if arrhythmias were found, for treatment adjustments or reassurance. Data on emergency care utilisation, hospitalisation and patient-reported outcome measures are used to assess quality of life and self-management.

Results

129 symptomatic CHD patients were invited to participate, 55 participated. Reasons for refusing consent included too time consuming to participate in research (30) and to monitor vital signs (14). At baseline 22 patients were in New York Heart Association class ≥ II heart failure, 43 patients had palpitations or documented arrhythmias, and 8 had hypertension. Mean follow-up was 3.0 months, one patient dropped out, and adherence was 97%.

Conclusion

The first results indicate that this program is feasible with high adherence.

     

Comparative Effectiveness of Different Forms of Telemedicine for Individuals with Heart Failure (HF): A Systematic Review and Network Meta-Analysis

BackgroundPrevious studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care. Little has been done to determine the comparative impact of different telemedicine options for a specific population such as individuals with heart failure (HF).LimitationsMuch of the evidence currently available has focused on the comparing either telephone support or telemonitoring with usual care. This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.ConclusionsCompared to usual care, structured telephone support and telemonitoring significantly reduced the odds of deaths and hospitalization due to heart failure. Despite being the most widely studied forms of telemedicine, little has been done to directly compare these two interventions against one another. Further research into their comparative cost-effectiveness is also warranted.     

Prevention. How much harm? How much benefit? 1. Influence of reporting methods on perception of benefits.

Before a physician or a patient can decide whether a preventive program is worth while, each must understand the nature and degree of its benefits and the frequency and magnitude of its adverse effects. Preventive interventions can be divided into two major categories: those with infrequent or minor adverse effects and those with adverse effects that are frequent or serious. Accident prevention, avoidance of high-risk behaviour and healthy lifestyle choices such as breast-feeding and moderate exercise are associated with few adverse consequences. By contrast, screening populations for disease, risk classification for the purpose of selective preventive interventions, dietary intervention and prophylactic drug treatment may lead to more frequent and serious adverse effects. When assessing whether the benefits of a preventive intervention outweigh the harm, one must be aware that the methods used to report benefits of clinical trials may distort the reader''s perception of their magnitude. The relative reduction of morbidity or mortality rate often grossly exaggerates benefits and should never be used as a basis for clinical decision making. More realistic ways of recording benefits are the absolute reduction of morbidity or mortality rate, the number of patients that need to be treated to avoid one adverse event, and the total cohort mortality rate.     

Mobile Agriculturalists and the Emergence of Sedentism: Perspectives from Northern Mexico

A truism in anthropology is that hunters and gatherers are mobile and agriculturalists are sedentary. Factors affecting residential mobility are examined using data from a Rarámuri (Tarahumara) community of residentially mobile agriculturalists in northern Mexico who move among principal residences, growing-season residences associated with distant fields, winter locations, and a ceremonial center. This case indicates that the unilineal model from mobile hunting and gathering to sedentary agriculture must be broadened and that economic factors alone do not totally determine settlement patterns. Explanatory models related to the causes of sedentism are considered.     

A Review of Frailty Analysis in Older Adults: From Clinical Tools Towards Fully Automated Preventive Systems

ObjectivesFrailty is a geriatric syndrome characterized by sarcopenia and physiological impairment. Although the majority of older adults wish to age at home, being frail threatens this choice since it increases the risk of falls and loss of functional independence. Hence, frailty screening and early detection are needed to stop or at least slow down the physical weakening process. In this paper, we present a review in which we discuss the proposed methods from the literature that targets frailty detection and analysis, starting from traditional clinical tools then introducing data-driven studies before highlighting the importance of fully automated systems.Material and methodsWe conducted a review study by searching several databases such as Google Scholar, IEEE Xplore, MDPI, and ScienceDirect to name a few. This work presents clinical tools and classical performance tests to assess the health status and the physical function, as well as statistical and observational studies to analyze the frailty syndrome. Moreover, we discuss briefly the work of our research team in this context, represented by the development of a telemonitoring system which aims at the transition from a curative to a preventive model.ResultsFirstly, this review points out the absence of a gold standard to detect frailty in older individuals. Secondly, it discusses the limitations of self-reported measures/questionnaires and other traditional performance tests which are based on subjective data and done under supervised conditions. Thirdly, our study emphasizes the lack of robust approaches that target the early detection of frailty and the prediction of a future risk of physical worsening. We propose new research directions based, on the one hand, on automatic activity identification and tracking and, on the other hand, on the analysis of spontaneous speech of elderly.ConclusionThis paper describes research findings and highlights the existing gaps in the context of frailty, and serves as a state of the art for researchers. Additionally, this work suggests future research directions regarding the early detection and prevention of frailty.     

Prevention in practice: what Wessex general practitioners are doing.

A random sample of 214 general practitioners in the Wessex region was invited to complete a postal questionnaire about the practice of preventive medicine and 90% replied. This inquired into their attitude and behaviour towards smoking and accident prevention, promoting exercise, and controlling obesity and hypertension. The results were generally encouraging. Most recognised their key role in health promotion and health education and their shared responsibility with other professionals. Many had made progress in smoking prevention and control of obesity and hypertension. Promoting exercise and accident prevention left room for improvement. The availability of information in patients'' records to identify and monitor problem areas was particularly lacking. We conclude that further progress might be achieved by better training of general practitioners, and developing information systems orientated towards promoting health. The team approach in primary care needs to be strengthened. In particular extending the role of the health visitor and practice nurse may provide the support so vital for the successful outcome of preventive initiatives. Community unit management teams need to consider carefully how they may encourage advances in health promotion in primary care.     

Distribution of changes in systolic blood pressure and waist circumference--indicators for primary prevention

Eliminating or diminishing risk behaviors that lead to cardiovascular diseases could be achieved through primary prevention during the general practice visits. However, there is difference in effectiveness of preventive measure while there are no symptoms, and reactive response when burden of diseases start to show. We analyzed trends in gender and age--pattern changes of systolic blood pressure and waist circumference, as a reflection of primary prevention. Results show increase of values for both indicators in both genders, through youngest and middle age groups. In the oldest group stagnation and even decrease of values is evident. These results signal possible absence of primary prevention in younger age groups and some action when symptoms occur. It is hard to distinguish weather lower values is consequence of medication or lifestyle change. The absence of primary prevention is usually missed opportunity that is charged later both to the patient and health care system.     

Understanding disease control: influence of epidemiological and economic factors

We present a model of disease transmission on a regular and small world network and compare different control options. Comparison is based on a total cost of epidemic, including cost of palliative treatment of ill individuals and preventive cost aimed at vaccination or culling of susceptible individuals. Disease is characterized by pre-symptomatic phase, which makes detection and control difficult. Three general strategies emerge: global preventive treatment, local treatment within a neighborhood of certain size and only palliative treatment with no prevention. While the choice between the strategies depends on a relative cost of palliative and preventive treatment, the details of the local strategy and, in particular, the size of the optimal treatment neighborhood depend on the epidemiological factors. The required extent of prevention is proportional to the size of the infection neighborhood, but depends on time till detection and time till treatment in a non-nonlinear (power) law. The optimal size of control neighborhood is also highly sensitive to the relative cost, particularly for inefficient detection and control application. These results have important consequences for design of prevention strategies aiming at emerging diseases for which parameters are not nessecerly known in advance.     

Determining the impact of community awareness-raising activities on the prevention of malaria transmission in Palawan,the Philippines

Palawan has the highest malaria endemicity in the Philippines, and malaria remains a major health burden in the region. In 1999, 344 microscopists were trained in Palawan. This allowed for early diagnosis and prompt treatment throughout the island. To take a significant step toward the elimination of malaria on the island, microscopists implemented community awareness-raising activities aimed at preventing transmission of malaria. The objective of the present study was to determine the impact of these activities on the self-implemented preventive measures against malaria by the ex-patients of the microscopists. Structured interviews were carried out from January to February in 2012, in 20 remote malaria-endemic villages throughout Palawan. In total, 141 ex-patients who had previously been diagnosed malaria-positive by the microscopists, volunteered to participate in the present study. Structural equation modeling was conducted to determine factors associated with self-implemented preventive measures against malaria, which included: (1) place of residence; (2) socio-demographic characteristics; (3) knowledge on malaria; (4) participation in community awareness-raising activities for malaria prevention; and (5) satisfaction with microscopists. Structural equation modeling identified six significant factors independently associated with self-implemented preventive measures against malaria; ethnicity, knowledge on malaria transmission, knowledge on vector species, knowledge on vector's most active time, participation in awareness-raising activities for malaria prevention by microscopists, and satisfaction with microscopists. Tagalog ethnicity (the predominant ethnic group) was positively related to better self-implemented preventive measures. In conclusion, aside from providing early diagnosis and treatment, microscopists played a significant role in self-implemented preventive measures against malaria. The strengthening of awareness-raising activities by microscopists was suggested to be an effective strategy for reducing malaria re-infection in Palawan. These activities should be strengthened to improve preventive measures implemented by ex-patients traveling to mountain areas and to enhance the knowledge on malaria transmission particularly among indigenous residents.     

Heat injury prevention--a military perspective

Heat-related injuries, and specifically exertional heat stroke, are a significant occupational risk in the armed forces, especially for those soldiers who are rapidly deployed from a temperate climate region to hot climate regions. Traditionally, adaptation to heat was considered as a matter of physiological adaptation. It is clear today that these injuries are mostly avoidable when applying proper education and behavioral adaptations. Education on behavioral adaptation for the prevention of heat injuries should be targeted at the individual and the organization level. This article summarizes the issue of proper preventive measures that should be taken to avoid, or at least minimize, the risk of exertional heat related injuries during military operations and training.     

Prevention of developmental abnormalities with particular emphasis of primary prevention

The Hungarian total (birth + fetal) prevalences of different developmental abnormalities offer a possibility to estimate the proportion of preventable development abnormalities. The effectiveness of primary, secondary and tertiary preventive methods are evaluated with a particular emphasis of primary prevention based on periconceptional folic acid or folic acid-containing multivitamin supplementation. The total prevalence of informative offspring with developmental abnormalities is 66.83 per 1,000 in Hungary and within this major DAs have 27.01 per 1,000 rate. The latter can be reduced by 26.6% by primary preventive methods due to mainly periconceptional folic acid/multivitamin supplementation. Secondary prevention particularly neonatal orthopedic screening is very effective for deformities such as congenital dislocation of the hip. Antenatal diagnoses followed by termination of pregnancy can avoid the birth of malformed newborn infants in 8.7% of DAs, however, this figure is 20 and 27% among major and multiple developmental abnormalities, respectively. Early surgical intervention can achieve a complete recovery in 33.5% of cases with developmental abnormalities. Thus there are two major conclusions: at present the major part of developmental abnormalities are preventable, however, different developmental abnormalities do not represent a single pathological category therefore there is no single strategy for their prevention.     

Colorectal cancer prevention: Immune modulation taking the stage

Prevention or early detection is one of the most promising strategies against colorectal cancer (CRC), the second leading cause of cancer death in the US. Recent studies indicate that antitumor immunity plays a key role in CRC prevention. Accumulating evidence suggests that immunosurveillance represents a critical barrier that emerging tumor cells have to overcome in order to sustain the course of tumor development. Virtually all of the agents with cancer preventive activity have been shown to have an immune modulating effect. A number of immunoprevention studies aimed at triggering antitumor immune response against early lesions have been performed, some of which have shown promising results. Furthermore, the recent success of immune checkpoint blockade therapy reinforces the notion that cancers including CRC can be effectively intervened via immune modulation including immune normalization, and has stimulated various immune-based combination prevention studies. This review summarizes recent advances to help better harness the immune system in CRC prevention.     

Anti-malarial drugs and the prevention of malaria in the population of malaria endemic areas

Anti-malarial drugs can make a significant contribution to the control of malaria in endemic areas when used for prevention as well as for treatment. Chemoprophylaxis is effective in preventing deaths and morbidity from malaria, but it is difficult to sustain for prolonged periods, may interfere with the development of naturally acquired immunity and will facilitate the emergence and spread of drug resistant strains if applied to a whole community. However, chemoprophylaxis targeted to groups at high risk, such as pregnant women, or to periods of the year when the risk from malaria is greatest, can be an effective and cost effective malaria control tool and has fewer drawbacks. Intermittent preventive treatment, which involves administration of anti-malarials at fixed time points, usually when a subject is already in contact with the health services, for example attendance at an antenatal or vaccination clinic, is less demanding of resources than chemoprophylaxis and is now recommended for the prevention of malaria in pregnant women and infants resident in areas with medium or high levels of malaria transmission. Intermittent preventive treatment in older children, probably equivalent to targeted chemoprophylaxis, is also highly effective but requires the establishment of a specific delivery system. Recent studies have shown that community volunteers can effectively fill this role. Mass drug administration probably has little role to play in control of mortality and morbidity from malaria but may have an important role in the final stages of an elimination campaign.     

Future directions for root caries research

Interest among researchers in the diagnosis, aetiology, prevention, and treatment of root caries has increased substantially over the past two decades. However, there are some fundamental problems impeding the advancement of the field which remain to be addressed and resolved. A universally acceptable definition of root caries is not yet available. The relationship of root caries to coronal caries has not been established. The underlying disease process is still not clearly understood. The optimal utilisation of preventive/therapeutic agents for the treatment or prevention of root caries has not been determined. New treatment materials and preventive agents have not yet been tested in controlled clinical trials. These are a few of the issues and problems which we address in this paper.     

A Systematic Assessment of Smartphone Tools for Suicide Prevention

BackgroundSuicide is a leading cause of death globally, and there has been a rapid growth in the use of new technologies such as mobile health applications (apps) to help identify and support those at risk. However, it is not known whether these apps are evidence-based, or indeed contain potentially harmful content. This review examines the concordance of features in publicly available apps with current scientific evidence of effective suicide prevention strategies.MethodsApps referring to suicide or deliberate self-harm (DSH) were identified on the Android and iOS app stores. Systematic review methodology was employed to screen and review app content. App features were labelled using a coding scheme that reflected the broad range of evidence-based medical and population-based suicide prevention interventions. Best-practice for suicide prevention was based upon a World Health Organization report and supplemented by other reviews of the literature.ResultsOne hundred and twenty-three apps referring to suicide were identified and downloaded for full review, 49 of which were found to contain at least one interactive suicide prevention feature. Most apps focused on obtaining support from friends and family (n = 27) and safety planning (n = 14). Of the different suicide prevention strategies contained within the apps, the strongest evidence in the literature was found for facilitating access to crisis support (n = 13). All reviewed apps contained at least one strategy that was broadly consistent with the evidence base or best-practice guidelines. Apps tended to focus on a single suicide prevention strategy (mean = 1.1), although safety plan apps provided the opportunity to provide a greater number of techniques (mean = 3.9). Potentially harmful content, such as listing lethal access to means or encouraging risky behaviour in a crisis, was also identified.DiscussionMany suicide prevention apps are available, some of which provide elements of best practice, but none that provide comprehensive evidence-based support. Apps with potentially harmful content were also identified. Despite the number of apps available, and their varied purposes, there is a clear need to develop useful, pragmatic, and multifaceted mobile resources for this population. Clinicians should be wary in recommending apps, especially as potentially harmful content can be presented as helpful. Currently safety plan apps are the most comprehensive and evidence-informed, for example, “Safety Net” and “MoodTools—Depression Aid”.     

The utility of genetically altered mouse models for nutrition and cancer chemoprevention research

The development of effective cancer preventive interventions is being enhanced by the use of relevant animal models to confirm, refine, and extend potential leads from clinical and epidemiologic studies. In particular, genetically altered mice, with specific cancer-related genes modulated, are providing powerful tools for studying carcinogenesis, as well as important conduits for translating basic research findings from the laboratory bench to the bedside. This review explores the utility of genetically altered mice for developing cancer preventive strategies that can offset increased cancer susceptibility resulting from specific genetic lesions. Examples will focus on preventing cancer by dietary interventions, particularly obesity prevention/energy balance modulation, as well as chemoprevention, in mice with alterations in genes such as the p53 or Apc tumor suppressors, components of the ErbB pathway, and other pathways frequently altered in human cancer.     

Do health service organizations and community health centres have higher disease prevention and health promotion levels than fee-for-service practices?

We interviewed health care providers representing 23 fee-for-service (FFS) practices, 19 health service organizations (HSOs) and 11 community health centres (CHCs) in Ontario to compare self-reported approaches to disease prevention and health promotion. Few significant differences were found across practice types in the presence of recall systems for screening or in knowledge of, compliance with or estimated coverage for selected preventive maneuvers recommended by the Canadian Task Force on the Periodic Health Examination. CHCs reported a significantly greater variety of formal health promotion programs and a greater tendency to use nonphysician health care personnel to carry out both prevention and health promotion activities. The results must be interpreted with caution because of the use of self-reported data, the low response rate for FFS practices and the use of a restrictive definition of disease prevention tied to evidence from the reports of the task force. Thus, the results cast some doubt on the common assumption that increasing the population served by alternative modes of delivery such as HSOs and CHCs necessarily increases the level of disease prevention and health promotion activity.     

Printed information for the lay public on cardiovascular disease.

Booklets from several countries on various aspects of cardiovascular disease, intended for distribution to the public and to patients, could be classified into three categories dealing with primary prevention, secondary prevention, and management. Much material was duplicated, whereas some diseases were completely ignored. Only two types of booklets should be available. One would deal with preventive measures for all cardiovascular diseases, while the other would be a series of booklets on individual conditions, combining information on secondary prevention and on management.