Acceptability of a home-based visual field test (Eyecatcher) for glaucoma home monitoring: a qualitative study of patients' views and experiences

Objectives To explore the acceptability of home visual field (VF) testing using Eyecatcher among people with glaucoma participating in a 6-month home monitoring pilot study. Design Qualitative study using face-to-face semistructured interviews. Transcripts were analysed using thematic analysis. Setting Participants were recruited in the UK through an advertisement in the International Glaucoma Association (now Glaucoma UK) newsletter. Participants Twenty adults (10 women; median age: 71 years) with a diagnosis of glaucoma were recruited (including open angle and normal tension glaucoma; mean deviation=2.5 to -29.9 dB). Results All participants could successfully perform VF testing at home. Interview data were coded into four overarching themes regarding experiences of undertaking VF home monitoring and attitudes towards its wider implementation in healthcare: (1) comparisons between Eyecatcher and Humphrey Field Analyser (HFA); (2) capability using Eyecatcher; (3) practicalities for effective wider scale implementation; (4) motivations for home monitoring. Conclusions Participants identified a broad range of benefits to VF home monitoring and discussed areas for service improvement. Eyecatcher was compared positively with conventional VF testing using HFA. Home monitoring may be acceptable to at least a subset of people with glaucoma

What’s the importance of portable tele-monitoring devices in patient therapeutic adherence?

In the United Kingdom, it’s estimated that the National Health System spends every year almost $121 million in unused drugs. The hospital admission costs attributed to patients not taking their prescribed medicine properly was estimated to be between$44m and $240m per year. In the United States of America, medication non-adherence is estimated in$100 to $300 billions of avoidable healthcare costs annually, representing 3–10% of total United States healthcare costs. Studies show that improving medication adherence may have a greater influence on the health of the population than the discovery of any new therapy. Effective medicines are available for many conditions. Yet patients are non-adherent 50% of the time, reaching its critical point in certain disease states, such as asymptomatic conditions like hypertension, in which the incidence may approach 80%. Each disease has its special challenges. To answer the non-adherence problem, we must understand that people under certain disease states, are not aware of the danger when they unconsciously neglect the treatment and stop taking the prescribed medication. With the technological boom over the recent years, we were flooded with gadgets and devices that allow us to do practically everything in our everyday life, and the rise of tele-monitoring devices is going to be a reality, not only to monitor bio-signals but to help us with medication compliance. The objective of this dissertation is to gather information to establish what are the main strengths of nowadays technology to assemble the best integrated monitoring and control device, for therapeutic adherence. Our proposal is to create a therapeutic adherence monitoring device that consists in a smart blister coupled to a device which has the capacity to collect (from other medical devices) and send data (medicine taking time, blood pressure and oximetry) to a cloud every day. This allows the clinician to know, with high certain, if the patient is taking his medicine exactly how it has prescribed as well as the schedule of the same. Concluding, therapeutic non-adherence is a public health problem that leads to high economical and health losses. Nevertheless, we find that the technological devices fit within the lifestyle of the average person and present themselves as a solution

Where is Hope in Old Age? A Study of Chinese Migrant Workers\u27 Migration Experience and Well-being

China has been undergoing massive rural-to-urban migration in the past four decades. As of 2019, there are approximately 300 million migrant workers in China’s labor force, which accounts for approximately 20% of its entire population. However, policy makers and society as a whole have paid insufficient attention to migrant workers’ well-being. This dissertation examines the relationship between Chinese migrant workers’ migration experiences and their well-being into aging and retirement. Using a sample of 1,083 migrant workers from three Chinese emigration provinces (Anhui, Sichuan, and Henan) in a quantitative dataset and 30 follow-up interviews, this dissertation examines: (1) factors of migration experience that affect migrant workers’ health and healthcare, (2) factors influencing migrant workers’ retirement savings, and (3) the structural relationships between migration experience, hopefulness toward retirement, self-rated health, and overall retirement planning. Quantitative findings of this dissertation revealed that longer work experience and lower income are negatively associated with their poorer health; Having higher income, better social support network, and being hopeful for retirement are positively correlated with having retirement savings. Qualitative findings revealed the social context of the cumulative disadvantages that rural migrant workers experience because of their social status as rural residents. The non-transferable healthcare and retirement benefits associated with rural migrant workers’ social status resulted in their poor health and reduced chance of retirement saving. Continued cultural belief in intergenerational support led to migrant workers’ reduced chance of savings for retirement. Yet, having hope for retirement and confidence in retirement insurance system resulted in increasing participation of migrant workers in social insurance. This dissertation sheds light on the understanding of the interactions between urbanization, population aging, and the Chinese cultural expectations. It adds to the existing literature by linking migration and urbanization with social policies and cultural expectations for migrant workers’ aging and retirement in rural China

An Integrated and Distributed Framework for a Malaysian Telemedicine System (MyTel)

The overall aim of the research was to produce a validated framework for a Malaysian integrated and distributed telemedicine system. The framework was constructed so that it was capable of being useful in retrieving and storing a patient's lifetime health record continuously and seamlessly during the downtime of the computer system and the unavailability of a landline telecommunication network. The research methodology suitable for this research was identified including the verification and validation strategies. A case study approach was selected for facilitating the processes and development of this research. The empirical data regarding the Malaysian health system and telemedicine context were gathered through a case study carried out at the Ministry of Health Malaysia (MOHM). The telemedicine approach in other countries was also analysed through a literature review and was compared and contrasted with that in the Malaysian context. A critical appraisal of the collated data resulted in the development of the proposed framework (MyTel) a flexible telemedicine framework for the continuous upkeep o f patients' lifetime health records. Further data were collected through another case study (by way of a structured interview in the outpatient clinics/departments of MOHM) for developing and proposing a lifetime health record (LHR) dataset for supporting the implementation of the MyTel framework. The LHR dataset was developed after having conducted a critical analysis of the findings of the clinical consultation workflow and the usage o f patients' demographic and clinical records in the outpatient clinics. At the end of the analysis, the LHR components, LHR structures and LHR messages were created and proposed. A common LHR dataset may assist in making the proposed framework more flexible and interoperable. The first draft of the framework was validated in the three divisions of MOHM that were involved directly in the development of the National Health JCT project. The division includes the Telehealth Division, Public and Family Health Division and Planning and Development Division. The three divisions are directly involved in managing and developing the telehealth application, the teleprimary care application and the total hospital information system respectively. The feedback and responses from the validation process were analysed. The observations and suggestions made and experiences gained advocated that some modifications were essential for making the MyTel framework more functional, resulting in a revised/ final framework. The proposed framework may assist in achieving continual access to a patient's lifetime health record and for the provision of seamless and continuous care. The lifetime health record, which correlates each episode of care of an individual into a continuous health record, is the central key to delivery of the Malaysian integrated telehealth application. The important consideration, however, is that the lifetime health record should contain not only longitudinal health summary information but also the possibility of on-line retrieval of all of the patient's health history whenever required, even during the computer system's downtime and the unavailability of the landline telecommunication network

Development and initial validation of a computer-administered health literacy assessment in Spanish and English: FLIGHT/VIDAS.

Current measures of health literacy have been criticized on a number of grounds, including use of a limited range of content, development on small and atypical patient groups, and poor psychometric characteristics. In this paper, we report the development and preliminary validation of a new computer-administered and -scored health literacy measure addressing these limitations. Items in the measure reflect a wide range of content related to health promotion and maintenance as well as care for diseases. The development process has focused on creating a measure that will be useful in both Spanish and English, while not requiring substantial time for clinician training and individual administration and scoring. The items incorporate several formats, including questions based on brief videos, which allow for the assessment of listening comprehension and the skills related to obtaining information on the Internet. In this paper, we report the interim analyses detailing the initial development and pilot testing of the items (phase 1 of the project) in groups of Spanish and English speakers. We then describe phase 2, which included a second round of testing of the items, in new groups of Spanish and English speakers, and evaluation of the new measure\u27s reliability and validity in relation to other measures. Data are presented that show that four scales (general health literacy, numeracy, conceptual knowledge, and listening comprehension), developed through a process of item and factor analyses, have significant relations to existing measures of health literacy

The association between socioeconomic status and linear growth in Nepalese children under 2 years of age

Postponed access: the file will be accessible after 2022-05-31The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) advocate the importance of the first 1,000 days (from conception to the 2nd birthday) for a child ́s optimum health, growth, and neurodevelopment. Most studies have investigated child linear growth and its determinants among children under 5 years of age. Furthermore, several studies have used single component measures of socioeconomic status (SES) such as assets, income, education, and occupation but few studies used multidimensional measures of SES. Therefore, we aimed to investigate the association of a range of measures of SES including multidimensional measures on linear growth among 600 children under 2 years of age from Bhaktapur, Nepal. Linear growth was assessed as length-for-age z-score using the WHO child growth standard. Length was measured at baseline (child aged 6-11 months) and follow-up (child aged 18-24 months). Measures of SES assessed were a WAMI (water and sanitation, assets, maternal education) index, combined or as individual components, father ́s education, and mother ́s or father ́s occupation. Linear regression models were employed to regress linear growth on the selected measures of SES. There were 49% female children. At baseline, the mean age (SD) was 8 (1.8) months, the mean length-for-age z-score (SD) was -1.8 (0.6), and the mean (SD) WAMI index was 0.65 (0.14). At baseline, only mother’s education was associated with length-for- age, whereas at follow-up, the WAMI index, parental education and occupation, and assets were associated with length-for-age when adjusted for mother’s age and type of family. The estimates did not change considerably when adjusted for mother’s height and child ́s sex in addition. In conclusion, different measures of SES were positively associated with linear growth among children under 2 years of age, where WAMI index, a multidimensional measure of SES, could be used as standardized approach to generalize SES of family across diverse population.M.Phil. in Global Health - ThesisINTH395AMAMD-GLO