Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Sleep homeostasis in the European jackdaw (<i>Coloeus monedula</i>):Sleep deprivation increases NREM sleep time and EEG power while reducing hemispheric asymmetry

Introduction: Sleep is a wide-spread phenomenon that is thought to occur in all animals. Yet, the function of it remains an enigma. Conducting sleep experiments in different species may shed light on the evolution and functions of sleep. Therefore, we studied sleep architecture and sleep homeostatic responses to sleep deprivation in the European jackdaw (Coloeus monedula).Methods: A total of nine young adult birds were implanted with epidural electrodes and equipped with miniature data loggers for recording movement activity (accelerometery) and electroencephalogram (EEG). Individually-housed jackdaws were recorded under controlled conditions with a 12:12-h light-dark cycle.Results: During baseline, the birds spent on average 48.5% of the time asleep (39.8% non-rapid eye movement (NREM) sleep and 8.7% rapid eye movement (REM) sleep). Most of the sleep occurred during the dark phase (dark phase: 75.3% NREM sleep and 17.2% REM sleep; light phase 4.3% NREM sleep and 0.1% REM sleep). After sleep deprivation of 4 and 8 h starting at lights off, the birds showed a dose-dependent increase in NREM sleep time. Also, NREM sleep EEG power in the 1.5–3 Hz frequency range, which is considered to be a marker of sleep homeostasis in mammals, was significantly increased for 1-2 h after both 4SD and 8SD. While there was little true unihemispheric sleep in the Jackdaws, there was a certain degree of hemispheric asymmetry in NREM sleep EEG power during baseline, which reduced after sleep deprivation in a dose-dependent manner.Conclusion: In conclusion, jackdaws display homeostatic regulation of NREM sleep and sleep pressure promotes coherence in EEG power

A longitudinal study of the experiences and psychological well-being of Indian surrogates

Study question: What is the psychological well-being of Indian surrogates during and after the surrogacy pregnancy? Summary answer: Surrogates were similar to a matched group of expectant mothers on anxiety and stress. However, they scored higher on depression during and after pregnancy. What is known already: The recent ban on trans-national commercial surrogacy in India has led to urgent policy discussions regarding surrogacy. Whilst previous studies have reported the motivations and experiences of Indian surrogates no studies have systematically examined the psychological well-being of Indian surrogates, especially from a longitudinal perspective. Previous research has shown that Indian surrogates are motivated by financial payment and may face criticism from their family and community due to negative social stigma attached to surrogacy. Indian surrogates often recruited by agencies and mainly live together in a “surrogacy house.” Study design, size, duration: A longitudinal study was conducted comparing surrogates to a matched group of expectant mothers over two time points: (a) during pregnancy (Phase1: 50 surrogates, 70 expectant mothers) and (b) 4–6 months after delivery (Phase 2: 45 surrogates, 49 expectant mothers). The Surrogates were recruited from a fertility clinic in Mumbai and the matched comparison group was recruited from four public hospitals in Mumbai and Delhi. Data collection was completed over 2 years. Participants/materials, setting, methods: Surrogates and expectant mothers were aged between 23 and 36 years. All participants were from a low socio-economic background and had left school before 12–13 years of age. In-depth faceto-face semi-structured interviews and a psychological questionnaire assessing anxiety, stress and depression were administered in Hindi to both groups. Interviews took place in a private setting. Audio recordings of surrogate interviews were later translated and transcribed into English. Main results and the role of chance: Stress and anxiety levels did not significantly differ between the two groups for both phases of the study. For depression, surrogates were found to be significantly more depressed than expectant mothers at phase 1 (p = 0.012) and phase 2 (p = 0.017). Within the surrogacy group, stress and depression did not change during and after pregnancy. However, a non-significant trend was found showing that anxiety decreased after delivery (p = 0.086). No participants reported being coerced into surrogacy, however nearly all kept it a secret from their wider family and community and hence did not face criticism. Surrogates lived at the surrogate house for different durations. During pregnancy, 66% (N = 33/50) reported their experiences of the surrogate house as positive, 24% (N = 12/50) as negative and 10% (N = 5/50) as neutral. After delivery, most surrogates (66%, N = 30/45) reported their experiences of surrogacy to be positive, with the remainder viewing it as neutral (28%) or negative (4%). In addition, most (66%, N = 30/45) reported that they had felt “socially supported and loved” during the surrogacy arrangement by friends in the surrogate hostel, clinic staff or family. Most surrogates did not meet the intending parents (49%, N = 22/45) or the resultant child (75%, N = 34/45). Limitations, reasons for caution: Since the surrogates were recruited from only one clinic, the findings may not be representative of all Indian surrogates. Some were lost to follow-up which may have produced sampling bias. Wider implications of the findings: This is the first study to examine the psychological well-being of surrogates in India. This research is of relevance to current policy discussions in India regarding legislation on surrogacy. Moreover, the findings are of relevance to clinicians, counselors and other professionals involved in surrogacy. Trial registration number: N/A