Features of a mobile support app for patients with Chronic Obstructive Pulmonary Disease : literature review and current applications

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a serious long-term lung disease in which the airflow from the lungs is progressively reduced. By 2030, COPD will become the third cause of mortality and seventh cause of morbidity worldwide. With advances in technology and mobile communications, significant progress in the mobile health (mHealth) sector has been recently observed. Mobile phones with app capabilities (smartphones) are now considered as potential media for the self-management of certain types of diseases such as asthma, cancer, COPD, or cardiovascular diseases. While many mobile apps for patients with COPD are currently found on the market, there is little published material on the effectiveness of most of them, their features, and their adoption in health care settings. OBJECTIVES: The aim of this study was to search the literature for current systems related to COPD and identify any missing links and studies that were carried out to evaluate the effectiveness of COPD mobile apps. In addition, we reviewed existing mHealth apps from different stores in order to identify features that can be considered in the initial design of a COPD support tool to improve health care services and patient outcomes. METHODS: In total, 206 articles related to COPD management systems were identified from different databases. Irrelevant materials and duplicates were excluded. Of those, 38 articles were reviewed to extract important features. We identified 214 apps from online stores. Following exclusion of irrelevant apps, 48 were selected and 20 of them were downloaded to review some of their common features. RESULTS: Our review found that out of the 20 apps downloaded, 13 (65%, 13/20) had an education section, 5 (25%, 5/20) consisted of medication and guidelines, 6 (30%, 6/20) included a calendar or diary and other features such as reminders or symptom tracking. There was little published material on the effectiveness of the identified COPD apps. Features such as (1) a social networking tool; (2) personalized education; (3) feedback; (4) e-coaching; and (5) psychological motivation to enhance behavioral change were found to be missing in many of the downloaded apps. CONCLUSIONS: This paper summarizes the features of a COPD patient-support mobile app that can be take

Συστήματα υποστήριξης ιατρικών αποφάσεων με εφαρμογή στο σακχαρώδη διαβήτη τύπου 2

Εθνικό Μετσόβιο Πολυτεχνείο--Μεταπτυχιακή Εργασία. Διεπιστημονικό-Διατμηματικό Πρόγραμμα Μεταπτυχιακών Σπουδών (Δ.Π.Μ.Σ.) “Φυσική και Τεχνολογικές Εφαρμογές

Environmental Substances Associated with Chronic Obstructive Pulmonary Disease-A Scoping Review

Chronic obstructive pulmonary disease (COPD) is a slowly developing non-communicable disease (NCD), causing non-reversible obstruction and leading to marked morbidity and mortality. Besides traditional risk factors such as smoking, some environmental substances can augment the risk of COPD. The European Human Biomonitoring Initiative (HBM4EU) is a program evaluating citizens' exposure to various environmental substances and their possible health impacts. Within the HBM4EU, eighteen priority substances or substance groups were chosen. In this scoping review, seven of these substances or substance groups are reported to have an association or a possible association with COPD. Main exposure routes, vulnerable and high-exposure risk groups, and matrices where these substances are measured are described. Pesticides in general and especially organophosphate and carbamate insecticides, and some herbicides, lead (Pb), and polycyclic aromatic hydrocarbons (PAHs) showed an association, and cadmium (Cd), chromium (Cr and CrVI), arsenic (As), and diisocyanates, a possible association with COPD and/or decreased lung function. Due to long latency in COPD's disease process, the role of chemical exposure as a risk factor for COPD is probably underestimated. More research is needed to support evidence-based conclusions. Generally, chemical exposure is a growing issue of concern, and prompt action is needed to safeguard public health.Peer reviewe

Report on International Practice on Digital Apps

This landscape review provides an overview and examination of current international initiatives and practices to develop, assess and evaluate the use of mobile health and wellbeing apps and services. To accomplish this, seventeen academic, national, regional and international initiatives have been identified, examined and compared, detailing their wide-ranging approaches and scopes. The identified approaches include self-assessments questionnaires, independent accreditations, general guidelines / guiding principles, Codes of Conduct, risk-based assessments and Quality Assurance Frameworks. The examination and comparison of these drew attention to seven cohering quality parameters or criterions, which exist across many of the reviewed initiatives: * ‘Privacy / Data protection’ * ‘Credible sources / Evidence-based information’ * ‘Usability / user experience’ * ‘Functionality’ * ‘Security / authentication’ * ‘Effectiveness / Impact’ * ‘Interoperability’ These cohering parameters were identified in at least nine and up to sixteen instances, amongst the examined initiatives. Out of these ‘Privacy / Data protection’, ‘Credible sources / Evidence-based information’ and ‘Functionality’ were highly represented with sixteen and fifteen instances, while there is variation in their terminology and extent. The variation has been covered more extensively in section 1.1, where all seven indicators have been examined in-depth. Out of the seventeen initiatives examined, only four include all seven cohering parameters. These are the UK based Digital Assessment Questions (DAQs) and Quality Assurance Framework, the Canadian based Guiding Principles and the WHO MAPS toolkit. Yet of these, the DAQs are the only one, which covers all seven parameters comprehensively and in detail, whereas the Canadian Initiative and MAPS toolkit is not as detailed or specific within all of the seven parameters and the Quality Assurance Framework is still being drafted. The DAQs, created by NHS England can therefore be recommended to be used for approaching and assessing the hundred health and wellbeing apps in the clinical/wellbeing areas for the mPower interventions

Urban air pollution and health inequities: a workshop report.

Over the past three decades, an array of legislation with attendant regulations has been implemented to enhance the quality of the environment and thereby improve the public's health. Despite the many beneficial changes that have followed, there remains a disproportionately higher prevalence of harmful environmental exposures, particularly air pollution, for certain populations. These populations most often reside in urban settings, have low socioeconomic status, and include a large proportion of ethnic minorities. The disparities between racial/ethnic minority and/or low-income populations in cities and the general population in terms of environmental exposures and related health risks have prompted the "environmental justice" or "environmental equity" movement, which strives to create cleaner environments for the most polluted communities. Achieving cleaner environments will require interventions based on scientific data specific to the populations at risk; however, research in this area has been relatively limited. To assess the current scientific information on urban air pollution and its health impacts and to help set the agenda for immediate intervention and future research, the American Lung Association organized an invited workshop on Urban Air Pollution and Health Inequities held 22-24 October 1999 in Washington, DC. This report builds on literature reviews and summarizes the discussions of working groups charged with addressing key areas relevant to air pollution and health effects in urban environments. An overview was provided of the state of the science for health impacts of air pollution and technologies available for air quality monitoring and exposure assessment. The working groups then prioritized research needs to address the knowledge gaps and developed recommendations for community interventions and public policy to begin to remedy the exposure and health inequities

Comparison of household measure descriptions and food photographs in determining food portion sizes among young adults.

Background: Portion size estimation is one of the largest sources of error in dietary assessment and relies on individuals’ perception, memory and conceptual skills(1). Varying methods adopted by researchers and practitioners have led to conflicting conclusions on accuracy of current dietary assessment methods including food photography and household measure estimations. There is also an absence of research focusing on young adults in this area. This study aimed to assess the accuracy of portion size estimations using household measures and food photographs compared to actual weights, among young adults. Methods: In a cross-sectional study design, 35 (18 female, 17 male; aged 18–26 years) participants were recruited by posters distributed around a North England university campus. Participants volunteered by arriving at a designated location indicated on the posters. A short demographic questionnaire was completed before participants self- served a meal consisting of three items with either a definite shape (jacket potato) or amorphous foods of no defined shape (baked beans and grated cheese). Serving dishes were weighed before and after serving, providing the actual weight of foods served. Fifteen minutes after eating, a questionnaire was used to collect dietary information. Participants described portions using household measures e.g. number of spoonfuls or ‘small’, ‘medium’ or ‘large’. These were quantified using a portion size reference guide(2). A food photograph atlas(3) was used for selection of a photograph representing each item and the associated weight recorded. In total each participant provided three weights per component (i.e. actual weight, household measure estimate, food photograph estimate) providing 315 weights overall. Results: For the overall meal, household measure estimations were the most accurate with an average 4% underestimation compared to actual weight. Food photographs overestimated portion weight by 14% on average. For individual meal components food photographs were more accurate in estimating the size of jacket potatoes with no significant difference between estimates and actual weights (P = 0.34). Cheese was significantly overestimated by food photographs (P = 0.029) and underestimated by household description (P = 0.005) compared to actual weights. Baked beans were overestimated by both methods. Females overestimated more frequently, however differences in estimation between males and females were not statistically significant. Discussion: Estimated portion weights of all three food components differed significantly to actual weight for at least one of the methods. It would therefore be inappropriate to suggest that either method can assess the dietary intake of young adults without error. Household measure descriptions were closer to actual weight than estimations based on food photographs. Amorphous foods may be particularly prone to overestimation regardless of method. Consideration should be given to the likely overestimation in portion size associated with food photographs and underestimation with household measures. Both under- and over-estimation can be associated with household measure descriptions according to the type of food being assessed. Food photographs and household methods are useful portion size assessment tools for use among young adults only when inherent errors in both methods are acknowledged

Features of a mobile health intervention to manage chronic obstructive pulmonary disease: a qualitative study

Background: The use of mobile health (mHealth) interventions has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes. Further research is needed to determine which mHealth features are required to potentially enhance COPD self-management. Aim: The aim of this study was to explore the potential features of an mHealth intervention for COPD management with healthcare providers (HCPs) and patients with COPD. It could inform the development and successful implementation of mHealth interventions for COPD management. Methods: This was a qualitative study. We conducted semi-structured individual interviews with HCPs, including nurses, pharmacists and physicians who work directly with patients with COPD. Interviews were also conducted with a diverse sample of patients with COPD. Interview topics included demographics, mHealth usage, the potential use of medical devices and recommendations for features that would enhance an mHealth intervention for COPD management. Results: A total of 40 people, including nurses, physicians and pharmacists, participated. The main recommendations for the proposed mHealth intervention were categorised into two categories: patient interface and HCP interface. The prevalent features suggested for the patient interface include educating patients, collecting baseline data, collecting subjective data, collecting objective data via compatible medical devices, providing a digital action plan, allowing patients to track their progress, enabling family members to access the mHealth intervention, tailoring the features based on the patient’s unique needs, reminding patients about critical management tasks and rewarding patients for their positive behaviours. The most common features of the HCP interface include allowing HCPs to track their patients’ progress, allowing HCPs to communicate with their patients, educating HCPs and rewarding HCPs. Conclusion: This study identifies important potential features so that the most effective, efficient and feasible mHealth intervention can be developed to improve the management of COPD

EQ-5D-5L population norms and health inequalities for Trinidad and Tobago

The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values. The Kakwani index and logistic regression models were used to evaluate inequalities in health. Mean EQ-5D index values and EQ-VAS values were calculated by age group, ethnicity, gender, income, educational attainment, employment status and place of residence. The 10 most commonly observed EQ-5D-5L states accounted for 90% of the respondents. The mean VAS value for the sample was 83.6 and the mean EQ-5D-5L index value was 0.95. Pain/discomfort was found to be the EQ-5D dimension with the highest prevalence of reported problems with 22% of the population reporting pain at any level. Self-care was the dimension with the lowest prevalence of problems reported at any level (3%). Health declines with increasing age, and men reported fewer problems and higher levels of self-reported health than women. Age, gender and education level were found to be important drivers of health status as measured by the EQ-5D instrument. Being in a very low income group was also observed to affect EQ-VAS values among younger respondents. The population norms provided in this study can be used by clinicians, academics and policy makers in several ways. They can be used in comparing different demographic groups or patient groups, or as a basis for tracking the progress of patients through a treatment regimen. They can also provide a baseline for cost utility analysis of health interventions for Trinidad and Tobago