Collaborative group support in e-Health

In critical areas such as decision making, the Collaborative Work has an uttermost importance. Being a complex problem, the collective decision taking is currently a popular form of taking decisions. In this work we present the VirtualECare project: an intelligent multi-agent system able to monitor, interact and serve its customers (in need of care services). In developed countries, recent census data report a sudden increase in the elderly community together with a decrease of child birth. This is a new reality that needs to be dealt by the health sector, particularly by the public one. In an early stage, this new situation appears mostly as a financial problem. The costs involved in the health care are considerable. Thus, alternative technological solutions that lead to straightforward solutions should be adopted. Recently, a growing interest in combining the advances in information society - computing, telecommunications and presentation - to create Group Decision Support Systems (GDSS), has been observed. It is our view that the use of the GDSS in the health care area will pursue the achievement of better results in terms of patients Electronically Clinical Profile (ECP). Additionally, we believe that the best way of managing health appointments is through the use of calendars - one application that can manage both the physicians and patients calendars and consequently their day schedule. Within this area, the approaches used in the VirtualECare and iGenda projects are presented.(undefined

From the Workplace to Home: The Impact of an Email Intervention Targeting the Family

Background and Purpose: Improved employee health contributes to improved employer outcomes in productivity, attendance and workplace satisfaction. Wellness programs focus on the employee to improve these outcomes, but fail to offer opportunities that include the family. A focus on the employee and their child may yield greater health improvements. This pilot study explored the impact of an e-mail intervention targeting the employee and his/her child on their physical activity level, self-efficacy and social control (SC). Methods: Parent and child dyads were recruited from faculty and staff at a university and were subsequently randomized into an intervention group (family-focused activities) or a control group (employee-focused activities). Both parents and children (ndyads = 19) completed a baseline and follow-up (10 weeks later) online questionnaire that measured physical activity, self-efficacy, and SC. Results: Significant differences in parents were found in task efficacy, scheduling efficacy, and collaborative SC, where the intervention group reported higher changes for these outcomes compared to the control group (p<0.10). Changes in collaborative SC reported by children in the intervention group approached significance (p = 0.13). Conclusion: Findings provide initial support for an e-mail based wellness programs’ targeting family-based activities compared to an intervention targeting the employee alone

Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: Design of a cluster randomized controlled trial

Background: Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual. Methods: This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4-26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6

Healthcare professionals' perspectives on mental health service provision : a pilot focus group study in six European countries

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision

A Common Monitoring & Evaluation Framework Guided by the Collective Impact Model: Recommendations to Enhance the Tobacco Control Effort in Sub-Saharan Africa

Background: Tobacco use is one of the most ubiquitous causes of death and disability worldwide. In sub-Saharan Africa, despite the rising trend the use of tobacco in generally low among adults - less than 10% in men and around 2% in women. As a result the region is viewed as being in the early stages of the four stage tobacco epidemic model. Projections suggest that the tobacco epidemic, if unchecked, can peak in Sub-Saharan Africa in the middle of this century. This offers the public health community an extraordinary opportunity – not only is the epidemic predicted so far in the future, there is knowledge on how to prevent it. The purpose of this study is to (a) research and assess case studies and theoretical frameworks used to guide global collaborative efforts in public health and development; (b) develop, administer, and summarize feedback collected from key stakeholders representing organizations critical in SSA tobacco control efforts; (c) analyze findings and identify gaps in the collective action; recommend opportunities to improve the systematic operations/capacity of all collaborating partners within SSA so that progress and collective impacts are maximized in the future. Methods: Secondary data was first sorted using a comparative, thematic approach to detect themes related to M&E practices at individual (organizational) level and at the group (collective) level. The sorted data was then analyzed using hypothesized content analysis for alignment of individual and group perceptions across the five components necessary for a collaborative effort to achieve a collective impact - shared agenda, shared measurements, mutually reinforcing activities, on-going communications, and support organization. Results: Current practices of M&E are perceived as sub-optimal both at individual and group levels. Even though the secondary data was focused primarily on shared measurements, the mapping of individual and group level perceptions against the five components of collective impact indicates that attributes of the other four components were organically included in the discussion in varied depths. Analysis of perception indicates general willingness to adopt a common monitoring and evaluation framework. Conclusions: A common M&E framework remains a missing component of the collaborative effort striving to prevent the tobacco epidemic in sub-Saharan Africa. It is needed to learn from past successes and challenges and to inform strategy of current and future initiatives so that collaborating organizations are better able seize the unprecedented opportunity of preventing death and suffering from tobacco related illnesses in sub-Saharan Africa. It is important that such an M&E framework be thoughtfully conceptualized within the context of a common agenda, and supported by processes that facilitate mutually reinforcing activities and continuous communication among collaborators

Blended learning: combining action learning and virtual learning to facilitate independent and collaborative learning for post-graduate Specialist Community Public Health Nursing (SCPHN) students

The aim of this paper is to present a critical appraisal of the use of a blended approach to support part-time post graduate student learning. The effectiveness of blended learning approaches using action learning and a virtual learning environment for post-graduate part-time Public Health Nursing students will be discussed using examples from current experience, student feedback and supported by appraisal of published evidence. Strengths and limitations of this blended learning approach will be evaluated and the potential for further developments considered. The development of a new MSc Public Health Nursing Practice programme in 2006 has enabled the team to implement flexible approaches to learning within the curriculum. Post-graduate/post-registration students on this three year part-time course are engaged with a range of learning media to enhance skills development in the use of ICT and independent and collaborative learning techniques. Using E-learning in conjunction with Action Learning Sets to undertake both formative and summative assessment activities provides the necessary support to help students engage in on-line activities. Groups are asked to work together, on-line and face to face, on assigned tasks and present the outcomes online to the student group and tutor for feedback. Students are supported to develop their IT literacy through the provision of face to face taught sessions by IT experts and on-line tutorials. Lecturers can assess student progress and analyse student contributions through reviewing student interactions and work and evaluating learning online. The Department for Education and Skills and Department of Health are encouraging the use of e-learning and recognise its potential value in promoting lifelong learning and increasing flexibility and access to education. It is envisaged that this combination of teaching and learning strategies will help overcome some of the perceived barriers to e-learning and facilitate independent and collaborative learning for post-graduate students

A Multilevel Investigation of Participation Within Virtual Health Communities

Virtual health communities are a major channel through which health consumers share health-related knowledge and/or exchange social support with their peers. These virtual environments can be a form of, or a potential component of, integrated Patient-centered e-Health (PCEH) applications, which represent emerging healthcare information systems that emphasize the role of patients and revolve around providing patient-focus, patient-activity, and patient-empowerment services. Because of the collaborative nature of virtual health communities, user participation is a critical factor for community growth and prosperity. In this study, we examine user participation at the individual and group (thread) levels. At the individual level, we investigate the impact of reciprocity and homophily (similarity of user characteristics such as age, gender, and tenure) on user participation within virtual health communities. At the thread level, we study the role of highly active users (power users) as thread initiators as well as the role of thread initiators’ participation on the overall thread vibrancy. To do so, we analyzed 2,176 threads initiated by 130 users and 1,947 messages exchanged between these users and their peers. Our results support short-term reciprocity, but refute the positive relationship associated with long-term reciprocity. Among homophily hypotheses, our results support gender homophily, but not age or tenure homophily. At the thread level our findings suggest that a discussion thread is vibrant if the thread initiator is a power user or participates actively within the thread. These findings have important implications for future research and practice in PCEH applications

Mastering Of Hypermedia Resources By Virtual Learning Communities: Possibilities And Constraints For Interaction, Communication And Construction Of Network Knowledge.

The purpose of this paper is to present the procedures and some of the results from the investigation on the use of hypermedia resources for the construction of network knowledge. These resources, available in a distance learning support environment, are used for the process of interaction and production of knowledge through a virtual learning community (VLC) under formation. This VLC aims at providing a collaborative environment equipped with multimedia resources focused on information, communication and continuing education for community health agents[1], as well as nurses, physicians, teachers and other people who work in public establishments which offer access to Information and Communication Technologies in the city of Pedreira in the countryside of São Paulo. In this context, collaborative learning situations are shaped where users/learners master procedures, strategies and multimedia resources available and make “products” using audiovisual aids.  The “products” are presented, discussed and revised by the group to be later distributed to and shared with the relevant community. Based on such activities, it was possible to understand that the use of audiovisual aids in virtual learning environments (i.e., tools which enable different forms of expression and the establishment of the distance communication among people on the Web through the joint use of visual and sound components) are able to boost the learning process by overcoming the training constraints typically found in traditional models and thus expanding the range of possibilities for the construction of knowledge.[1] In Brazil, a community health agent is a lay health care worker who is not certified to practice medicine or nursing, but has the primary task of gathering information on the health status of a small community by means of a close relationship with it.[pt]Este artigo tem como objetivo apresentar e discutir ideias, métodos, procedimentos e resultados relacionados à investigação sobre a utilização de recursos hipermidiáticos para a construção de conhecimentos em rede. Estes recursos, disponíveis em um ambiente de suporte de educação a distância são utilizados para o processo de interação e produção de conhecimentos por uma comunidade virtual de aprendizagem (CVA) em formação. Esta CVA pretende ser um espaço colaborativo, com recursos multimídia, voltada para a informação, comunicação e formação continuada de agentes comunitários de saúde, enfermeiros, médicos, professores e demais pessoas vinculadas aos espaços públicos de acesso as tecnologias de informação e comunicação do município de Pedreira-SP

Barley-ß-glucans reduce systemic inflammation, renal injury and aortic calcification through ADAM17 and neutral-sphingomyelinase2 inhibition

In chronic kidney disease (CKD), hyperphosphatemia-induced inflammation aggravates vascular calcification (VC) by increasing vascular smooth muscle cell (VSMC) osteogenic differentiation, ADAM17-induced renal and vascular injury, and TNFα-induction of neutral-sphingomyelinase2 (nSMase2) to release pro-calcifying exosomes. This study examined anti-inflammatory β-glucans efficacy at attenuating systemic inflammation in health, and renal and vascular injury favoring VC in hyperphosphatemic CKD. In healthy adults, dietary barley β-glucans (Bβglucans) reduced leukocyte superoxide production, inflammatory ADAM17, TNFα, nSMase2, and pro-aging/pro-inflammatory STING (Stimulator of interferon genes) gene expression without decreasing circulating inflammatory cytokines, except for γ-interferon. In hyperphosphatemic rat CKD, dietary Bβglucans reduced renal and aortic ADAM17-driven inflammation attenuating CKD-progression (higher GFR and lower serum creatinine, proteinuria, kidney inflammatory infiltration and nSMase2), and TNFα-driven increases in aortic nSMase2 and calcium deposition without improving mineral homeostasis. In VSMC, Bβglucans prevented LPS- or uremic serum-induced rapid increases in ADAM17, TNFα and nSMase2, and reduced the 13-fold higher calcium deposition induced by prolonged calcifying conditions by inhibiting osteogenic differentiation and increases in nSMase2 through Dectin1-independent actions involving Bβglucans internalization. Thus, dietary Bβglucans inhibit leukocyte superoxide production and leukocyte, renal and aortic ADAM17- and nSMase2 gene expression attenuating systemic inflammation in health, and renal injury and aortic calcification despite hyperphosphatemia in CKD.A grant to A.S.D. and M.J.M. from IRBLleida and Agrotecnio Research collaborative projects from the Consell Social at Lleida University supported initial work, Instituto de Salud Carlos III and co-funded by European Union (ERDF/FEDER) (FIS PI11/00259, PI14/01452, PI17/02181), Plan de Ciencia, Tecnología e Innovación 2013–2017 y 2018–2022 del Principado de Asturias (GRUPIN14-028, IDI-2018-000152), RedInRen from ISCIII (ISCIII-RETIC REDINREN RD16/0009). Investigator support included: NC-L by GRUPIN14-028 and IDI-2018-000152, LM-A by GRUPIN14-028, SP by FICYT; MVA and PV by Educational Grant 2 A/2015 from ERA-EDTA CKD-MBD Working Group; PV and AC by ERA-EDTA fellowships 2011 and 2012; JR-C by MINECO (“Juan de la Cierva” program, FJCI-2015-23849); A.S.D. by Asociación Investigación de Fisiología Aplicada. A.S.D. and M.J.M. are members of the Campus Iberus (Ebro Valley Campus of International Excellence)

Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care