HealtheLife: Using a Patient Portal App to Reduce Type 2 Diabetes in East Los Angeles

The following proposal explores a potentially cost effective and cost efficient solution to alleviate the burden of type 2 diabetes among White Memorial Medical Center (WMMC) patients and their primary service area within Los Angeles County Service Planning Area 4 (SPA-4). SPA-4 is a medically underserved area with numerous key health indicators that indicate the need for increased self-management efforts among its Hispanic population. In response, WMMC has made a commitment to the SPA-4 community and made diabetes atop its community priority. An organization-wide Glycemic Control Project was created by WMMC administrators to provide more effective services by using Health Information Technology (HIT) within its operations. In support of this project, the WMMC Clinical Informatics Systems (CIS) department has proposed the use of Healthelife mobile application to improve diabetes self-management in WMMC transitional care. A literature review was conducted but, found very limited efficacy studies on mobile patient portal apps and patient portals mhealth interventions among Hispanic diabetics. However, several studies have implied that there are great research opportunities in tailoring the use of a patient portal mobile application for Hispanics, expanding its use within DMSE sessions through Community Health Workers, utilizing the trending mhealth functionality of patient portals, as well as proposing eHealth interventions that reduce health disparities. As a newly available resource to WMMC, the Healthelife mobile application is Cerner’s multilingual patient portal mobile application that is already live and fully integrated with WMMC’s “My Adventist Health” patient portal”. Accordingly, WMMC CIS has proposed a HealtheLife pilot program among its Hispanic patients to determine if its use will improve self-management efficacy and glycemic control among WMMC Type 2 diabetics (18+ years old). Technological Acceptance Model (TAM), Social Support, and Social Cognitive Theory will be applied throughout the pilot to gradually condition Healthelife usage among WMMC patients/caregivers for tailored educational experiences that strengthen WMMC Diabetes Self-Management (DSME) sessions. Essentially, diabetes educators will conduct the pilot program on adult Hispanics (18+) who are inpatient diabetics transitioning to Adventist Health Physician Network (AHPN) Physicians and DSME outpatient services. Primarily, the pilot will aim to improve A1Cs, Self-efficacy, and DSME attendance. Secondary outcomes of the intervention will be asses by qualitative assessment of Healthelife functionality, observed ED use, and ED readmission. All outcomes will be assessed through an internal quasi-experimental study examining an intervention group using Healthelife against a retrospective control groups from 2016. In sum, goal of the pilot program will set forth a care path that improve patients’ continuity of care and diabetes prevention beyond the walls of WMMC operations. By adopting the use of Healthelife as a population health tool, WMMC has the potential to intensify current DSME curriculum, to preventative unnecessary ED use, and to improve type 2 diabetes prevention efforts within SPA-4. More importantly, the suggestion to pilot Healthelife progressively introduces the benefits of HIT to Hispanic populations who are underserved and with limited resources

Mobile health applications for disease screening and treatment support in low-and middle-income countries

The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile phone penetration is increasing exponentially in low-and middle-income countries, hence using mobile phones for healthcare services could reach more people in resource-limited settings than the traditional forms of healthcare provision. The review presents recent literature on facilitators and barriers of implementing mHealth for disease screening and treatment support in low-and middle-income countries. We searched for relevant literature from the following electronic databases: MEDLINE; CINAHL with full text via EBSCOhost; Science Direct; PubMed; Google Scholar and Web of Science using the keywords for relevant studies. We searched for published studies from 2015 to August 2020 with no language limitations. A total of 721 articles identified, 125 articles met the inclusion criteria and were included in the qualitative synthesis. The review demonstrates relevant facilitators for the implementation of mHealth, which includes knowledge, attitudes, and perceptions of stakeholders on the use of mHealth and the performance of mHealth for disease diagnosis in low and-middleincome countries. Barriers and challenges hindering the implementation of mHealth applications were also identified. We proposed a framework for improving the implementation of mHealth for disease screening and treatment support in low-and middle-income countries.http://www.cell.com/heliyonam2022School of Health Systems and Public Health (SHSPH

Perceptions of Patients Regarding Mobile Health Interventions for the Management of Chronic Obstructive Pulmonary Disease: Mixed Methods Study

Background: Using a mobile health (mHealth) intervention consisting of a smartphone and compatible medical device has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective: This study aims to describe the demographics, use, and access to smartphones of patients with COPD. It also aims to explore and develop an understanding of potential facilitators and barriers that might influence patients using mHealth interventions for COPD management. Methods: This was an explanatory, sequential mixed methods study. Patients who attended respirology clinics completed a questionnaire on technology access and use. We conducted semistructured individual interviews with the patients. Interview topics included the following: demographics, mHealth use, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of mHealth interventions for COPD management. Results: A total of 100 adults completed the survey but 22 participants were excluded because they were not diagnosed with COPD. Of these, 10 patients with COPD participated in the interview. The quantitative component revealed that many patients with COPD owned a mobile phone, but only about one-fourth of the participants (18/77, 23%) owned a smartphone. The likelihood of owning a smartphone was not associated with age, sex, marital status, or geographical location, but patients with high educational status were more likely to own a smartphone. The qualitative component found that patients with COPD, in general, had a positive attitude toward mHealth adoption for COPD management, but several facilitators and barriers were identified. The main facilitators of mHealth adoption are possible health benefits for patients, ease of use, educating patients, and credibility. Alternatively, the barriers to adoption are technical issues, lack of awareness, potential limited uptake from older adults, privacy and confidentiality issues, finances, and lack of interest in mHealth Conclusions: It is important to understand the perceptions of patients with COPD regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management

An adaptive real-time intelligent system to enhance self-care of chronic disease (ARISES)

Diabetes mellitus is an increasingly prevalent chronic metabolic condition characterised by impaired glucose homeostasis and raised blood glucose levels (hyperglycaemia). Broadly categorised as either type 1 (T1DM) or type 2 diabetes (T2DM), people with diabetes are largely responsible for self-managing their blood glucose levels. Despite the development of diabetes technologies such as real time continuous glucose monitoring (RT-CGM), many individuals are frequently exposed to iatrogenic low blood glucose levels (hypoglycaemia). Severe hypoglycaemia is associated with an increased risk of recurrent hypoglycaemia, impaired symptomatic awareness of hypoglycaemia, and potentially death if left untreated. This thesis affirmed the existing clinical impact of severe hypoglycaemia and its recurrent risk in a six-month analysis of severe hypoglycaemia attended by the London Ambulance Service NHS Trust (LAS). Fewer incidents of severe hypoglycaemia observed in a date matched repeat analysis during the 2020 COVID-19 lockdown suggested improved self-management possibly motivated by a proximal fear of hospitalisation and improved structure at home. Finally, a 12-week randomised control trial demonstrating a significant difference in time spent in hypoglycaemia <3mmol/L, is the first study to prove the immediate provision of RT-CGM significantly reduces the risk of recurrent hypoglycaemia. Moreover, it highlighted the impact of socioeconomic disparity as a barrier to effective hypoglycaemia risk modification. This guided the design of an adaptive real time intelligent system to enhance self-care of chronic disease (ARISES) aimed to deliver therapeutic and lifestyle decision support for people with T1DM. The ARISES graphic user interface (GUI) design was a collaborative process conceived in a series of focus group meetings including people with T1DM. Finally, a 12-week observational study using RT-CGM, a physiological sensor wristband, and a mobile diary app, allowed for a sub-analysis identifying measurable physiological parameters associated with current and impending hypoglycaemia in people with T1DM.Open Acces

An overview of the current stage and future

Perante o acentuado desenvolvimento da e-saúde, das suas ferramentas e possíveis utilizações, urge fazer uma avaliação do estado de arte, reunir os conceitos chave para a sua abordagem e interpretação, apresentar as vantagens e obstáculos que existem na sua integração nos sistemas de saúde e, também, enumerar alguns exemplos em vigor no mundo, que provam o sucesso destas tecnologias. Assim, neste trabalho, são caracterizadas as populações e áreas que mais podem beneficiar com este tipo de práticas (e de que forma o podem fazer), qual o papel que a telessaúde desempenha, atualmente, e qual poderá vir a ter num futuro próximo. Defende-se que o seu desenvolvimento seja sustentável e sempre respeitador da segurança do utilizador, colocandoo no centro de todos os projetos, garantindo que é o utente o maior beneficiário de todos estes processos e que não vê os seus cuidados de saúde saírem prejudicados com a implementação deste tipo de tecnologias. Muitas questões merecem uma séria reflexão por serem novas e não terem sido, ainda, alvo de legislação e regulamentação apropriadas: algumas delas são apresentadas no decorrer deste trabalho.With the rapidly progress of e-health, its tools and possible uses, come the need to evaluate the current stage and gather all the basic concepts for its approach and right interpretation, as well as the advantages and obstacles it brings to the health systems. It is also necessary to give some examples of what is, currently, being done in the world and their proof of success. Therefore, I characterize the areas and populations that might have more to benefit with the use of these technologies (and how they can do it), the e-health’s role and what it can do in the near future. I advocate the growth of these alternative ways of practicing medicine to be sustainable and respectful of the patient´s safety, prioritizing them, and ensuring that they benefit from this process without ever putting their health in jeopardy. Many questions deserve consideration, as they bring new dilemmas and are not yet under proper legislation: some of them are presented in this wor

Healthcare Access

Adequate healthcare access not only requires the availability of comprehensive healthcare facilities but also affordability and knowledge of the availability of these services. As an extended responsibility, healthcare providers can create mechanisms to facilitate subjective decision-making in accessing the right kind of healthcare services as well various options to support financial needs to bear healthcare-related expenses while seeking health and fulfilling the healthcare needs of the population. This volume brings together experiences and opinions from global leaders to develop affordable, sustainable, and uniformly available options to access healthcare services

A Latent Profile Analysis of Health-related Quality of Life Domains in Cancer Survivors

PurposeThe aim of this research was to examine heterogeneity of Health-related Quality of Life (HrQOL) in Cancer Survivors (both undergoing and completed treatment) using latent profile analysis and to determine whether these groups differed by demographic and health characteristics.MethodsParticipants(n=229) recruited through an oncology day ward and outpatient department in a local hospital, completed height, weight and handgrip measures as well as the validated patient generated subjective global assessment and EORTC-QLQ-C30 questionnaires. A latent profile analysis was performed to identify subgroups based on HrQOL domain scores. Multinominal Logistic Regression was conducted to determine the relationship between these subgroups and demographic and health characteristics. ResultsThree latent subtypes were identified: (1)high quality of life(n=122, 52.8%); (2)compromised quality of life(n=79, 34.2%) and (3)low quality of life(n=30, 12.99%). All subtypes scored lower for functioning scales (with the exception of the higher quality of life group for physical, role and emotional functioning) and higher for symptom scales then the reference norm population. There were large clinically meaningful differences between the high quality of life group and the low quality of life group for all HrQOL scales. Those in the low quality of life group were slightly younger than those in the high quality of life group(OR = 0.956, p &lt; .05, CI = 0.917– 0.998). Workers were &gt;7 times more likely to be in low quality of life than the high quality of life group. Compared to the high quality of life group, the odds of belonging to the compromised quality of life group decreased significantly by having higher handgrip strength (OR = .955, p &lt; .05, CI = .924 - .988). The odds of belonging to the low quality of life group increased significantly for those with higher number of nutrition impact symptoms (NIS) (OR = 1.375, p &lt; .05, CI = 1.004 – 1.883).ConclusionsThis is the first study to examine heterogeneity of HrQOL using latent profile analysis in Irish Cancer Survivors. In clinical practice understanding how aspects of HrQOL group together may allow clinicians to better understand and treat cancer survivors, informing more individualised nutrition care.<br/

A Latent Class Analysis of Nutrition Impact Symptoms in Cancer Survivors

Purpose: Those with a cancer diagnosis report experiencing a wide range of nutrition impact symptoms with prevalence varying by study, group and cancer type. We aimed to identify groups of cancer survivors with specific patterns of nutrition impact symptoms.Methods: 229 individuals attending oncology day ward and outpatient clinics completed a series of questionnaires and physical measurements. A latent class analysis was performed to identify subgroups based on 13 nutrition impact symptoms taken from the Patient Generated Subjective Global Assessment Short Form. The identified classes were subsequently compared using analysis of variance and chi-square tests, by sociodemographic, clinical and nutritional variables as well as by Global health status (GHS) and five functioning scales determined using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Results: Three latent subtypes were identified: (1) Fatigue (n=58, 28%); (2) Low Symptom Burden (n=146, 64%) and (3) High Symptom Burden (n=25, 11%). Those in the High Symptom Burden group were more likely to be female, currently receiving any form of treatment and have consumed less food than usual in the last month compared to those in the Low Symptom Burden group. Those in the Fatigue group were more likely were more likely to have reported consuming less food in the previous month and less likely to have reported their food intake to be unchanged than those in the Low Symptom Burden group. Those who received their diagnosis two years+ ago were most likely to be classed in the Fatigue group. The EORTC-QLQ-C30 functioning and GHS scores were all significantly different between the three nutrition impact symptoms classes (p&lt;0.001)Conclusion: This is the first study to examine heterogeneity of nutrition impact symptoms in Irish Cancer Survivors. The findings of this work will inform and allow for more individualised nutrition care.<br/

Health Promotion in Health Care - Vital Theories and Research

This Open Access textbook represents a vital contribution to global health education, offering insights into health promotion as part of patient care for bachelor’s and master’s students in health care (nurses, occupational therapists, physiotherapists, radiotherapists, social care workers etc.) as well as health care professionals, and providing an overview of the field of health science and health promotion for PhD students and researchers.  Written by leading experts from seven countries in Europe, America, Africa and Asia, it first discusses the theory of health promotion and vital concepts. It then presents updated evidence-based health promotion approaches in different populations (people with chronic diseases, cancer, heart failure, dementia, mental disorders, long-term ICU patients, elderly individuals, families with newborn babies, palliative care patients) and examines different health promotion approaches integrated into primary care services.  This edited scientific anthology provides much-needed knowledge, translating research into guidelines for practice. Today’s medical approaches are highly developed; however, patients are human beings with a wholeness of body-mind-spirit. As such, providing high-quality and effective health care requires a holistic physical-psychological-social-spiritual model of health care is required. A great number of patients, both in hospitals and in primary health care, suffer from the lack of a holistic oriented health approach: Their condition is treated, but they feel scared, helpless and lonely. Health promotion focuses on improving people’s health in spite of illnesses. Accordingly, health care that supports/promotes patients’ health by identifying their health resources will result in better patient outcomes: shorter hospital stays, less re-hospitalization, being better able to cope at home and improved well-being, which in turn lead to lower health-care costs.  This scientific anthology is the first of its kind, in that it connects health promotion with the salutogenic theory of health throughout the chapters. the authors here expand the understanding of health promotion beyond health protection and disease prevention. The book focuses on describing and explaining salutogenesis as an umbrella concept, not only as the key concept of sense of coherence. publishedVersio

Tomorrow's healthy society - Research priorities for foods and diets

Health promotion and disease prevention through provision and consumption of healthy diets are increasingly recognised as crucial, both socially and economically, in the face of strained healthcare systems, an ageing population, and the high individual and economic costs of diseases.The Foresight study ‘Tomorrow's healthy society – research priorities for foods and diets’ was initiated to inform the selection of research challenges to receive funding under the Horizon 2020 programme. The exploratory scenario-building approach focused on the European consumer with the year 2050 as a long-term time horizon. Four different future scenarios were developed using the extremes of two main drivers – agricultural commodity prices (low or high) and societal values (community spirit or individualistic society). The scenarios provided the basis for the identification and prioritisation of research needs to address the challenges and opportunities arising from the different scenarios. The resulting ten research priorities fall into four thematic areas: Towards healthier eating: integrated policy-making; Food, nutrients and health: cross-interactions and emerging risks; Making individualised diets a reality; and Shaping and coping with the 2050 food system.JRC.DDG.02-Foresight and Behavioural Insight