Towards a Smarter organization for a Self-servicing Society

Traditional social organizations such as those for the management of healthcare are the result of designs that matched well with an operational context considerably different from the one we are experiencing today. The new context reveals all the fragility of our societies. In this paper, a platform is introduced by combining social-oriented communities and complex-event processing concepts: SELFSERV. Its aim is to complement the "old recipes" with smarter forms of social organization based on the self-service paradigm and by exploring culture-specific aspects and technological challenges.Comment: Final version of a paper published in the Proceedings of International Conference on Software Development and Technologies for Enhancing Accessibility and Fighting Info-exclusion (DSAI'16), special track on Emergent Technologies for Ambient Assisted Living (ETAAL

Treatment of hypertension in rural Cambodia: results of a 6-year programme

This study was aimed to describe the outcomes of a hypertension treatment programme in two outpatient clinics in Cambodia. We determined proportions of patients who met the optimal targets for blood pressure (BP) control and assessed the evolution of mean systolic and diastolic BP (SBP/DBP) over time. Multivariate analyses were used to identify predictors of BP decrease and risk factors for LTFU. A total of 2858 patients were enrolled between March 2002 and June 2008 of whom 69.2% were female, 30.5% were aged >/=64years and 32.6% were diabetic. The median follow-up time was 600 days. By the end of 2008, 1642 (57.4%) were alive-in-care, 8 (0.3%) had died and 1208 (42.3%) were lost to follow-up. On admission, mean SBP and DBP were 162 and 94 mm Hg, respectively. Among the patients treated, a significant SBP reduction of 26.8 mm Hg (95% CI: 28.4-25.3) was observed at 6 months. Overall, 36.5% of patients reached the BP targets at 24 months. The number of young adults, non-overweight patients and non-diabetics reaching the BP targets was more. Older age (>64 years), uncontrolled DBP (>/=90 mm Hg) on last consultation and coming late for the last consultation were associated with LTFU, whereas non-diabetic patients were 1.5 times more likely to default than diabetics (95% CI: 1.3-1.7). Although the definite magnitude of the BP decrease due to antihypertension medication over time cannot be assessed definitely without a control group, our results suggest that BP reduction can be obtained with essential hypertension treatment in a large-scale programme in a resource-limited setting

Knowledge of Type II Diabetes and its Complications Among Adult Vietnamese Immigrants

This was a non-experimental quantitative study using survey method to assess diabetic knowledge of 102 adult Vietnamese immigrants. The Health Belief Model provided the theoretical framework, and the 24-item diabetes knowledge questionnaire was adopted from the Starr County Texas study to use for this study. Data were categorized and analyzed using descriptive methods such as frequency and percentage. The findings indicated that lack of knowledge about diabetes was a significant issue among the Vietnamese immigrant population. Health care providers should develop an appropriate cultural educational program about diabetes to help the Vietnamese population to detect diabetes early and to control diabetes effectively

Physical activity and hypertension in South African adults

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 2.5 South Africa LicenseEstimates suggest that approximately 6-million South Africans have hypertension, with half classified as stage 1 (mild). Mindful of the cost of lifelong drug therapy, the South African Hypertension Society guidelines suggest delaying drug therapy through lifestyle modification (increased physical activity and weight management) in all but those with the highest risk. This pilot study examined the relationship of BP with physical activity and bodyweight in black South African adults employed in physical occupationsNon peer reviewe

Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Mobile Health Monitoring

Chronic diseases impose heavy burden and costs on the health industry in many countries. Suitable health procedures, management, and prevention of disease by continuous monitoring through modern technologies can lead to a decrease in health costs and improve people empowerment. Applying remote medical diagnosis and monitoring system based on mobile health systems can help significantly reduce health care costs and correct performance management particularly in chronic disease management. In this chapter, mHealth opportunities in patient monitoring with the introduction of various systems specifically in chronic disease are expressed. Also mHealth challenges in patient monitoring in general and specific aspects are identified. Some of the general challenges include threats to confidentiality and privacy, and lack of information communication technology (ICT), and mobile infrastructure. In specific aspect, some difficulties include lack of system interoperability with electronic health records and other IT tools, decrease in face-to-face communication between doctor and patient, ill-functioning of system that leads to medical errors and negative effects on care outcomes, patients, and personnel, and factors related to the telecommunication industry include reliability and sudden interruptions of telecommunication networks

Evaluation of a Comprehensive Diabetes Mellitus Protocol at a Rural, Federally Qualified Health Center in Southern West Virginia

Background: Diabetes mellitus is a chronic disease that affects nearly 34 million Americans. In rural Appalachia, the population is affected disproportionately at a rate of 14% compared to the national average of 10%. Diabetes is a lifelong, chronic condition managed best by a multidisciplinary team-based approach to achieve optimal disease control. Best practices in the care of diabetes support the use of evidenced based care protocols and leveraging technology to decrease the burden of disease. Type 2 diabetes mellitus (T2DM) is the most common type, making it the focal population for evaluation. Purpose: The purpose of this project was to evaluate the impact of a standardized diabetes mellitus protocol for patients with T2DM at a rural federally qualified health center (FQHC) in rural southern West Virginia. Program evaluation completes the care cycle. This information can inform stakeholders about a protocol’s effectiveness, thus leading to recommendations for change to improve T2DM education and outcomes in healthcare delivery. Intervention and Methods: Program Evaluation was completed using a retrospective chart review and a provider survey. Objective 1 was to evaluate the diabetes protocol using seven core quality measures (hemoglobin A1c, blood pressure, low density lipoprotein [LDL] cholesterol, diabetes self-management education (DSME), annual urine microalbumin, retinopathy, and neuropathy exams) over three years (pre-protocol T1 and post-protocol T2 and T3). Objective 2 utilized a provider survey to determine behaviors regarding Type 2 Diabetes Mellitus (T2DM) protocol and diabetes education team awareness and utilization. Results: Results for Objective 1 found statistically significant improvement at T3 for diastolic blood pressure and annual microalbumin, but not for other metrics. Overall, most metrics noted improvement or stabilization over all time periods despite the evaluation taking place during the COVID-19 pandemic. Results for Objective 2 found that majority of providers were aware of the T2DM protocol and utilized the diabetes education accreditation program (DEAP) team regularly. Conclusion: The evaluation provided valuable insight on the current efforts to reduce the burden of diabetes mellitus at the facility in rural West Virginia. Over half of all core quality measures met facility benchmarks, however measures for DSME referral, A1c, retinopathy and neuropathy exams are still lower than expected. All providers agree that COVID-19 had a negative impact on patient care. Recommendations for improvements in practice include a patient-individualized approach to care with increasing utilization of the DEAP team, and continuous provider support of DSME in the management of patients with T2DM