SHELDON Smart habitat for the elderly.

An insightful document concerning active and assisted living under different perspectives: Furniture and habitat, ICT solutions and Healthcare

Cenários comunicacionais baseados em IOT para a promoção do bem-estar físico, psicológico e social dos séniores

The main objective of this research is to design and validate IoT based social hybrid scenario model that has the potential to promote psychological and physical wellbeing among older adults. The main reason to design and validate the model is age growth, older adults face psychological, physical and social well-being problems that increase mild cognitive impairment and frailty among older adults. Thus, to overcome older adults' problems, the study proposes and validates an IoT-based social hybrid scenario model. The model's features contain passive communication in which Drs, caregivers, and family members can monitor older adults' physical data from long distances. The model's features also contained intentional communication in which Older adults can interact online by text, audio, video calls, sharing images, and online activities such as painting, exercises and cooking. Moreover, older adults can do outdoor activities by inviting peers, friends or family members; the activities can be location-based IoT games, city tours, groups gardening and dinners. The outcomes of model validation will indicate how IoT characteristics can promote physical, psychological and social well-being and provide an opportunity for older adults to spend their life independently. The research that embodies this thesis includes 411 senior Portuguese Universities which are located mainland and on the island of Portugal. Using descriptive research methodology, where quantitative results are analysed, the results indicated a holistic scenario of passive and intentional communication in the context of well-being promotion among olderadults. from here, the social hybrid scenario is outlined, a hybrid model that offers passive and intentional communication between olderadults, family and medical doctors in the context of well-being promotion. The design and characteristics of the model are based on the existing knowledg, and needs of older adults, family members and also medical doctors. Such as model is a compound of passive and intentional characteristics that helps to reduce problem-related mental and physical health. The Passive and intentional communication characteristics are capable to create an environment for older adultsto take care of their psychological and physical health without any intervention and also increase their social physical and online activities, these activities help to promote the well-being of olderadults andd improve the daily lifestyle.O principal objetivo desta pesquisa é projetar e validar um modelo de cenário híbrido social baseado em IoT que tenha o potencial de promover o bem-estar psicológico e físico entre os idosos. A principal razão para projetar e validar o modelo é o crescimento da idade, os idosos enfrentam problemas psicológicos, físicos e de bem-estar social que aumentam o comprometimento cognitivo leve e a fragilidade entre os idosos. Assim, para superar os problemas dos idosos, o estudo propõe e valida um modelo de cenário híbrido social baseado em IoT. Os recursos do modelo contêm comunicação passiva na qual médicos, cuidadores e familiares podem monitorar os dados físicos dos idosos a longas distâncias. As características do modelo também contemplam comunicação intencional em que os idosos podem interagir online por meio de texto, áudio, videochamadas, compartilhamento de imagens e atividades online como pintura, exercícios e culinária. Além disso, os idosos podem fazer atividades ao ar livre convidando colegas, amigos ou familiares; as atividades podem ser jogos de IoT baseados em localização, passeios pela cidade, jardinagem em grupo e jantares. Os resultados da validação do modelo indicam como as características da IoT podem promover o bem-estar físico, psicológico e social e fornecer uma oportunidade para os idosos passarem sua vida de forma independente. A investigação que dá corpo a esta tese inclui 411 universidades portuguesas seniores localizadas no continente e na ilha de Portugal. Utilizando metodologia de pesquisa descritiva, onde são analisados resultados quantitativos, os resultados indicaram um cenário holístico de comunicação passiva e intencional no contexto da promoção do bem-estar entre idosos. a partir daqui, delineia-se o cenário social híbrido, um modelo híbrido que oferece comunicação passiva e intencional entre idosos, médicos de família e médicos no contexto da promoção do bem-estar. O desenho e as características do modelo baseiam-se no conhecimento existente e nas necessidades dos idosos, familiares e também médicos. Tal modelo é um composto de características passivas e intencionais que ajuda a reduzir os problemas relacionados com a saúde mental e física. As características de comunicação passiva e intencional são capazes de criar um ambiente para que os idosos cuidem de sua saúde psicológica e física e também aumentem suas atividades sociais físicas e online, essas atividades ajudam a promover o bem-estar dos idosos e melhorar o estilo de vida diário.Programa Doutoral em Informação e Comunicação em Plataformas Digitai

Addressing data accuracy and information integrity in mHealth using ML

The aim of the study was finding a way in which Machine Learning can be applied in mHealth Solutions to detect inaccurate data that can potentially harm patients. The result was an algorithm that classified accurate and inaccurate data

Ageing and Technology: Perspectives from the Social Sciences

The booming increase of the senior population has become a social phenomenon and a challenge to our societies, and technological advances have undoubtedly contributed to improve the lives of elderly citizens in numerous aspects. In current debates on technology, however, the "human factor" is often largely ignored. The ageing individual is rather seen as a malfunctioning machine whose deficiencies must be diagnosed or as a set of limitations to be overcome by means of technological devices. This volume aims at focusing on the perspective of human beings deriving from the development and use of technology: this change of perspective - taking the human being and not technology first - may help us to become more sensitive to the ambivalences involved in the interaction between humans and technology, as well as to adapt technologies to the people that created the need for its existence, thus contributing to improve the quality of life of senior citizens

eine retrospektive Analyse der randomisierten, kontrollierten Studien TIM-HF und TIM-HF2

Hintergrund: In der Betreuung von Herzinsuffizienzpatienten werden zunehmend telemedizinische Anwendungen eingesetzt. Das Telemonitoring bildet dabei eine Teilkomponente innerhalb eines holistischen Betreuungskonzeptes (Remote Patient Management), das die ambulante Präsenzbetreuung und Patientenschulung ergänzt. Die Rationale der telemedizinischen Mitbetreuung besteht insbesondere in der Früherkennung kardialer Funktionsverschlechterungen und daraus abgeleiteter frühzeitiger Intervention, um Hospitalisierungen zu vermeiden und Mortalität zu senken. In den vergangenen 15 Jahren wurden mehrere randomisierte, klinische Telemedizinstudien mit sehr uneinheitlichen Ergebnissen durchgeführt. Als eine der Hauptursachen wird die Adhärenz angesehen. Methode: Die eigenen Adhärenzuntersuchungen beziehen sich auf zwei randomisierte, klinische, nicht-invasive Telemedizinstudien mit Herzinsuffizienzpatienten im Stadium NYHA II/III. In den Jahren 2008 bis 2010 wurde die TIM-HF-Studie (Telemedical Interventional Monitoring in Heart Failure) mit 710 Patienten durchgeführt. Zwischen 2013 und 2018 wurde die TIM-HF2-Studie (Telemedical Interventional Management in Heart Failure II) mit 1.538 Patienten nach einem stationären Aufenthalt wegen hydropischer Dekompensation durchgeführt. Die primären Endpunkte waren in TIM-HF „Tod jeder Genese“ und in TIM-HF2 „Verlorene Tage wegen ungeplanter kardiovaskulärer Krankhausaufenthalte und durch Tod jeder Genese im einjährigen Follow-up“. In beiden Studien sollten die Patienten der Interventionsgruppe täglich Vitalwerte mittels einer Waage, eines Blutdruckmessgeräts und eines EKG-Geräts messen sowie eine Selbsteinschätzung zum körperlichen Befinden an das Telemedizinzentrum (TMZ) übermitteln. Post-hoc wurde die Adhärenz zu den Messungen erhoben und zwischen täglicher Messung mindestens eines Vitalwertes (relative Adhärenz) und aller Vitalwerte (absolute Adhärenz) unter-schieden. Anschließend wurden die Adhärenzeinflussfaktoren gemäß WHO-Definition anhand der Studiendaten sowie Fragebögen zur Patientenzufriedenheit untersucht. Ergebnisse: Es zeigten sich sehr hohe Adhärenzwerte (TIM-HF: absolute Adhärenz 81,8 ± 22,8 %, relative Adhärenz 88,9 ± 21,5 %; TIM-HF2: absolute Adhärenz 89,1 ± 14,1 %, relative Adhärenz 94,6 ± 10,1 %), die im Studienverlauf konstant hoch waren. Es gab keine signifikanten Adhärenzunterschiede zwischen der Nutzung der Messgeräte zur Messung der Vitalparameter. Bei der Analyse der WHO-Einflussfaktoren - sozioökonomische Faktoren sowie Art und Schwere der Erkrankung - ließen sich keine spezifischen Ursachen für die hohe Adhärenz sichern. Die beiden Post-hoc-Befragungen deuten darauf hin, dass die Adhärenz von einfacher Messgerätebedienbarkeit, regelmäßigen Telefonkontakten mit dem TMZ so-wie einem guten Zusammenwirken zwischen TMZ und primär behandelnden Haus- und Fachärzten abhängt. Weiterhin sind die Erwartung des Patienten an einen individuellen und unmittelbaren medizinischen Nutzen sowie die enge Verbindung zum primär betreuenden Arzt relevant (WHO-Faktoren „Gesundheitssystem“, „Patient“ sowie „Therapiekomplexität“). Schlussfolgerung: Bei vergleichbar hoher Adhärenz in beiden Studien wurde nur in der TIM-HF2-Studie ein positiver primärer Endpunkt erreicht. Die Adhärenz zur täglichen Vitaldatenmessung ist deshalb eine notwendige, aber nicht hinreichende Bedingung für das klinische Interventionsergebnis.Background: Telemedical applications are increasingly being used in medical care for heart failure (HF) patients. Telemonitoring is one aspect within a holistic care concept (Remote Patient Management/RPM) that completes outpatient care and patient training. The rationale of RPM is the early detection of cardiac deterioration and intervention derived therefrom to avoid hospitalization and reduce mortality. Over the past 15 years, several randomized controlled trials (RCT) have been conducted with very inconsistent results. The lack of adherence is considered as one of the main reasons. Methods: The adherence analysis relates to two RCTs in non-invasive telemedicine with HF patients. In 2008-2010, the TIM-HF (Telemedical Interventional Monitoring in Heart Failure) trial was performed with 710 HF patients. Between 2013 and 2018, the TIM-HF2 trial (Telemedical Interventional Management in Heart Failure II) was performed with 1,538 HF patients. The primary endpoint in TIM-HF was "all-cause death“ and in TIM-HF2 "days lost due to unplanned cardiovascular hospital admissions and all-cause death“. In both studies, RPM-patients were instructed to measure and transmit vital signs daily using a scale, a blood pressure monitor, an ECG device, and to report a self-rated health status to the telemedicine centre (TMC). The adherence to the measurements was determined post-hoc, distinguishing between daily measurement of at least one (relative adherence) and all vital parameters (absolute adherence). Subsequently, the adherence factors according to the WHO-definition were examined based on the study data as well as from post-hoc surveys on patient satisfaction received. Results: Both studies showed very high adherence rates (TIM-HF: absolute adherence 81.8 ± 22.8 %, relative adherence 88.9 ± 21.5 %, TIM-HF2: absolute adherence 89.1 ± 14.1 %, relative adherence 94.6 ± 10.1 %), which were consistently high during the study course. There were no significant differences between the adherence of the various vital signs. The WHO factors analysis - socioeconomic, type and severity of the disease -) did not identify specific causes for high adherence. Two post-hoc surveys suggest that adherence is strongly dependent on ease of device usability, regular phone contact with the TMC, and good interaction between TMC and primary care physicians. Furthermore, the patient expectation on individual and immediate physical benefit is relevant (WHO factors "health system“, ”patient" and "therapy complexity"). Conclusion: Despite of high adherence rates in both telemedical studies, only TIM-HF2 achieved a positive primary endpoint. Adherence to daily telemonitoring is therefore a necessary but not sufficient requirement regarding the clinical outcome of the intervention

Contributions to interoperability, scalability and formalization of personal health systems

The ageing of the world's population combined with unhealthy lifestyles are contributing to a major prevalence of chronic diseases. This scenario poses the challenge of providing good healthcare services to that people affected by chronic illnesses, but without increasing its costs. A prominent way to face this challenge is through pervasive healthcare. Research in pervasive healthcare tries to shift the current centralized healthcare delivery model focused on the doctors, to a more distributed model focused on the patients. In this context Personal Health Systems (PHSs) consists on approaching sampling technologies into the hands of the patients, without disturbing its activities of the daily life, to monitor patient's physiological parameters and providing feedback on their state. The use of PHSs involves the patients in the management of their illness and in their own well being too. The development of PHSs has to face technological issues in order to be accepted by our society. Within them it is important to ensure interoperability between different systems in order to make them work together. Scalability it is also a concern, as their performance must not decrease when increasing the number of users. Another issue is how to formalize the medical knowledge for each patient, as different patients may have different target goals. Security and privacy are a must feature because of the sensitive nature of medical data. Other issues involve the the integration with legacy systems, and the usability of graphical user interfaces in order to encourage old people with the use these technologies. The aim of this PhD thesis is to contribute into the state-of-the-art of PHSs by tackling together different of the above-mentioned challenges. First, to achieve interoperability we use the CDA standard as a format to encode and exchange health data and alerts related with the status of the patient. We show how these documents can be generated automatically through the use of XML templates. Second, we address the scalability by distributing the computations needed to monitor the patients over their devices, rather than performing them in a centralized server. In this context we develop the MAGPIE agent platform, which runs on Android devices, as a framework able to provide intelligence to PHSs, and generate alerts that can be of interest for the patients and the medical doctors. Third, we focus on the formalization of PHSs by providing a tool for the practitioners where they can define, in a graphical way, monitoring rules related with chronic diseases that are integrated with the MAGPIE agent platform. The thesis also explores different ways to share the data collected with PHSs in order to improve the outcomes obtained with the use of this technology. Data is shared between individuals following a Distributed Event-Based System (DEBS) approach, where different people can subscribe to the alerts produced by the patient. Data is also shared between institutions with a network protocol called MOSAIC, and we focus on the security aspects of this protocol. The research in this PhD focuses in the use case of Diabetes Mellitus; and it has been developed in the context of the projects MONDAINE, MAGPIE, COMMODITY12 and TAMESIS.L'envelliment de la població mundial combinat amb uns estils de vida no saludables contribueixen a una major prevalença d'enfermetats cròniques. Aquest escenari presenta el repte de proporcionar uns bons serveis sanitaris a les persones afectades per aquestes enfermetats, sense incrementar-ne els costos. Una solució prometedora a aquest repte és mitjançant l'aplicació del que en anglès s'anomena "pervasive healthcare". L'investigació en aquesta camp tracta de canviar l'actual model centralitzat de serveis sanitaris enfocat en el personal sanitari, per un model de serveis distribuït enfocat en els pacients. En aquest context, els Personal Health Systems (PHSs) consisteixen en posar a l'abast dels pacients les tecnologies de monitorització, i proporcionar-los informació sobre el seu estat. L'ús de PHSs involucra els pacients en la gestió de la seva enfermetat i del seu propi benestar. L'acceptació dels PHSs per part de la societat implica certs reptes tecnològics en el seu desenvolupament. És important garantir la seva interoperabilitat per tal de que puguin treballar conjuntament. La seva escalabilitat també s'ha de tenir en compte, ja que el seu rendiment no s'ha de veure afectat al incrementar-ne el número d'usuaris. Un altre aspecte a considerar és com formalitzar el coneixement mèdic per cada pacient, ja que cada un d'ells pot tenir objectius diferents. La seguretat i privacitat són característiques desitjades degut a la naturalesa sensible de les dades mèdiques. Altres problemàtiques impliquen la integració amb sistemes heretats, i la usabilitat de les interfícies gràfiques per fomentar-ne el seu ús entre les persones grans. L'objectiu d'aquesta tesi és contribuir a l'estat de l'art dels PHSs tractant de manera conjunta varis dels reptes mencionats. Per abordar l'interoperabilitat s'utilitza l'estàndard CDA com a format per codificar les dades mèdiques i alertes relacionades amb el pacient. A més es mostra com aquests documents poden generar-se de forma automàtica mitjançant l' ús de plantilles XML. Per tractar l'escalabilitat es distribueixen les computacions per monitoritzar els pacients entre els seus terminals mòbils, en comptes de realitzar-les en un servidor central. En aquest context es desenvolupa la plataforma d'agents MAGPIE com a framework per proporcionar intelligència als PHSs i generar alertes d'interès per al metge i el pacient. La formalització s'aborda mitjançant una eina que permet als metges definir de manera gràfica regles de monitorització relacionades amb enfermetats cròniques, que a més estan integrades amb la plataforma d'agents MAGPIE. La tesi també explora diferents maneres de compartir les dades recol·lectades amb un PHS, amb l'objectiu de millorar els resultats obtinguts amb aquesta tecnologia. Les dades es comparteixen entre individus seguint un enfoc de sistemes distribuïts basats en events (DEBS), on diferents usuaris poden subscriure's a les alertes produïdes per el pacient. Les dades també es comparteixen entre institucions mitjançant un protocol de xarxa anomenat MOSAIC. A la tesi es desenvolupen els aspectes de seguretat d'aquest protocol. La test es centra en la Diabetis Mellitus com a cas d'ús, i s'ha realitzat en el context dels projectes MONDAINE, MAGPIE, COMMODITY12 i TAMESIS.El envejecimiento de la población mundial combinado con unos estilos de vida no saludables contribuyen a una mayor prevalencia de enfermedades crónicas. Este escenario presenta el reto de proporcionar unos buenos servicios sanitarios a las personas afectadas por estas enfermedades, sin incrementar sus costes. Una solución prometedora a este reto es mediante la aplicación de lo que en inglés se denomina "pervasive healthcare". La investigación en este campo trata de cambiar el actual modelo centralizado de servicios sanitarios enfocado hacia el personal sanitario, por un modelo distribuido enfocado hacia los pacientes. En este contexto, los Personal Health Systems (PHSs) consisten en poner al alcance de los pacientes las tecnologías de monitorización, y proporcionarles información sobre su estado. El uso de PHSs involucra a los pacientes en la gestión de su enfermedad y en su propio bienestar. La aceptación de los PHSs por parte de la sociedad implica ciertos retos tecnológicos en su desarrollo. Es importante garantizar su interoperabilidad para que puedan trabajar conjuntamente. Su escalabilidad también se debe tener en cuenta, ya que su rendimiento no tiene que verse afectado al incrementar su número de usuarios. Otro aspecto a considerar es cómo formalizar el conocimiento médico para cada paciente, ya que cada uno puede tener objetivos distintos. La seguridad y privacidad son características deseadas debido a la naturaleza sensible de los datos médicos. Otras problemáticas implican la integración con sistemas heredados, y la usabilidad de las interfaces gráficas para fomentar su uso entre las personas mayores. El objetivo de esta tesis es contribuir al estado del arte de los PHSs tratando de manera conjunta varios de los retos mencionados. Para abordar la interoperabilidad se usa el estándar CDA como formato para codificar los datos médicos y alertas relacionados con el paciente. Además se muestra como estros documentos pueden generarse de forma automática mediante el uso de plantillas XML. Para tratar la escalabilidad se distribuye la computación para monitorizar a los pacientes en sus terminales móbiles, en lugar de realizarla en un servidor central. En este contexto se desarrolla la plataforma de agentes MAGPIE como framework para proporcionar inteligencia a los PHSs y generar alertas de interés para el médico y el paciente. La formalización se aborda mediante una herramienta que permite a los médicos definir de manera gráfica reglas de monitorización relacionadas con enfermedades crónicas, que ademas están integradas con la plataforma de agentes MAGPIE. La tesis también explora distintas formas de compartir los datos recolectados con un PHS, con el fin de mejorar los resultados obtenidos mediante esta tecnología. Los datos se comparten entre individuos siguiendo un enfoque de sistemas distribuidos basados en eventos (DEBS), donde distintos usuarios pueden suscribirse a las alertas producidas por el paciente. Los datos también se comparten entre instituciones mediante un protocolo dered llamado MOSAIC. En la tesis se desarrollan los aspectos de seguridad de este protocolo. La tesis se centra en la Diabetes Mellitus como caso de uso, y se ha realizado en el contexto de los proyectos MONDAINE, MAGPIE, COMMODITY12 y TAMESIS.Postprint (published version