FDA approved to improve patient and practitioner experience in healthcare settings.
FDA approved to improve patient and practitioner experience in healthcare settings.
Digital Strategy and the Shift to Value-Based Care
by Guest Author, Terence Maytin
The U.S. healthcare system is rapidly transitioning from fee-for-service to value- based care as part of massive and ongoing industry-wide transformation. Digital strategy is evolving to meet new challenges, help drive disruptive innovation, and better engage a large, growing audience of connected health consumers.
Already complex and fragmented, the healthcare sector will look very different over the coming years. The Affordable Care Act (ACA) has spurred rapid innovation and disruptive change across the entire ecosystem in the quest for better quality care across the entire population at lower per capita cost. Payers are accelerating rollout of value- based payment models with providers, and the shift to pay for performance arrangements with Pharma companies is increasing as well.
Moving an entire industry from volume-oriented reimbursement requires aggressive, innovative approaches to move from traditional siloed care to collaborative models, with system-wide provider coordination, patient engagement and proactive interventions. Technology will continue to act as a critical change agent, enabling large- scale improvements in process efficiency, automation, connectivity, collaboration, interoperability and advanced analytics.
With the convergence of healthcare and digital technology, industry stakeholders are reassessing their digital strategies to help tackle new business opportunities and challenges. Just a few years ago, digital health efforts largely focused either on acquisition marketing, community aggregation, or customer service portals designed to redirect volume from higher cost channels. However amid the current environment, digital offers much greater and far-reaching impact potential than ever before.
Digital investments are ramping up to support the shift from volume to value, particularly in the areas of care coordination, patient engagement, post-discharge monitoring, measurement, and behavior change. Since 2014, venture capital has provided $10B in new funding for clinical tools, analytics, consumer engagement, mHealth, telemedicine, wearables, and business services. In 2016, firms have raised a record $1.8B.
Two important trends drive home the relevance and importance of having a comprehensive, well articulated digital strategy: the rise of consumerism and nearly ubiquitous web/mobile adoption. Across all age groups, large audiences not only already consume digital services but also expect high quality, omni-channel experiences. In order to deliver on this promise, companies must design optimized, journey-based experiences that balance customer needs, preferences, and behaviors against desired business objectives and outcomes. Companies must embrace the concept of “putting the customer first” throughout the organization and across functions (e.g. strategy, product development, marketing, operations and technology). This also must be accompanied by an insights-driven, decision-making approach.
Essentially, digital strategy will be most effective if viewed as an organizational imperative. Armed with a holistic vision and comprehensive strategy, stakeholders will be better able to leverage and capitalize on digital’s full disruptive potential to help solve some of the most pressing challenges facing healthcare today.
Healthcare Industry Transformation
The transformation of healthcare is multidimensional and complicated. Disruptive innovation, technology and consumer trends are upending traditional business models. The competitive landscape is getting ever more crowded with new entrants while at the same time, insurer and provider consolidation is accelerating.
Consumers are motivated with more skin in the game and greater information access than ever before. Payment models are shifting from volume to value, and payers, providers, pharma, and medtech will need to collaborate and coordinate to a much larger degree within a more integrated care delivery system. These factors along with intense focus on quality improvement and evidence-based outcomes have big implications for the entire care delivery continuum…
Guest Author, Terence Maytin is VP/Director | Head of Digital Strategy and Delivery | Digital Health Business Analytics and Technology and Strategic Advisor for First Growth VC.
Maria Dorfner is the founder of NewsMD and Healthy Within Network. This is her blog.
She can be reached at email@example.com
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There is now a non-surgical alternative to gastric bypass.
It’s for people with a BMI of at least 30-40 who despite changing habits can’t lose weight.
It’s called ORBERA and it involves inflatable balloons that help you shed 20 to 80 pounds.
ORBERA balloon is inserted down throat and into stomach using an endoscope in less than 30 min.
The balloons are then filled with saline, filling up space in the stomach.
The Food and Drug Administration recently approved the dual balloon technology and NYC Gastroenterologist Dr. Prem Chattoo of Hudson River Gastroenterology is one of the first doctors to offer the procedure. His office is located in lower Manhattan.
“It’s not a long term solution like bariatric surgery. The procedure is used for a quick, six-month weight loss to get rid of 10 percent of your body weight. After six months, the balloon is removed and you should see a pretty noticeable weight loss,” Dr. Chattoo says.
The end result is weight loss and reduced hunger.
After the procedure, ORBERA has a 12-month diet and exercise program to follow.
The biggest benefits about ORBERA, according to Dr. Chattoo, are that no abdominal surgery is needed and that the procedure is completed in the same day.
The procedure is recommended to those with a body mass index (BMI) of 30-40 or those who have other risk factors for heart disease such as diabetes or high blood pressure. A BMI or 30 or higher is defined as obese. More than a third of U.S. adults fit that range.
The procedure costs 6-8K and is not covered by insurance.
One procedure will be donated for free to one person in need who meets requirements. Contact: firstname.lastname@example.org Write: Orbera in Subject, include your contact information.
Additional Images for Media: https://apolloendo.box.com/s/t7ukrrujfjk4mrgjwo5l5w5obd3djmbt
For more information contact Dr. Prem Chattoo at http://www.hudsonrivergi.com
For more information about the Orbera procedure visit: http://www.orbera.com
“Always remember the benefits of daily exercise for your mind, body and spirit. If you hate or dread exercise start with walking. Break it up into 15 minutes at a time until you reach 30 minutes. Then, increase it to 45 or 60 minutes. You don’t even need a gym to do that.
Remove all junk food from your home. Load up on healthy snacks. Remove all processed foods and soda. Drink lots of water. You’ll begin to notice a difference in 6 months. In one year, it will all be a habit.
No matter what help you get surgically or non-surgically, you always want to strive to develop lifelong healthy habits. Address the underlying of ‘why’ you select unhealthy foods. Stressed? Find someone to talk to. There are lots of free counselling services where you can call and talk to someone confidentially.
Rushed? Fix meals the night before. Hate your job? Start looking for a new one. Sit at a computer all day? Get up every 15 minutes and walk around office. Take stairs. Depressed? Again, find someone to talk to and exercise daily. Make an appointment with a professional psychologist if it’s really bad. When exercising, don’t focus on the physical. Focus on the mental benefits when you start. Physical has a way of catching up when you fix your mind and thoughts first. Stay positive.
Good things take commitment, dedication and time.
Your goal should never be a quick fix, but to change habits that got you to the place where you feel tired, sluggish and unhealthy and replace them with new, better, healthy ones. You can do it. One day at a time. ” -Maria Dorfner
Fat people have less than thin people. Older people have less than younger people. Men have less than younger women.
It is brown fat, actually brown in color, and its great appeal is that it burns calories like a furnace. A new study finds that one form of it, which is turned on when people get cold, sucks fat out of the rest of the body to fuel itself. Another new study finds that a second form of brown fat can be created from ordinary white fat by exercise.
Of course, researchers say, they are not blind to the implications of their work. If they could turn on brown fat in people without putting them in cold rooms or making them exercise night and day, they might have a terrific weight loss treatment. And companies are getting to work.
But Dr. André Carpentier, an endocrinologist at the University of Sherbrooke in Quebec and lead author of one of the new papers, notes that much work lies ahead. It is entirely possible, for example, that people would be hungrier and eat more to make up for the calories their brown fat burns.
“We have proof that this tissue burns calories — yes, indeed it does,” Dr. Carpentier said. “But what happens over the long term is unknown.”
Until about three years ago, researchers thought brown fat was something found in rodents, which cannot shiver and use heat-generating brown fat as an alternate way to keep warm. Human infants also have it, for the same reason. But researchers expected that adults, who shiver, had no need for it and did not have it.
Then three groups, independently, reported that they had found brown fat in adults. They could see it in scans when subjects were kept in cold rooms, wearing light clothes like hospital gowns. The scans detected the fat by showing that it absorbed glucose.
There was not much brown fat, just a few ounces in the upper back, on the side of the neck, in the dip between the collarbone and the shoulder, and along the spine. Although mice and human babies have a lot more, and in different places, it seemed to be the same thing. So, generalizing from what they knew about mice, many researchers assumed the fat was burning calories.
But, notes Barbara Cannon, a researcher at Stockholm University, just because the brown fat in adults takes up glucose does not necessarily mean it burns calories.
“We did not know what the glucose actually did,” she said. “Glucose can be stored in our cells, but that does not mean that it can be combusted.”
A new paper in The Journal of Clinical Investigation by Dr. Carpentier and his colleagues answers that question and more. By doing a different type of scan, which shows the metabolism of fat, the group reports that brown fat can burn ordinary fat and that glucose is not a major source of fuel for these cells. When the cells run out of their own small repositories of fat, they suck fat out of the rest of the body.
In the study, the subjects — all men — were kept chilled, but not to the point of shivering, which itself burns calories. Their metabolic rates increased by 80 percent, all from the actions of a few ounces of cells. The brown fat also kept its subjects warm. The more brown fat a man had, the colder he could get before he started to shiver.
Brown fat, Dr. Carpentier and Jan Nedergaard, Dr. Cannon’s husband, wrote in an accompanying editorial, “is on fire.”
On average, Dr. Carpentier said, the brown fat burned about 250 calories over three hours.
But there is another type of brown fat. It has been harder to study because it often is interspersed in the white fat and does not occur in large masses. Investigators discovered it in mice years ago. Now, in a recent article, Bruce Spiegelman, professor of cell biology and medicine at the Dana-Farber Cancer Institute, and his colleagues report that, in mice at least, exercise can make it appear, by turning ordinary white fat brown.
When mice exercise, their muscle cells release a newly discovered hormone that the researchers named irisin. Irisin, in turn, converts white fat cells into brown ones. Those brown fat cells burn extra calories.
Dr. Spiegelman said the brown fat he studies is different from the type that appears in large, distinct masses in rodents, the type Dr. Carpentier was examining in his subjects. That brown fat is derived from musclelike cells and not from white fat.
Dr. Spiegelman suspects that humans, like mice, make brown fat from white fat when they exercise, because humans also have irisin in their blood. And human irisin is identical to mouse irisin.
“What I would guess is that this is likely to be the explanation for some of the effects of exercise,” Dr. Spiegelman says. The calories burned during exercise exceed the number actually used to do the work of exercising. That may be an effect of some white fat cells turning brown.
Many questions remain. The only brown fat that can be easily seen in people is the muscle-derived fat that shows up in scans. And that brown fat, notes Dr. C. Ronald Kahn, chief academic officer at the Joslin Diabetes Center in Boston, is visible in people only when it is turned on by making them cold.
Almost everyone of normal weight or below shows this brown fat if they are chilled, although individuals vary greatly in how much they have. But this brown fat almost never shows up in obese people. Is that one reason they are obese, or is their extra body fat keeping them so warm that there is no reason to turn on their brown fat?
There is also an intriguing relationship between the brown fat that emerges under the skin and the density of bone. Dr. Clifford Rosen, a professor of medicine at Tufts University School of Medicine in Boston, is studying mice that cannot make brown fat and was astonished by the state of their bones.
“The animals have the worst bone density we have ever seen,” Dr. Rosen said. “I see osteoporotic bones all the time,” he added, “but, oh my God, these are the extreme.”
And while exercise may induce brown fat in humans, it remains to be seen how important a source of calorie burning it is, researchers say.
As for deliberately making yourself cold if you want to lose weight, Dr. Carpentier said, “there is still a lot of research to do before this strategy can be exploited clinically and safely.”
ABOUT THIS BLOG:
MARIA DORFNER is the founder of NewsMD Communications and Healthy Within Network. This blog is a part of that. She began her career in 1983 at NBC News in NYC where she continued to work behind-the-scenes on TODAY SHOW, NIGHTLY NEWS and all programs until 1989 when she helped launch CNBC.
As a producer, she has produced talk shows, segments and series and travelled extensively. In 1993, she developed and senior produced 7 health series: Healthy Living, Healthcare Consumers, Healthcare Practitioners, Lifestyles and Longevity and Green Magazine.
She co-anchored Healthy Living and Healthcare Consumers airing on CNBC for three years before launching NewsMD Communications. Her clients include a Who’s Who in Medical/Health, the Journal of the American Medical Association (JAMA) which she shot, wrote and produced weekly segments for NBC, CBS, ABC, CNN and Fox. Discovery Health Channel, where she wrote, produced and directed the documentary series, 21st Century Medicine. She has helped raise multi-millions of dollars for hospitals in need and has been a part of several successful health startups. She has worked as Director of Research for Roger Ailes at Ailes Communications, his consulting and production company and again as a producer. Her articles have been published in Broadcasting & Cable Magazine and she has hosted The Secret to Success.
She has continued to be a go-to person for network heath shows, stories and content. She was awarded a health reporting scholarship from The American Medical Association (AMA), a Freddie Award for Excellence in Medical Reporting, an Outstanding Achievement Award from the March of Dimes, an Angel of a Sponsor Award from Make A Wish Foundation and an Outstanding Leadership Abilities from her alma mater, Pace University and Commitment to the Advancement of Women in Media Award.
In 2014, she published 3 books. She was also awarded a scholarship to Columbia University by NBC News. She also received Media Recognition Award from the American Heart Association for her series Heart Smart. She has been specializing in Medical/Health for 23 years, and has worked in Media for 33 years after starting as an intern during college. In her spare time, she enjoys reading, learning, writing, nature, hiking, swimming, bike riding, working out, cooking, exploring museums and travel. She is a certified scuba diver and aerobics swim instructor.
“Health has been a passion of mine since I was a kid. What I do and who I am are seamless. I come from a large Italian family. If someone is sick I’m the one they call for research. My best friend growing up in Brooklyn was my cousin Josephine, and we’re still close. We were little health nerds. She became a pediatric nurse. We loved researching everything to death and still do. Two things I love and know well. Media and Medical. Yet, I think in both, they’ve forgotten the most important person –the patient. So, I want to help put the ME back in MEdia and MEdical. Today, it’s SO hard to know who to trust in both. Fortunately, people are smart and they are now well aware of the various financial ties “experts” and physicians and media have to promoting certain medications or other large companies, products or services that absolutely do not serve our health or our best interests. The worst part is when we learn they knew and do not reveal it to consumers for decades, which contradicts the oath, “First do no harm.” So much damage has been done and no one is accountable. How do you like that. Well, ethics matter. People matter. And people want and will choose what is best for their health. People are empowered and will use their money to denounce those companies aligned with making them sick. I created this blog to be a trusted resource for people. I do it for free because I believe Virgil is right. There is no greater wealth than health and you absolutely have to trust who is telling you information and why more than any other time in your life. It’s even worse if you’re rich because then people try to sell you even more things. That may be fine when it’s a handbag, but your health is too precious and there are no returns or refunds if you end up paying a price for trusting the wrong advice. Remember, “expert” doesn’t always mean that. I feel extremely blessed to be healthy. I’ve been healthy all my life. I’ve never even had stitches. I love to help people and my career became a vocation when I was able to utilize my communication and journalism skills to do that.”
Thanks for following my health blog.
by Alyssa Danigelis
Wearable Electronic Patch
Innovations in soft materials and electronics are helping researchers create wearable electronic patches.
Photo Credit: Donghee Son and Jongha Lee, Seoul National University
No more tough breaks. As “smart” electronics get smaller and softer, scientists are developing new medical devices that could be applied to — or in some cases, implanted in — our bodies.
And these soft and stretchy devices shouldn’t make your skin crawl, because they’re designed to blend right in, experts say.
We want to solve the mismatch between rigid wafer-based electronics and the soft, dynamic human body, said Nanshu Lu, an assistant professor of aerospace engineering and engineering mechanics at the University of Texas at Austin.
Lu, who previously studied with John Rogers, a soft-materials and electronics expert at the University of Illinois Urbana-Champaign, focuses her research on stretchable bioelectronics.
Lu and her colleagues have invented a cheaper and faster method for manufacturing electronic skin patches called epidermal electronics, reducing what was a multiday process to 20 minutes.
Smart and flexible enough to essentially meld with the human body.
From the latest advancements in smart tattoos to injectable brain monitoring to stretchable electronics for drug delivery, here are five fascinating technologies that could soon be on (or inside) your body.
Smart temporary tattoos
“When you integrate electronics on your skin, it feels like part of you,” Lu said. “You don’t feel it, but it is still working.” That’s the idea behind “smart” temporary tattoos that John Rogers and his colleagues are developing. Their tattoos, also known as biostamps, contain flexible circuitry that can be powered wirelessly and are stretchy enough to move with skin.
These wireless smart tattoos could address clinically important — but currently unmet — needs, Rogers told Live Science.
Although there are numerous potential applications, his team is focused now on how biostamps could be used to monitor patients in neonatal intensive care units and sleep labs.
MC10, the Massachusetts-based company Rogers helped start, is conducting clinical trials and expects to launch its first regulated products later this year.
Biochemical Sensors – Temporary Tattoos
Nanoengineers at the University of California, San Diego, have tested a temporary tattoo that both extracts and measures the level of glucose in the fluid in between skin cells.
Photo Credit: Joseph Wang, University of California, San Diego
Skin-mounted biochemical sensors
Another new body-meld technology in development is a wearable biochemical sensor that can analyze sweat through skin-mounted devices and send information wirelessly to a smartphone. These futuristic sensors are being designed by Joseph Wang, a professor of nanoengineering at the University of California, San Diego, and director of the Center for Wearable Sensors.
“We look at sweat, saliva and tears to provide information about performance, fitness and medical status,” Wang told Live Science.
Earlier this year, members of Wang’s lab presented a proof-of-concept, flexible, temporary tattoo for diabetics that could continuously monitor glucose levels without using needle pricks.
He also led a team that created a mouth-guard sensor that can check levels of health markers that usually require drawing blood, like uric acid, an early indicator for diabetes and gout.
Wang said the Center for Wearable Sensors is pushing to commercialize these emerging sensor technologies with the help of local and international companies.
Nanomaterial drug delivery
Dae-Hyeong Kim, an associate professor of chemical and biological engineering at Seoul National University in South Korea, and his colleagues are pursuing nanotechnologies to enable next-generation biomedical systems. Kim’s research could one day yield nanomaterial-enabled electronics for drug delivery and tissue engineering, according to Lu. “He has made stretchable memory, where you can store data on the tattoo, ” she said.
In 2014, Kim’s research group made a stretchable, wearable electronic patch that contains data storage, diagnostic tools and medicine. “The multifunctional patch can monitor movement disorders of Parkinson’s disease,” Kim told Live Science. Collected data gets recorded in the gold nanoparticle device’s memory.
When the patch detects tremor patterns, heat and temperature sensors inside it release controlled amounts of drugs that are delivered through carefully designed nanoparticles, he explained.
Injectable Electronic Mesh
This nanoscale electronic mesh can be injected into brain tissue through a needle.
Photo Credit: Lieber Research Group, Harvard University
Injectable brain monitors
Although implantable technology exists for monitoring patients with epilepsy or brain damage, Lu pointed out that these devices are still sharp and rigid, making long-term monitoring a challenge. She compared soft brain tissue to a bowl of tofu constantly in motion. “We want something that can measure the brain, that can stimulate the brain, that can interact with the brain — without any mechanical strain or loading,” she said.
Enter Charles Lieber, a Harvard University chemistry professor whose research group focuses on nanoscale science and technology. His group’s devices are so small that they can be injected into brain tissue through a needle. After injection, nanoscale electronic mesh opens up that can monitor brain activity, stimulate tissue and even interact with neurons. “That,” said Lu, “is very cutting edge.”
Long-term implantable devices
Spinal Cord Implant
The e-Dura spinal cord implant.
Photo Credit: Laboratory for Soft Bioelectronic Interfaces, EPFL
Stéphanie Lacour and Grégoire Courtine, scientists at the École Polytechnique Fédérale de Lausanne’s School of Engineering, announced in early 2015 that they had developed a new implant for treating spinal cord injuries.
The small e-Dura device is implanted directly on the spinal cord underneath its protective membrane, called the dura mater. From there, it can deliver electrical and chemical stimulation during rehabilitation.
The device’s elasticity and biocompatibility reduce the possibility of inflammation or tissue damage, meaning it could stay implanted for a long time.
Paralyzed rats implanted with the device were able to walk after several weeks of training, the researchers reported in the journal Science.
Lu called e-Dura one of the best-functioning, long-term implantable flexible stimulators. “It shows the possibilities of using implantable, flexible devices for rehabilitation and treatment,” she said.
Meanwhile, technologies that replicate human touch are growing increasingly sophisticated.
Stanford University chemical engineering professor Zhenan Bao has spent years developing artificial skin that can sense pressure and temperature and heal itself.
Her team’s latest version contains a sensor array that can distinguish between pressure differences like a firm or limp handshake.
Lu said she and her colleagues in this highly multidisciplinary field hope to make all wafer-based electronics more epidermallike. “All those electronic components that used to be rigid and brittle now have a chance to become soft and stretchable,” she said.
Follow @livescience, Facebook & Google+. Original article on Live Science at:
Also Check Out Editor’s Recommendations at http://www.livescience.com
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Maria Dorfner is the founder of NewsMD Communications, LLC and Healthy Within Network (HWN). This is her blog. Contact: email@example.com
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“When We Tell Stories…People Listen.”
You don’t have to drink to love this app called DRUNK MODE.
It’s another way to make sure people who drink do not drive or get into trouble
I spoke to founder, Joshua Anton who originally created it for a funny reason
Joshua says, “I originally created it to prevent students from drunk calling their friends.”
You do that by setting your phone to DRUNK MODE any time you’ll be out drinking or with drinkers much like you set it to Airplane Mode when you’re on a plane.
A feature called FIND MY DRUNK keeps track of friends and keeps them safe.
BREADCRUMBS tracks your night to retrace your steps the next day (Lost Keys? Wallet?).
FIND A RIDE lets users easily find an Uber.
HOTSPOTS– See where the party’s at in real time.
SAFEMODE– Add trusted contacts to watch over you on your way home, call for assistance with a BlueLight button, or easily dial 911.
Rahul Bajaj is the Business Development Lead for the App.
RAHUL, HOW DID YOU MEET JOSHUA?
I met Joshua at a business club meeting at college. He told me about the app. When he presented the idea it was really interesting how this app can help people. I don’t drink but many of my friends do and I thought it could help them stay off the road. So I joined the team to help promote it because I really believe in the product.
[photo of team: Rahul Bajaj, Joshua Anton on far left]
WHERE CAN PEOPLE GET MORE INFORMATION ABOUT DRUNKMODE?
We have a website. www.drunkmode.org or they can find us on Twitter @DrunkModeApp.
WHERE CAN MEDIA CONTACT JOSHUA ABOUT THE DRUNKMODE APP?
Of course, not drinking at all is safest. But even those that drink socially could use this.
Stay safe. Stay healthy! Download the app. 1.2M users already installed it. ~Maria
MARIA DORFNER is a medical/health journalist and TV producer. She helped launch CNBC in 1989 after beginning with an executive internship at NBC News in 1983. As senior producer of medical programming at CNBC, she developed original health programs including “Healthcare Consumers,” “Healthcare Practitioners,” “Healthy Living” and “Lifestyles and Longevity.” She founded NewsMD Communications, LLC an award-winning production company specializing in original health content, health PR and cutting-edge stories. She has worked as medical and special projects producer for NBC Miami, screenwriter/producer/director for Discovery Health for the documentary series, “21st Century Medicine”. She helped create and launch The Cleveland Clinic News Service and was an on-site Senior Media Advisor for them. Most recently, she produced the pilot “Healthy Within” for NBC Network. A partial list of her awards include a Medical Reporting Scholarship from the American Medical Association, a Media Recognition Award from the American Heart Association and Freddie Award for Excellence in Medical Reporting. She serves on the advisory board of Super Body/Super Brain and is the author of 3 books. She is the founder of Healthy Within Network (HWN). This is her blog.
HAVE A HOT MEDICAL OR HEALTH STORY, PRODUCT OR SERVICE THE WORLD SHOULD KNOW ABOUT? CONTACT: firstname.lastname@example.org
This morning, I step outside and feel a familiar cold chill –reminiscent of pre-sunrise in San Diego. Later, I glance out the window. Sunshine hides like my favorite red augyle sock after laundry.
Gloomy skies get me thinking about Seasonal Affective Disorder and what new therapies exist.
People generally talk about S.A.D. (pun!) when Fall arrives. What about cloudy days in Spring? I’ve never been diagnosed with S.A.D., but I’m a bit of a hypocondriac. I know. Ironic.
Other people get to benefit from it. In the past, doctors. They’d laugh and say I was the healthiest person they’d ever seen. I’d get sent home with a lollipop. And a bill.
Friends and relatives because each time I think I have something, I put my glasses on and do extensive research. Lightning speed. I don’t need eyeglasses anymore (thank you, Dr. Bell of The San Diego Eye Institute). So now, I’m even faster. Research Ninja.
Ever since I was a little kid, my cousin Josephine and I loved researching our imagined illnesses. We loved using big medical words too. Some words made us crack up. Today, if we want to laugh all we have to do is say, “Spinabifida.” Josephine is a top pediatric nurse now.
It’s written by a caregiver named Gary LeBlanc.
I contact Gary & ask for permission to share his blog. I thought it would help other people. He says yes. (Don’t worry, I get back to light therapy options for Seasonal Affective Disorder later.) So, I switch gears and decide to put the spotLIGHT on Alzheimer’s instead of S.A.D.
I thank Gary for allowing me to repost his unique experience utilizing light to care for his father with Alzheimer’s disease. I always trust real people sharing their medical experiences, rather than professionals. I have to read between the lines with the latter. Who is funding them? What’s the agenda? Are they PR flacks? When it’s real people –there is no agenda.
Gary was the primary caregiver of his father for a decade after he was diagnosed with Alzheimer’s disease. Gary has a book, but it is one based on his experience. It’s called, “Staying Afloat in a Sea of Forgetfulness.”
I notice his article got 7 clicks. Since I have over 1.2 million people within my social network, and most work in NATIONAL MEDIA and MEDICAL –I thought I’d share his story and shed some LIGHT on something a lot of other Americans are dealing with right now. It’s so cool when something little –something you can DO can make a big difference. Gary explains.
For many years now I have preached how beneficial it is to keep the homes of those suffering from Alzheimer’s Disease well lit. Throughout my father’s illness I kept the lights on at full tilt in both the bedroom and bathroom throughout the night. By doing so it kept him from experiencing mass confusion during his frequent bathroom runs in the wee hours.
Even during the daylight hours he had trouble crossing the threshold into the bathroom. The difference from one room’s carpet turning into tiles had him believing there was a step, making him raise his foot high, stepping over nothing. Color contrast can become very deceiving.
A friend of mine, who cares for her father-in-law with Alzheimer’s, recently told me that when she takes him to his doctor’s office, there’s a black welcome mat that scares him to pieces. He refuses to walk on it because he believes it’s a deep hole.
As caregivers we must keep things as simple and safe as possible for our loved ones. Paying close attention to their habits is a good way to start.
For those experiencing Sundowners, also known as “Sundown Syndrome,” start lighting up the house a good hour before dusk. By preventing shadows from creeping in, this will take away some of the hardships experienced during that time of day. Researchers have even found that by using the correct color temperature light bulbs may have a positive effect on mood and behavior.
For instance, what is perceived to be cool-white light has been reported to help the patients remain more alert and verbally active. On the other hand, warm-white light, which has more of a reddish-yellow tinge to it, is said to keep the patient calmer, helping to temper behavior problems.
Unfortunately, visual perception becomes altered from Alzheimer’s. A good tip to keep in mind is to always consider the color contrast in all situations. If you’re having problems getting patients to eat, take into account the way in which the table is set. A white plate on a white table cloth may be very difficult for them to see. Think “Bold Colors.” Try placing their food on a red plate. Even when it comes to the silverware, bright colored handles may encourage them to start digging in. A recent study has found this method has increased intake by 25 percent.
Let’s say there’s a clear glass of water on a white table; change it to a blue cup. This will help them to visually recognize it easier, actually encouraging them to pick it up and drink from it, preventing dehydration. How important is that?
Here’s little refresher for anyone who isn’t aware of Alzheimer’s statistics:
Right now, 15 million Americans serve as caregivers, and this is projected to rise to 45 million by 2050. I got that from The Alzheimer’s Association.
1 in 8 older Americans has Alzheimer’s Disease and 1 in 7 lives alone. So, there’s all this cheerleading going on about “Living Longer” but are we living Healthier?
According to Psychiatric Times, as many as 50% of persons older than 85 years have some form of dementia (Alzhemier’s disease being the cause in at least two-thirds of cases).
Psychosis occurs in approx. 40% of persons with Alzheimer’s disease, and agitation occurs in 80% or more of persons with dementia at some point. The photo below on the left is what a normal brain looks like. The middle brain shows mild cognitive impairment. The one on the far right is Alzheimeer’s Diseasse.
When I first saw this photo this morning, I wondered why they can’t track the progression on MRI scans, and then a new study popped up saying researchers discovered they can do just that. News story below.
A study in March 22 issue of the Journal, Neuron says Alzheimer’s disease and other forms of dementia may spread within nerve networks in the brain by moving directly betweenn connected neurons. They’re thinking an MRI could track the progression of it.
This makes absolute sense and I wonder why they didn’t have this A ha! moment sooner. I was also looking at photos of the brain this morning and photos of the brain without Alzheimer’s and with are remarkably different, so I had the same thought. Why can’t doctors track the progression with a brain scan.
I’d LOVE to know how to PREVENT dementia and Alzheimer’s Disease. Something is causing it in so many Americans. My first instinct tells me it is related to NUTRITION. Something people are eating or drinking is eroding brain cells. Is it soda? Did you see how when someone said they found a mouse in their soda and tried to sue the soda company –the soda executive’s defense was that it was “impossibe” because the mouse would have dissolved in the soda? Wow. I could almost hear the fizzling sound of brain cells. Until we discover how to prevent it, I am always on the lookout for anything that can help patients, families and caregivers.
Consequently, my dear friend, Dr. Max Gomez from CBS just lost his father to Alzheimer’s. Sympathies go out to the Gomez family at this time. If you’d like to reach out, here’s a note from Max:
“Some folks have asked about flowers… please don’t. If you’re inclined, I’d much rather you send a donation in my father’s name, Dr Max Gomez, Sr., to the Alzheimer’s research group at NYU where they diagnosed and cared for Dad; check should be made out to the NYU Center for Brain Health and sent to: Center for Brain Health, NYU School of Medicine, Dept. of Psychiatry, 145 E. 32 St., 5th fl, New York, NY 10016. Attn: Dr. Mony DeLeon. They will also supply tax receipts. Thank you for your thoughts and prayers.”
LIGHT THERAPY is fascinating in that it can help with the following. Sometimes, when people have exhausted all else —and they still suffer –they may want to try it. Psoriasis isn’t on this list. I read earlier it was being used for that too:
LET’S TAKE A LOOK AT WHERE YOU CAN GET LIGHT THERAPY, PRICES along with REVIEWS from HEALTHYLIVING.COM:
Phillips GoLight BLU
Some researchers and light therapy users believe that blue light is the most important part of the spectrum for treating SAD. The Phillips GoLite BLUE is compact, portable, and operates on a rechargeable battery. It’s easy to bring it and use it almost anywhere.
This handy device is tiny, inexpensive, and very portable. You can mount on the top of your computer monitor, where it draws power vis USB cable, or plug it into your car’s cigarette lighter and mount it on the visor — you can commute and get your light therapy in at the same time! Two brightness settings allow you to select the amount of light you want.
This kit provides clips to attach the Syrcadian Blue to your visor, and a car charger to power the device. Use your morning commute to get your light therapy!
Multi-country adapters to plug your Syrcadian Blue into a wall outlet.
If entirely blue light is too intense for you, Phillips offers a therapy device that’s half blue light and half white light. It features the same low weight and compact dimensions as the GoLite Blu.
The Litebook Elite runs on a long-lasting rechargeable battery. It features a custom lens to provide a uniform field of full spectrum light.
This portable plug-in sunlamp offers three intensity settings: 5,000 lux, 8,000 lux, and 10,000 lux. It comes with its own travel pouch so you can bring it anywhere.
Another portable sunlamp, only this one works on batteries. Coming in at 2,500 lux, it’s a good choice for those who experience eyestrain or headaches with higher lux, or who would like to double it up as a task lamp for longer periods of time.
This light therapy visor will be the next therapy device I try. It works on a rechargeable lithium battery and emits 10,000 lux of blue-green light. A visor is included in the package, as well as clips to attach to your favorite baseball cap.
The Phillips Dawn and Dusk Simulator allows you to wake up with the dawn, whatever the actual time might be. At night, use a timer so that the light dims slowly, triggering your body’s natural sleep process. The alarm also has some pretty nice sound options, such as birdsong — much nicer than a buzzing, jangling alarm clock!
Stay Healthy, everyone! 🙂
Link to Gary LeBlanc’s book, “Staying Afloat in a Sea of Forgetfulness” at Barnes & Noble: http://www.barnesandnoble.com/s/staying-afloat-in-a-sea-of-forgetfulness?keyword=staying+afloat+in+a+sea+of+forgetfulness&store=allproducts
Parenting in the internet age certainly still has its challenges, but tech-savvy parents have several options in the App Store that can help ease some of the stress. Storing important information, accessing records and even entertaining your newborn can all be done with a tap of the screen; here are ten iPhone apps that all new parents should check out.
All new parents need some help, so it is a great idea for the iPhone to serve multiple purposes. Check out the App Store for these and other great apps for new parents. You never knew a phone could do so much.
THANK YOU NANNY NET – Debbie Denard
BEST NEW PARENTING BLOG: NANNY NET – http://www.nanny.net/blog/10-iphone-apps-for-new-parents
HOW A BABY TAKES SHAPE INSIDE YOUR BODY: http://www.babycentre.co.uk/video/pregnancy/baby-takes-shape/
WONDERFUL PBS DOCUMENTARY recommended by author, Michael Gonzalez Wallace: http://topdocumentaryfilms.com/the-secret-life-of-the-brain/
1. My Diet Diary-Calorie Counter
To help you slim down, My Diet Diary tracks your food (including calculating calories and personalized nutritional needs using a database of 150,000 foods), exercise, water consumption, and how your actual weight is trending against your goal weight. You can share your progress on social media and graph your results.
To boost your motivation, RunKeeper turns your mobile device into smart run or fitness tracker, using the GPS to track the speed, distance and duration of your workouts. You can calculate calories burned, share your results on social media, get audio feedback as to whether you are on your target pace, and create a personal data dashboard on the runkeeper.com site.
Widely used by doctors, this free drug reference tool provides details on thousands of medications. Not only can you look up potential side effects on Epocrates Rx, but if you take more than one medication, you can also check for potentially dangerous interactions and confirm drug coverage for many health plans, including Medicare Part D. And if you sometimes forget to take your medications, also check out RxmindMe, a free app that lets you create 9 types of reminders.
Developed by emergency physicians, iTriage lets you look up symptoms and possible causes, tap into a national directory of ERs, doctors, urgent care centers, and clinics, use your phone’s GPS to identify the closest medical facilities and get driving directions. This free app is designed to answer 2 questions: “What’s wrong with me?” and “Where can I get treatment?”
If you’re one of the 20 million Americans with chronic kidney disease, your doctor has probably told you to watch the potassium, protein, phosphorus and salt in your diet. The KidneyDiet app provides nutritional data on thousands of foods, including brand name products and menu items from some chain restaurants, to help you make the best choices. Foods that might be harmful for people on a kidney diet are highlighted in red.
Want to quit smoking? Developed by the National Cancer Institute, QuitGuide helps you prepare to kick the habit, provides support during the days and weeks after you quit, and discusses the challenges you may experience. For more free resources, visit smokefree.gov.
This free app lets you track blood sugar levels, carb intake, and insulin doses. WaveSense Diabetes Manager provides color-coded results—making it easy to see if your glucose results are in the high or low ranges—is customizable with target ranges, lets you tag your results with info on food, exercise, medication or health issues, and email reports to your healthcare team.
Up to 20 percent of veterans of the Iraq and Afghanistan wars suffer from flashbacks, nightmares, panic attacks and other symptoms of post-traumatic stress disorder (PTSD. Created by the VA and Department of Defense, PTSD Coach, a free iPhone and Android app, delivers information on the disorder and a self-assessment, along with insights into treatments and coping tools. Users can upload their contacts, photos and music.
AsthmaMD can track your asthma triggers, map “severity zones,” share your data with your doctor, and help researchers study asthma by pooling real-time data from thousands of patients through secure “cloud” storage.
Rest assured that you’ll wake up on time. The free Sleep on It app combines an alarm clock with a variety of sounds with clever features to track how the duration and quality of your slumber is impacting your health and mood. You can record medications, symptoms, and naps to see which factors may explain poor sleep and generate graphs of overall sleep trends and hours snoozed in the last 7, 30, and 90 days.
This new magnetic resonance spectroscopy (MRS) technique provides a definitive diagnosis of cancer based on imaging of a protein associated with a mutated gene found in 80 percent of low- and intermediate-grade gliomas. Presence of the mutation also means a better prognosis.
“To our knowledge, this is the only direct metabolic consequence of a genetic mutation in a cancer cell that can be identified through noninvasive imaging,” said Dr. Elizabeth Maher, associate professor of internal medicine and neurology at UT Southwestern and senior author of the study, available online in Nature Medicine. “This is a major breakthrough for brain tumor patients.”
UT Southwestern researchers developed the test by modifying the settings of a magnetic resonance imaging (MRI) scanner to track the protein’s levels. The data acquisition and analysis procedure was developed by study lead author Dr. Changho Choi, associate professor of the Advanced Imaging Research Center (AIRC) and radiology. Previous research linked high levels of this protein to the mutation, and UT Southwestern researchers already had been working on MRS of gliomas to find tumor biomarkers.
“Our next step is to make this testing procedure widely available as part of routine MRIs for brain tumors. It doesn’t require any injections or special equipment,” said Dr. Maher, medical director of UT Southwestern’s neuro-oncology program.
To substantiate the test as a diagnostic tool, biopsy samples from 30 glioma patients enrolled in the UT Southwestern clinical trial were analyzed; half had the mutation and expected high levels of the protein. MRS imaging of these patients had been done before surgery and predicted, with 100 percent accuracy, which patients had the mutation.
For Thomas Smith of Grand Prairie, the test helped determine the best time to begin chemotherapy. When an MRS scan showed a sharp rise in the 25-year-old’s protein levels, this indicated to his health care team that his tumor was moving from dormancy to rapid growth.
“We treated him with chemotherapy and his protein levels came down,” Dr. Maher said.
Before participating in the study, Mr. Smith had tumor removal surgery in 2007. Because part of the tumor could not be safely removed, however, he continued to suffer seizures and had other neurological problems. Since chemotherapy, his symptoms have diminished.
“I did six rounds of chemo, every six weeks,” Mr. Smith said. “My seizures stopped and all my symptoms improved. I am only on anti-seizure medication now.”
Notes about this brain cancer research article
Other UT Southwestern researchers involved in the study included Sandeep Ganji, a doctorate student in radiological sciences; Dr. Ralph DeBerardinis, assistant professor of pediatrics and with the Eugene McDermott Center for Human Growth and Development; Dr. Kimmo Hatanpaa, associate professor of pathology; Dr. Dinesh Rakheja, assistant professor of pathology; Dr. Zoltan Kovacs, assistant professor in the AIRC; Drs. Xiao-Li Yang and Tomoyuki Mashimo, both senior research scientists in internal medicine; Dr. Jack Raisanen, professor of pathology; Dr. Isaac Marin-Valencia, resident in pediatrics; Dr. Juan Pascual, assistant professor of neurology and neurotherapeutics, pediatrics, and physiology; Dr. Christopher Madden, associate professor of neurological surgery; Dr. Bruce Mickey, professor of neurological surgery and otolaryngology-head and neck surgery, and radiation oncology; Dr. Craig Malloy, professor in the AIRC and of internal medicine and radiology; and Dr. Robert Bachoo, assistant professor in neurology and neurotherapeutics, and internal medicine.
Funding: The research was supported by grants from the National Institutes of Health, the Cancer Prevention and Research Institute of Texas and financial support from the Annette G. Strauss Center for Neuro-oncology at UT Southwestern.
Contact: Debbie Bolles – The University of Texas Southwestern Medical Center
Source: The University of Texas Southwestern Medical Center press release
Original Research: Abstract for “2-hydroxyglutarate detection by magnetic resonance spectroscopy in IDH-mutated patients with gliomas” by Changho Choi, Sandeep K Ganji, Ralph J DeBerardinis, Kimmo J Hatanpaa, Dinesh Rakheja, Zoltan Kovacs, Xiao-Li Yang, Tomoyuki Mashimo, Jack M Raisanen, Isaac Marin-Valencia, Juan M Pascual, Christopher J Madden, Bruce E Mickey, Craig M Malloy, Robert M Bachoo and Elizabeth A Maher from Nature Medicine
“We could build a surveillance system that alerts local ministries of health if we detect what looks like an outbreak,” Eagle says.
In addition to his role at HSPH, Nathan Eagle is CEO of Jana (formerly txteagle), a technology company that has built a platform capable of awarding billions of people with free mobile airtime in exchange for completing surveys or purchasing products.
This arrangement sprang from one of Eagle’s first mHealth projects, helping a hospital in rural Kenya prevent frequent blood supply shortages. He developed a text message application enabling nurses to alert the main blood bank about shortages before they became emergencies. But the project fell flat; the cost of sending daily text messages is a big chunk of a rural nurse’s income.
Eagle responded with airtime compensation, a system that automatically gives users free service in exchange for data transmission charges for each message sent. The scheme worked, and the nurses started texting again
Making this prediction model possible are giant data banks run by cellular service providers with records of every phone’s history. When a phone receives or sends a message, or moves in or out of a cell tower’s range, the network records it. In aggregate, all of the call data records from a given provider can give researchers an invaluable picture of how people behave.
Information that users generate as they move around and use their mobile phones, when combined with other data such as public health records, is called “Big Data” because of its volume and variety. But as Eagle discovered, moving from theory to practice in the emerging world of Big Data-driven public health still means working out the kinks.
“What I built turned out to be not a cholera predictor, but a flood detector,” he says with a laugh. People moved around less, not because they were sick, but because the roads were washing out. Yet fortuitously, Eagle’s prediction model also applied to cholera—because outbreaks generally erupt about two weeks after a flood.
The new field of “mHealth”
Eagle is part of a growing movement at HSPH and within the global health community to leverage the explosion in mobile phone availability—and the data cellphones can share and produce—to change how public health and medical problems are identified, prevented, and treated. This burgeoning field, which has expanded exponentially in the last five years, is called “mHealth.”
The variety of mHealth applications under development or available worldwide is staggering and ever evolving. In addition to using Big Data to track people’s movements and predict potential public health threats, mHealth is putting medical records, appointment reminders, health tips, and detailed standards of care literally in the hands of health workers and patients, whether in Tanzania or Tucson. Today, there are mHealth applications that diagnose medical ailments, manage chronic diseases, and support mental health therapies and addiction control.
More stories abouttechnological and computational innovations at the School from theHarvard Public Health Review
mHealth has the potential to help patients, doctors, and researchers make healthier, more informed choices by doing what no other technology can do: deliver valuable, actionable information to the right people at the moment it is needed, no matter where they are. And with projects ranging from outbreak prediction to humanitarian aid, HSPH is among the vanguard institutions defining this new terrain.
“Our faculty have always been leaders in developing interventions to improve health,” says Karen Emmons, HSPH associate dean for research. “mHealth provides an important opportunity to explore how to take those interventions to scale, to deliver them in remote places, and to fundamentally change the access of whole populations to evidence-based interventions.”
Cellphones curbing drug-resistant malaria?
Caroline Buckee, HSPH assistant professor of epidemiology, uses call data records from the largest service provider in Kenya to track the movements of 15 million people and correlate those movements with data about malaria. Her work focuses on understanding how human behaviors, such as where people travel and with whom they interact, influence the spread of diseases.
Though using mobility data to make predictive models of the spread of disease is nothing new, the data have generally been either inaccurate or unfeasible to collect at large scales. “Never before have we been able to look at individual people on this scale, moving in real time,” says Buckee. “It’s a huge deal for infectious disease researchers.”
In the future, Buckee plans to use these models to intervene at key moments—by sending text messages to travelers heading into malaria-plagued zones, detecting when their phones enter the range of a cell tower in that zone and reminding individuals who have opted to receive notifications to take precautions such as wearing long sleeves and pants and sleeping under a mosquito net.
“Mothers wanted us to leverage the one piece of technology they have access to: the mobile phone,” says Priya Agrawal, a visiting scientist and obstetrician and gynecologist working with the Women and Health Initiative at HSPH. The resulting tool, the Mother/Baby 7-day mCheck, was designed by mothers, for mothers. The checklist-based intervention cues mothers to examine their infants for common danger signs during the first week after birth.Of mothers and babies who die during childbirth, two-thirds die in these critical first seven days. Mobile phones not only remind mothers to do the checks, but also help them connect to medical aid and transport, when needed.
Reaching the unreachable
One of the driving forces behind this new field, in addition to the emergence of the smartphone and other wireless devices, is the rapid spread of mobile phones into remote niches. According to the mHealth Alliance, a research and advocacy organization hosted by the United Nations Foundation, close to 90 percent of the world’s population has wireless coverage. There are 6 billion cellphones on the planet—and 7 billion people. Moreover, 65 percent of subscribers reside in the developing world.
While the Internet revolution passed by without appreciably changing the lives of many people in the developing world, mobile technologies offer immediate advantages: they are far cheaper, they don’t demand steady supplies of electricity, and they don’t require the same extensive infrastructure to reach into people’s homes. For all these reasons, mHealth technologies are leap-frogging ahead of the personal computer.
“The use of cellular phones for health care and public health is one of the most promising developments in the quest to achieve universal health coverage worldwide,” notes HSPH Dean Julio Frenk, “because mobile phones are rapidly becoming the communication technology of choice—and increasingly so among the poor.”
Improving maternal and child health
Marc Mitchell, a pediatrician, management specialist, and lecturer on global health at HSPH, says 70 percent of the population in Tanzania has access to a mobile phone. He is among those leading the way in evaluating potential mHealth interventions in the developing world, having spent 20 years designing, validating, and delivering clinical protocols to guide health workers through examinations, diagnoses, and treatments.
Mitchell is a firm believer in mHealth as an effective and inexpensive means of getting such step-by-step protocols into the hands of health care practitioners when and where they’re needed. mHealth extends the reach of these protocols to remote places and makes them easier to apply. Mobile technologies automatically keep protocols current with the latest medical advances and supplement them with other valuable features such as digital appointment management tools and electronic patient records, two systems that many clinics in the developing world lack. In some clinics, the only records of patient visits are logbooks that patients sign on arrival, and the only records of diagnoses and treatment plans are on index cards that patients themselves carry.
Mitchell has launched several pilot projects in Tanzania using mobile phones to improve maternal health, child health, and malnutrition using time-tested protocols. Through his not-for-profit organization D-Tree (which stands for “decision tree,” a type of flowchart that is part of many clinical protocols), Mitchell runs a maternal health program in Zanzibar funded by the Bill & Melinda Gates Foundation. Also in Zanzibar, in a project funded by UNICEF, a mobile app that assists health workers as they screen children for malnutrition has helped reduce errors in health care delivery. If pilot projects such as this prove effective, says Mitchell, the next step will be scale-up.
In a decade-long mission asking survivors of war and mass conflict how they were faring and what they and their societies needed to heal, Patrick Vinck and his wife Phuong Pham often felt hampered by standard paper-and-pencil surveys. Both work at the Harvard Humanitarian Initiative (HHI)—Vinck as director of the Program on Vulnerable Populations, and Pham as the director of Evaluation and Implementation Science. Today, with open-source software that they themselves developed, called KoBo, the researchers are able to document both the complexities of postwar suffering and the most pressing public health needs in ravaged populations.“
mHealth technology represents the second wave of humanitarian assistance,” says Vinck. “When you ask victims how to redress war suffering, they will often say, ‘Help me get prosthetics for my injuries. Build a hospital for my children. Improve the health care system.’ In the past, we’ve seen billions of dollars poured into proceedings meant to help the victims—but nobody was asking the victims exactly what they wanted and needed. With digital technologies, we can do just that.”
Adds Pham, “We wanted smartphones that integrated audio, video, text, data, and geolocation all in one place, and we wanted it to be freely available.” Compared with conventional data-gathering tools, their mobile digital technology is more secure, more cost-effective, easier for trained health workers to use, and its results can be swiftly translated into case management and timely evidence-based policy recommendations. Ultimately, the phones could help health care workers diagnose disease, document human rights violations, photograph (through an attachment to a light microscope) a smear of blood potentially laced with malaria parasites, and even gauge through surveys how post-traumatic stress disorder colors postwar attitudes toward transitional justice and reconciliation.
Just a few years ago, according to Erica Kochi, co-lead of the Tech Innovations Team at UNICEF, people weren’t interested in using mobile technologies in health care in the developing world. “They laughed when we brought it up,” she says. After all, just five years ago, only the urban rich owned mobile phones in the developing world. Today, there are mobile phone owners in even the most remote villages. “Now, everyone is including mobile technology in their plans.”
mHealth applications enable aid workers to map where a crisis is unfolding in real time, giving researchers and aid workers a better shot at swiftly responding to threats of violence, disease, or malnutrition. Applications also provide patient monitoring, send text messages reminding patients to take needed medications, or offer suggestions for maintaining health while pregnant, even in war-ravaged places.
For organizations like the U.S. Centers for Disease Control and Prevention and the World Health Organization, with missions to avert dangerous epidemics, “this technology is a potential powerhouse,” adds Phuong Pham, a research scientist at HSPH and director of evaluation and implementation science at the Harvard Humanitarian Initiative, a University-wide program dedicated to developing ways to improve the delivery of health services in areas facing war, conflict, or natural disasters. “In epidemiology, determining person, place, and time are crucial. If you can look at those three components in real time, you can immediately make informed decisions and take action.”
Long-term research studies using mHealth
Mobile technologies are also energizing the workhorse of public health research—longitudinal studies, which collect behavioral and health data over time to reveal factors that may threaten or improve health.
For example, HSPH is developing a program to monitor the day-to-day behaviors of half a million people in sub-Saharan Africa over several decades, gathering information on what they eat and drink, where they live, and whether they smoke or exercise. The first study of its kind in this region, it will use an mHealth survey platform developed by Eagle that enables researchers to survey people in places too remote to reach with paper or personal interviews.
“Longitudinal data may be the most promising area in mHealth,” Eagle says. “It could change how we think about preventative health.”
Risks and obstacles
Scientific evidence that mHealth interventions actually work is beginning to emerge. Recent studies, for instance, have shown that mobile phones have assisted in relief effort coordination in Haiti and that text message reminders about proper malaria treatment have improved the care of sick children in Kenya.
In 2009, HSPH graduate student Martin Lajous, SM ’04, SD ’11, successfully collaborated with a large cellphone company in Mexico, surveying Mexican residents to characterize outbreaks of H1N1 influenza. Lajous pitched the idea as a test to determine whether cellphone technology could be used for public health response and surveillance. The cellphone company agreed, and the effort showed that cellular surveys may be a practical, inexpensive, and timely complement to traditional surveillance.
But will mHealth deliver on its early promise? The answer depends largely on who invests in mHealth and how. If the biggest investments are made by those who stand to profit, then, according to Mitchell, “mHealth would not reach those who most need it,” particularly those who cannot afford mobile phones without assistance, such as under-resourced clinics, women, and the poorest of the poor. Mobile health care could become boutique health care.
Privacy is another issue. Even though Buckee and Eagle depersonalize the data they use, there are no international standards that define what needs to be done to call data before it is handed off to researchers.
Equity is also a key issue. In Africa, for example, mobile phone owners still tend to be male and relatively affluent. “We need to be cognizant of the bias,” says Eagle. “It’s easy to slip into the idea that we’ve discovered a universal law of human behavior, when really we’ve identified a pattern in a subset of behavioral data from a subset of mobile phone subscribers in one country.”
A major concern is that academia and technology don’t typically operate on the same time frames. In the years it takes an investigator to write a proposal, submit it, and get it reviewed and funded, what had been cutting-edge mobile technology may become obsolete. And if mHealth applications race ahead of scientific and regulatory safeguards, the trend could backfire and do more harm than good.
Despite these questions, there is a gathering momentum and sense of inevitability about the nascent technology. “I’m doing this because mHealth is going to happen no matter what,” Mitchell says. “I believe it can happen in one of two ways. In one, it benefits people equitably. In the other, it goes to the highest bidder.”
—Elizabeth Dougherty is a freelance science journalist and novelist living in central Massachusetts.