Mobile phones: the next step towards healthcare delivery in rural India?

BACKGROUND

Given the ubiquity of mobile phones, their use to support healthcare in the Indian context is inevitable. It is however necessary to assess end-user perceptions regarding mobile health interventions especially in the rural Indian context prior to its use in healthcare. This would contextualize the use of mobile phone communication for health to 70% of the country's population that resides in rural India.

OBJECTIVES

To explore the acceptability of delivering healthcare interventions through mobile phones among users in a village in rural Bangalore.

METHODS

This was an exploratory study of 488 mobile phone users, residing in a village, near Bangalore city, Karnataka, South India. A pretested, translated, interviewer-administered questionnaire was used to obtain data on mobile phone usage patterns and acceptability of the mobile phone, as a tool for health-related communication. The data is described using basic statistical measures.

RESULTS

The primary use of mobile phones was to make or receive phone calls (100%). Text messaging (SMS) was used by only 70 (14%) of the respondents. Most of the respondents, 484 (99%), were willing to receive health-related information on their mobile phones and did not consider receiving such information, an intrusion into their personal life. While receiving reminders for drug adherence was acceptable to most 479 (98%) of our respondents, 424 (89%) preferred voice calls alone to other forms of communication. Nearly all were willing to use their mobile phones to communicate with health personnel in emergencies and 367 (75%) were willing to consult a doctor via the phone in an acute illness. Factors such as sex, English literacy, employment status, and presence of chronic disease affected preferences regarding mode and content of communication.

CONCLUSION

The mobile phone, as a tool for receiving health information and supporting healthcare through mHealth interventions was acceptable in the rural Indian context.

Cross-checking different sources of mobility information

The pervasive use of new mobile devices has allowed a better characterization in space and time of human concentrations and mobility in general. Besides its theoretical interest, describing mobility is of great importance for a number of practical applications ranging from the forecast of disease spreading to the design of new spaces in urban environments. While classical data sources, such as surveys or census, have a limited level of geographical resolution (e.g., districts, municipalities, counties are typically used) or are restricted to generic workdays or weekends, the data coming from mobile devices can be precisely located both in time and space. Most previous works have used a single data source to study human mobility patterns. Here we perform instead a cross-check analysis by comparing results obtained with data collected from three different sources: Twitter, census, and cell phones. The analysis is focused on the urban areas of Barcelona and Madrid, for which data of the three types is available. We assess the correlation between the datasets on different aspects: the spatial distribution of people concentration, the temporal evolution of people density, and the mobility patterns of individuals. Our results show that the three data sources are providing comparable information. Even though the representativeness of Twitter geolocated data is lower than that of mobile phone and census data, the correlations between the population density profiles and mobility patterns detected by the three datasets are close to one in a grid with cells of 2×2 and 1×1 square kilometers. This level of correlation supports the feasibility of interchanging the three data sources at the spatio-temporal scales considered.

Risks of toxic ash from artisanal mining of discarded cellphones

The potential environmental and human health impacts of artisanal mining of electronic waste through open incineration were investigated. A market-representative set of cellphones was dismantled into four component categories-batteries, circuit boards, plastics and screens. The components were shredded, sieved and incinerated at 743-818 °C. The concentrations of 17 metals were determined using U.S. EPA methods 6010C (inductively coupled plasma-atomic emission spectrometry; 6020A (inductively coupled plasma-mass spectrometry, or 7471B and 7470A (cold-vapor atomic absorption). EPA Method 8270 (gas chromatography/mass spectrometry) was used to identify polyaromatic hydrocarbon compounds and polybrominated diphenyl ethers. EPA Method 8082A was used to measure polychlorinated biphenyls and EPA Method 8290 was used for dioxin/furans in the residue ash. The life cycle assessment model USEtox(®) was used to estimate impacts of the ash residue chemicals on human health and the ecosystem. Among metals, copper in printed circuit boards had the highest ecotoxicity impact (1610-1930PAFm(3)/kg); Beryllium in plastics had the highest impact on producing non-cancer diseases (0.14-0.44 cases/kg of ash); and Nickel had the largest impact on producing cancers (0.093-0.35 cases/kg of ash). Among organic chemicals, dioxins from incinerated batteries produced the largest ecotoxicological impact (1.07E-04 to 3.64E-04PAFm(3)/kg). Furans in incinerated batteries can generate the largest number of cancers and non-cancer diseases, representing 8.12E-09 to 2.28E-08 and 8.96E-10 and 2.52E-09 cases/kg of ash, respectively. The results reveal hazards of burning discarded cellphones to recover precious metals, and pinpoints opportunities for manufacturers to reduce toxic materials used in specific electronic components marketed globally.

FEEL: a system for frequent event and electrodermal activity labeling

The wide availability of low-cost wearable biophysiological sensors enables us to measure how the environment and our experiences impact our physiology. This creates a challenge: in order to interpret the longitudinal data, we require the matching contextual information as well. Collecting continuous biophysiological data makes it unfeasible to rely solely on our memory for contextual information. In this paper, we first present an architecture and implementation of a system for the acquisition, processing, and visualization of biophysiological signals and contextual information. Next, we present the results of a user study: users wore electrodermal activity wrist sensors that measured their autonomic arousal. These users uploaded the sensor data at the end of each day. At first, they annotated their events at the end of each day; then, after a two-day break, they annotated the data from two days earlier. One group of users had access to both the signal and the contextual information collected by the mobile phone and the other group could only access the biophysiological signal. At the end of the study, the users filled in a system usability scale and user experience surveys. Our results show that the system enables the users to annotate biophysiological signals at a greater effectiveness than the current state of the art while also providing very good usability.

Time averaged transmitter power and exposure to electromagnetic fields from mobile phone base stations

Models for exposure assessment of high frequency electromagnetic fields from mobile phone base stations need the technical data of the base stations as input. One of these parameters, the Equivalent Radiated Power (ERP), is a time-varying quantity, depending on communication traffic. In order to determine temporal averages of the exposure, corresponding averages of the ERP have to be available. These can be determined as duty factors, the ratios of the time-averaged power to the maximum output power according to the transmitter setting. We determine duty factors for UMTS from the data of 37 base stations in the Swisscom network. The UMTS base stations sample contains sites from different regions of Switzerland and also different site types (rural/suburban/urban/hotspot). Averaged over all regions and site types, a UMTS duty factor for the 24 h-average is obtained, i.e., the average output power corresponds to about a third of the maximum power. We also give duty factors for GSM based on simple approximations and a lower limit for LTE estimated from the base load on the signalling channels.

Intervention strategies for improving patient adherence to follow-up in the era of mobile information technology: a systematic review and meta-analysis

BACKGROUND

Patient adherence to follow-up plays a key role in the medical surveillance of chronic diseases and affects the implementation of clinical research by influencing cost and validity. We previously reported a randomized controlled trial (RCT) on short message service (SMS) reminders, which significantly improved follow-up adherence in pediatric cataract treatment.

METHODS

RCTs published in English that reported the impact of SMS or telephone reminders on increasing or decreasing the follow-up rate (FUR) were selected from Medline, EMBASE, PubMed, and the Cochrane Library through February 2014. The impacts of SMS and telephone reminders on the FUR of patients were systematically evaluated by meta-analysis and bias was assessed.

RESULTS

We identified 13 RCTs reporting on 3276 patients with and 3402 patients without SMS reminders and 8 RCTs reporting on 2666 patients with and 3439 patients without telephone reminders. For the SMS reminders, the majority of the studies (>50%) were at low risk of bias, considering adequate sequence generation, allocation concealment, blinding, evaluation of incomplete outcome data, and lack of selective reporting. For the studies on the telephone reminders, only the evaluation of incomplete outcome data accounted for more than 50% of studies being at low risk of bias. The pooled odds ratio (OR) for the improvement of follow-up adherence in the SMS group compared with the control group was 1.76 (95% CI [1.37, 2.26]; P<0.01), and the pooled OR for the improvement of follow-up adherence in the telephone group compared with the control group was 2.09 (95% CI [1.85, 2.36]; P<0.01); both sets showed no evidence of publication bias.

CONCLUSIONS

SMS and telephone reminders could both significantly improve the FUR. Telephone reminders were more effective but had a higher risk of bias than SMS reminders.

An extra power saving scheme for prolonging lifetime of mobile handset in the 4G mobile networks

In the fourth generation or next generation networks, services of non-real-time variable bit rate (NRT-VBR) and best effort (BE) will dominate over 85% of the total traffic in the networks. In this paper, we study the power saving mechanism of NRT-VBR and BE services for mobile handsets (MHs) to prolong their battery lifetime (i.e., the sustained operation duration) in the fourth generation networks. Because the priority of NRT-VBR and BE is lower than that of real-time VBR (RT-VBR) or guaranteed bit rate (GBR) services, we investigate an extended sleep mode for lower priority services (e.g., NRT-VBR and BE) in an MH to conserve the energy. The extended sleep mode is used when the MH wakes up from the sleep mode but it cannot obtain the bandwidth from base station (BS). The proposed mechanism, named extra power saving scheme (EPSS), uses the Markovian queuing model to estimate the extended sleep duration to let MHs conserve their battery energy when the networks traffic is congested. To study the performance of EPSS, an accurate analysis model of energy is presented and validated by taking a series of simulations. Numerical experiments show that EPSS can achieve 43% extra energy conservation at most when downlink resource is saturated. We conclude that the energy of MHs can be conserved further by applying EPSS when the traffic load is saturated. The effect of energy saving becomes more obvious when the portion of NRT-VBR and BE services is greater than that of RT-VBR and GBR services.

IT tools empower the chronically ill

Hospitals across the country are experimenting with mHealth to better connect with, manage and monitor patients with chronic disease. The early results are promising.

Selenium reduces mobile phone (900 MHz)-induced oxidative stress, mitochondrial function, and apoptosis in breast cancer cells

Exposure to mobile phone-induced electromagnetic radiation (EMR) may affect biological systems by increasing free oxygen radicals, apoptosis, and mitochondrial depolarization levels although selenium may modulate the values in cancer. The present study was designed to investigate the effects of 900 MHz radiation on the antioxidant redox system, apoptosis, and mitochondrial depolarization levels in MDA-MB-231 breast cancer cell line. Cultures of the cancer cells were divided into four main groups as controls, selenium, EMR, and EMR + selenium. In EMR groups, the cells were exposed to 900 MHz EMR for 1 h (SAR value of the EMR was 0.36 ± 0.02 W/kg). In selenium groups, the cells were also incubated with sodium selenite for 1 h before EMR exposure. Then, the following values were analyzed: (a) cell viability, (b) intracellular ROS production, (c) mitochondrial membrane depolarization, (d) cell apoptosis, and (e) caspase-3 and caspase-9 values. Selenium suppressed EMR-induced oxidative cell damage and cell viability (MTT) through a reduction of oxidative stress and restoring mitochondrial membrane potential. Additionally, selenium indicated anti-apoptotic effects, as demonstrated by plate reader analyses of apoptosis levels and caspase-3 and caspase-9 values. In conclusion, 900 MHz EMR appears to induce apoptosis effects through oxidative stress and mitochondrial depolarization although incubation of selenium seems to counteract the effects on apoptosis and oxidative stress.

Toward more usable electronic voting: testing the usability of a smartphone voting system

OBJECTIVE

The goal of this research was to assess the usability of a voting system designed for smart-phones.

BACKGROUND

Smartphones offer remote participation in elections through the use of pervasive technology. Voting on these devices could, among other benefits, increase voter participation while allowing voters to use familiar technology. However, the usability of these systems has not been assessed.

METHOD

A mobile voting system optimized for use on a smartphone was designed and tested against traditional voting platforms for usability.

RESULTS

There were no reliable differences between the smartphone-based system and other voting methods in efficiency and perceived usability. More important, though, smartphone owners committed fewer errors on the mobile voting system than on the traditional voting systems.

CONCLUSION

Even with the known limitations of small mobile platforms in both displays and controls, a carefully designed system can provide a usable voting method. Much of the concern about mobile voting is in the area of security; therefore, although these results are promising, security concerns and usability issues arising from mitigating them must be strongly considered.

APPLICATION

The results of this experiment may help to inform current and future election and public policy officials about the benefits of allowing voters to vote with familiar hardware.

Multidimensional human dynamics in mobile phone communications

In today's technology-assisted society, social interactions may be expressed through a variety of techno-communication channels, including online social networks, email and mobile phones (calls, text messages). Consequently, a clear grasp of human behavior through the diverse communication media is considered a key factor in understanding the formation of the today's information society. So far, all previous research on user communication behavior has focused on a sole communication activity. In this paper we move forward another step on this research path by performing a multidimensional study of human sociality as an expression of the use of mobile phones. The paper focuses on user temporal communication behavior in the interplay between the two complementary communication media, text messages and phone calls, that represent the bi-dimensional scenario of analysis. Our study provides a theoretical framework for analyzing multidimensional bursts as the most general burst category, that includes one-dimensional bursts as the simplest case, and offers empirical evidence of their nature by following the combined phone call/text message communication patterns of approximately one million people over three-month period. This quantitative approach enables the design of a generative model rooted in the three most significant features of the multidimensional burst - the number of dimensions, prevalence and interleaving degree - able to reproduce the main media usage attitude. The other findings of the paper include a novel multidimensional burst detection algorithm and an insight analysis of the human media selection process.

Smartphone-based recognition of states and state changes in bipolar disorder patients

Today's health care is difficult to imagine without the possibility to objectively measure various physiological parameters related to patients' symptoms (from temperature through blood pressure to complex tomographic procedures). Psychiatric care remains a notable exception that heavily relies on patient interviews and self-assessment. This is due to the fact that mental illnesses manifest themselves mainly in the way patients behave throughout their daily life and, until recently there were no "behavior measurement devices." This is now changing with the progress in wearable activity recognition and sensor enabled smartphones. In this paper, we introduce a system, which, based on smartphone-sensing is able to recognize depressive and manic states and detect state changes of patients suffering from bipolar disorder. Drawing upon a real-life dataset of ten patients, recorded over a time period of 12 weeks (in total over 800 days of data tracing 17 state changes) by four different sensing modalities, we could extract features corresponding to all disease-relevant aspects in behavior. Using these features, we gain recognition accuracies of 76% by fusing all sensor modalities and state change detection precision and recall of over 97%. This paper furthermore outlines the applicability of this system in the physician-patient relations in order to facilitate the life and treatment of bipolar patients.

Oxidative Stress-Mediated Skin Damage in an Experimental Mobile Phone Model Can Be Prevented by Melatonin

Most mobile phones emit 900 MHz of radiation that is mainly absorbed by the external organs. The effects of 900 MHz of radiation on fibrosis, lipid peroxidation, and anti-oxidant enzymes and the ameliorating effects of melatonin (Mel) were evaluated in rat skin. Thirty Wistar-Albino rats were used in the study. The experimental groups were the control group, the irradiated group (IR), and the irradiated+Mel treated group (IR+Mel). A dose of 900 MHz, 2 W radiation was applied to the IR group every day for 10 days (30 min/day). The IR+Mel group received 10 mg/kg/day melatonin in tap water for 10 days before the irradiation. At the end of the 10th day, a skin specimen was excised from the thoracoabdominal area. The levels of malondialdehyde (MDA) and hydroxypyroline and the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) were studied in the skin samples. MDA and hydroxyproline levels and activities of CAT and GSH-Px were increased significantly in the IR group compared to the control group (p<0.05) and decreased significantly in the IR+Mel group (p<0.05). SOD activity was decreased significantly in the IR group and this decrease was not prevented by the Mel treatment. These results suggest that rats irradiated with 900 MHz suffer from increased fibrosis and lipid peroxidation (LPO). Mel treatment can reduce the fibrosis and LPO caused by radiation.

Reliability and concurrent validity of a peripheral pulse oximeter and health-app system for the quantification of heart rate in healthy adults

There are downloadable applications (Apps) for cell phones that can measure heart rate in a simple and painless manner. The aim of this study was to assess the reliability of this type of App for a Smartphone using an Android system, compared to the radial pulse and a portable pulse oximeter. We performed a pilot observational study of diagnostic accuracy, randomized in 46 healthy volunteers. The patients' demographic data and cardiac pulse were collected. Radial pulse was measured by palpation of the radial artery with three fingers at the wrist over the radius; a low-cost portable, liquid crystal display finger pulse oximeter; and a Heart Rate Plus for Samsung Galaxy Note®. This study demonstrated high reliability and consistency between systems with respect to the heart rate parameter of healthy adults using three systems. For all parameters, ICC was > 0.93, indicating excellent reliability. Moreover, CVME values for all parameters were between 1.66-4.06 %. We found significant correlation coefficients and no systematic differences between radial pulse palpation and pulse oximeter and a high precision. Low-cost pulse oximeter and App systems can serve as valid instruments for the assessment of heart rate in healthy adults.

The role of short messaging service in supporting the delivery of healthcare: An umbrella systematic review

Short messaging service (SMS) messages may present a convenient and cost-effective method to support healthcare interventions. This work assesses the effects of short messaging service on various healthcare interventions found in systematic reviews. The search strategy was based on two key concepts: short messaging service and healthcare delivery. The initial search was conducted in December 2012 and was updated in June 2013. Of the 550 identified references, 13 systematic reviews met the inclusion criteria, of which 8 were published in peer-reviewed journals and 5 were retrieved from the Cochrane library. Data analysis shows that low to moderate research evidence exists on the benefits of short messaging service interventions for appointment reminders, promoting health in developing countries and preventive healthcare. In many interventions, however, there were a few studies that were of high quality, and most of the studies were rated from low to moderate quality or had no rating at all. Healthcare organizations, policy makers, or clinicians using short messaging service messages to support healthcare interventions should (1) implement interventions that have been found to work in healthcare settings, (2) continue evaluating short messaging service interventions that have not been adequately assessed, and (3) improve collaboration between various healthcare entities to develop studies targeted at specific populations to evaluate the long-term impact of short messaging service on healthcare outcomes.

On the use of human mobility proxies for modeling epidemics

Human mobility is a key component of large-scale spatial-transmission models of infectious diseases. Correctly modeling and quantifying human mobility is critical for improving epidemic control, but may be hindered by data incompleteness or unavailability. Here we explore the opportunity of using proxies for individual mobility to describe commuting flows and predict the diffusion of an influenza-like-illness epidemic. We consider three European countries and the corresponding commuting networks at different resolution scales, obtained from (i) official census surveys, (ii) proxy mobility data extracted from mobile phone call records, and (iii) the radiation model calibrated with census data. Metapopulation models defined on these countries and integrating the different mobility layers are compared in terms of epidemic observables. We show that commuting networks from mobile phone data capture the empirical commuting patterns well, accounting for more than 87% of the total fluxes. The distributions of commuting fluxes per link from mobile phones and census sources are similar and highly correlated, however a systematic overestimation of commuting traffic in the mobile phone data is observed. This leads to epidemics that spread faster than on census commuting networks, once the mobile phone commuting network is considered in the epidemic model, however preserving to a high degree the order of infection of newly affected locations. Proxies' calibration affects the arrival times' agreement across different models, and the observed topological and traffic discrepancies among mobility sources alter the resulting epidemic invasion patterns. Results also suggest that proxies perform differently in approximating commuting patterns for disease spread at different resolution scales, with the radiation model showing higher accuracy than mobile phone data when the seed is central in the network, the opposite being observed for peripheral locations. Proxies should therefore be chosen in light of the desired accuracy for the epidemic situation under study.

Mobile health in maternal and newborn care: fuzzy logic

Whether mHealth improves maternal and newborn health outcomes remains uncertain as the response is perhaps not true or false but lies somewhere in between when considering unintended harmful consequences. Fuzzy logic, a mathematical approach to computing, extends the traditional binary “true or false” (one or zero) to exemplify this notion of partial truths that lies between completely true and false. The commentary explores health, socio-ecological and environmental consequences–positive, neutral or negative. Of particular significance is the negative influence of mHealth on maternal care-behaviors, which can increase stress reactivity and vulnerability to stress-induced illness across the lifespan of the child and establish pathways for intergenerational transmission of behaviors. A mHealth “fingerprinting” approach is essential to monitor psychosocial, economic, cultural, environmental and physical impact of mHealth intervention and make evidence-informed decision(s) about use of mHealth in maternal and newborn care.

Smartphone versus knee ligament arthrometer when size does not matter

PURPOSE

The use of available mechanical methods to measure anterior tibial translation (ATT) in anterior cruciate ligament (ACL)-deficient knees are limited by size and costs. This study evaluated the performance of a portable device based on a downloadable electronic smartphone application to measure ATT in ACL-deficient knees.

METHODS

A specific smartphone application (SmartJoint) was developed for this purpose. Two independent observers nonsequentially measured the amount of ATT during execution of a maximum manual Lachman test in 35 patients with an ACL-deficient knee using KT 1000 and SmartJoint on both involved and uninvolved knees. As each examiner performed the test three times on each knee, a total of 840 measurements were collected. Statistical analysis compared intertest, interobserver and intra-observer reliability using the interclass correlation coefficient (ICC). An ICC > 0.75 indicates excellent reproducibility among measurements.

RESULTS

Mean amount of ATT on uninvolved knees was 6.1 mm [standard deviation (SD = 2)] with the KT 1000 and 6.4 mm (SD = 2) with SmartJoint. Mean side-to-side difference was 8.1 mm. (SD = 4) with KT 1000 and 8.3 mm (SD = 3) with SmartJoint. Intertest reliability between the two methods yielded an ICC 0.797 [95 % confidence interval (CI) 0.717-0.857] for the uninvolved knee and of 0.987 (CI 0.981-0.991) for the involved knee. Interobserver ICC for SmartJoint and KT 1000 was 0.957 (CI 0.927-0.976) for the uninvolved knee and 0.992 (CI 0.986-0.996) for the involved knee and 0.973 (CI 0.954-0.985) for the uninvolved knee and 0.989 (CI 0.981-0.994) for involved knee, respectively.

CONCLUSION

The performance of SmartJoint is comparable and highly correlated with measurements obtained from KT 1000. SmartJoint may provide a truly portable, noninvasive, accurate, reliable, inexpensive and widely accessible method to characterize ATT in ACL-deficient knee.