Health checkup and telemedical intervention program for preventive medicine in developing countries: verification study

Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study

BACKGROUND

Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health.

OBJECTIVE

Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems.

METHODS

A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness.

RESULTS

Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024.

CONCLUSIONS

Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41586.

Portable health clinic COVID-19 system for remote patient follow-up ensuring clinical safety

Background

A developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities.

Methods

The PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients' treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy.

Results

This study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1-2 weeks.

Conclusions

This system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.

Women's health status before and during the COVID-19 pandemic in rural Bangladesh: A prospective longitudinal study

The coronavirus disease (COVID-19) pandemic has widely spread worldwide since 2020. Several countries have imposed lockdown or stay-at-home policies to prevent the infection. Bangladesh experienced a lockdown from March 2020 to May 2020, and internal travel was restricted. Such long and strict confinement may impact women's health. Herein, we aimed to assess the impact of the COVID-19 pandemic on women's health by comparing their health status before and during the pandemic. We conducted a prospective longitudinal study in two zones in the Chhaygaon union, rural district Shariatpur, Bangladesh. The study population comprised non-pregnant women aged 15-49 years. We visited the household of all eligible women and invited them for health checkups. The survey staff examined their health status at the checkup camps and conducted questionnaire interviews. In total, 121 non-pregnant women received health checkups both from June 2019 to July 2019 and in October 2020, before and during the COVID-19 pandemic, respectively. Compared with those during the 2019 health checkup, the medians of body mass index, systolic blood pressure, and diastolic blood pressure were significantly higher (22.7 kg/m2 to 23.6 kg/m2; 110.0 mmHg to 111.0 mmHg; and 73.0 mmHg to 75.0 mmHg, respectively, p<0.05) during the 2020 health checkup. In contrast, urine glucose levels were significantly lower (10.1% to 3.4%, p = 0.021). The lack of physical activity and other inconvenience accumulation caused by the prolonged confinement might have affected their health status. This necessitates local health workers to promote physical activity to prevent health deterioration during the pandemic.

Portable health clinic for sustainable care of mothers and newborns in rural Bangladesh

BACKGROUND AND OBJECTIVE

Regular health checkups are important for mothers and newborns to detect health problems at an early stage; however, this is often difficult in resource-limited settings. Therefore, the portable health clinic (PHC) for maternal and child health (MCH), a telemedicine health checkup system, was introduced as an intervention study in a rural area in Bangladesh. The aim of this research project was to report findings that we had observed at a mid-point of the intervention period.

METHODS

This was an intervention study conducted in Shariatpur, Bangladesh. The study population included pregnant/parturient women aged 15-49 years and their newborns. With the help of the newly created PHC for MCH, health workers, with a set of sensor devices in an attaché case, visited mothers and newborns at home to examine their health status. Their health status was triaged into four categories using a data management application, and in cases of affected or emergent health status, they were placed on remote video consultation with a doctor.

RESULTS

In total, 94 women were included in the PHC for MCH intervention. The rate of participants who received antenatal care at least four times or postnatal care at least once increased (from 29% to 51%, and from 27% to 78%, respectively) compared with before introducing PHC for MCH. Using the PHC for MCH, we detected health problems in pregnant/parturient women; a relatively high percentage had anemia (45-54%) and/or abnormal pulse rate (20-40%). Moreover, after introducing the PHC for MCH, more than 40% of women who received multiple antenatal care or postnatal care checkups improved their health status.

CONCLUSIONS

The PHC for MCH could be an effective system to improve the health of mothers and newborns by increasing the availability of care. In the future, this system is expected to be used as a primary resource for maternity healthcare, not only in rural areas but also in other social environments.

Assessing Apps for Health Care Workers Using the ISYScore-Pro Scale: Development and Validation Study

Background

The presence of mobile phone and smart devices has allowed for the use of mobile apps to support patient care. However, there is a paucity in our knowledge regarding recommendations for mobile apps specific to health care professionals.

Objective

The aim of this study is to establish a validated instrument to assess mobile apps for health care providers and health systems. Our objective is to create and validate a tool that evaluates mobile health apps aimed at health care professionals based on a trust, utility, and interest scale.

Methods

A five-step methodology framework guided our approach. The first step consisted of building a scale to evaluate apps for health care professionals based on a literature review. This was followed with expert panel validation through a Delphi method of (rated) web-based questionnaires to empirically evaluate the inclusion and weight of the indicators identified through the literature review. Repeated iterations were followed until a consensus greater than 75% was reached. The scale was then tested using a pilot to assess reliability. Interrater agreement of the pilot was measured using a weighted Cohen kappa.

Results

Using a literature review, a first draft of the scale was developed. This was followed with two Delphi rounds between the local research group and an external panel of experts. After consensus was reached, the resulting ISYScore-Pro 17-item scale was tested. A total of 280 apps were originally identified for potential testing (140 iOS apps and 140 Android apps). These were categorized using International Statistical Classification of Diseases, Tenth Revision. Once duplicates were removed and they were downloaded to confirm their specificity to the target audience (ie, health care professionals), 66 remained. Of these, only 18 met the final criteria for inclusion in validating the ISYScore-Pro scale (interrator reliabilty 92.2%; kappa 0.840, 95% CI 0.834-0.847; P<.001).

Conclusions

We have developed a reproducible methodology to objectively evaluate mobile health apps targeted to health care professionals and providers, the ISYScore-Pro scale. Future research will be needed to adapt the scale to other languages and across other domains (eg, legal compliance or security).

Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review

Hypertension remains the leading cause of cardiovascular disease worldwide and disproportionately impacts patients living in low- and middle-income countries (LMICs). Telemedicine offers a potential solution for improving access to health care for vulnerable patients in LMICs.

Association between serum uric acid and obesity in Chinese adults: a 9-year longitudinal data analysis

OBJECTIVES

Hyperuricaemia has been reported to be significantly associated with risk of obesity. However, previous studies on the association between serum uric acid (SUA) and body mass index (BMI) yielded conflicting results. The present study examined the relationship between SUA and obesity among Chinese adults.

METHODS

Data were collected at Guangdong Second Provincial General Hospital in Guangzhou City, China, between January 2010 and December 2018. Participants with ≥2 medical check-up times were included in our analyses. Physical examinations and laboratory measurement variables were obtained from the medical check-up system. The high SUA level group was classified as participants with hyperuricaemia, and obesity was defined as BMI ≥28 kg/m². Logistic regression model was performed for data at baseline. For all participants, generalised estimation equation (GEE) model was used to assess the association between SUA and obesity, where the data were repeatedly measured over the 9-year study period. Subgroup analyses were performed by gender and age group. We calculated the cut-off values for SUA of obesity using the receiver operating characteristic curves (ROC) technique.

RESULTS

A total of 15 959 participants (10 023 men and 5936 women) were included in this study, with an average age of 37.38 years (SD: 13.27) and average SUA of 367.05 μmol/L (SD: 97.97) at baseline, respectively. Finally, 1078 participants developed obesity over the 9-year period. The prevalence of obesity was approximately 14.2% for high SUA level. In logistic regression analysis at baseline, we observed a positive association between SUA and risk of obesity: OR=1.84 (95% CI: 1.77 to 1.90) for per-SD increase in SUA. Considering repeated measures over 9 year for all participants in the GEE model, the per-SD OR was 1.85 (95% CI: 1.77 to 1.91) for SUA and the increased risk of obesity were greater for men (OR=1.45) and elderly participants (OR=1.01). In subgroup analyses by gender and age, we observed significant associations between SUA and obesity with higher risk in women (OR=2.35) and young participants (OR=1.87) when compared with men (OR=1.70) and elderly participants (OR=1.48). The SUA cut-off points for risk of obesity using ROC curves were approximately consistent with the international standard.

CONCLUSIONS

Our study observed higher SUA level was associated with increased risk of obesity. More high-quality research is needed to further support these findings.

Patients' perceptions of teleconsultation during COVID-19: A cross-national study

In recent months, humanity has had to deal with a worldwide pandemic called COVID-19, which has caused the death of hundreds of thousands of people and paralyzed the global economy. Struggling to cure infected patients while continuing to care for patients with other pathologies, health authorities have faced the lack of medical staff and infrastructure. This study aimed to investigate the acceptance of teleconsultation solutions by patients, which help to avoid the spread of the disease during this pandemic period. The model was built using some constructs of the technology acceptance model UTAUT2, Personal traits, Availability, and Perceived Risks. A new scale on Contamination Avoidance was developed by the authors. The questionnaire was disseminated in several countries in Europe and Asia and a total sample of 386 respondents was collected. The results emphasize the huge impact of Performance Expectancy, the negative influence of Perceived Risk, and the positive influence of Contamination Avoidance on the adoption of teleconsultation solutions. The findings highlight the moderating effects of Age, Gender, and Country.

Co-design, Co-production, and Co-evaluation Processes for a Mobile Health Check-Up Research Project in Jaipur, India: A Case Study of the Portable Health Clinic, 2016–2020

This chapter summarizes the co-design, co-production, and co-evaluation processes of a mobile health check-up research project in Jaipur, India, from March 2016 to June 2020. It is the continuation of our previous paper which was published in November 2018 at Sustainability. The main focus of this chapter is to describe the processes of co-production, co-implementation, and co-evaluation research activities after November 2018. To accomplish this, all documents and materials related to the research processes of co-design, co-production, and co-evaluation were thoroughly reviewed, including minutes from meetings, consultations, workshops, trainings, presentation slides, pictures, and reports. After reviewing the past 4 year’s research process, the road map of a sustainable mobile health check-up project in India was proposed.

Blood Uric Acid Prediction With Machine Learning: Model Development and Performance Comparison

Background

Uric acid is associated with noncommunicable diseases such as cardiovascular diseases, chronic kidney disease, coronary artery disease, stroke, diabetes, metabolic syndrome, vascular dementia, and hypertension. Therefore, uric acid is considered to be a risk factor for the development of noncommunicable diseases. Most studies on uric acid have been performed in developed countries, and the application of machine-learning approaches in uric acid prediction in developing countries is rare. Different machine-learning algorithms will work differently on different types of data in various diseases; therefore, a different investigation is needed for different types of data to identify the most accurate algorithms. Specifically, no study has yet focused on the urban corporate population in Bangladesh, despite the high risk of developing noncommunicable diseases for this population.

Objective

The aim of this study was to develop a model for predicting blood uric acid values based on basic health checkup test results, dietary information, and sociodemographic characteristics using machine-learning algorithms. The prediction of health checkup test measurements can be very helpful to reduce health management costs.

Methods

Various machine-learning approaches were used in this study because clinical input data are not completely independent and exhibit complex interactions. Conventional statistical models have limitations to consider these complex interactions, whereas machine learning can consider all possible interactions among input data. We used boosted decision tree regression, decision forest regression, Bayesian linear regression, and linear regression to predict personalized blood uric acid based on basic health checkup test results, dietary information, and sociodemographic characteristics. We evaluated the performance of these five widely used machine-learning models using data collected from 271 employees in the Grameen Bank complex of Dhaka, Bangladesh.

Results

The mean uric acid level was 6.63 mg/dL, indicating a borderline result for the majority of the sample (normal range <7.0 mg/dL). Therefore, these individuals should be monitoring their uric acid regularly. The boosted decision tree regression model showed the best performance among the models tested based on the root mean squared error of 0.03, which is also better than that of any previously reported model.

Conclusions

A uric acid prediction model was developed based on personal characteristics, dietary information, and some basic health checkup measurements. This model will be useful for improving awareness among high-risk individuals and populations, which can help to save medical costs. A future study could include additional features (eg, work stress, daily physical activity, alcohol intake, eating red meat) in improving prediction.

Impacts of Anthropometric, Biochemical, Socio-demographic, and Dietary Habits Factors on the Health Status of Urban Corporate People in a Developing Country

This study focused on urban corporate people and applied multinomial logistic regression (MLR) to identify the impact of anthropometric, biochemical, socio-demographic and dietary habit factors on health status. Health status is categorized into four levels: healthy, caution, affected, and emergent. A cross-sectional study, based on convenience sampling method, was conducted to select 271 employees from 18 institutions under the Grameen Bank Complex, Dhaka, Bangladesh. Biochemical measurements such as blood uric acid are highly significant variables in the MLR model. When holding other factors as constants, with a one-unit increase in blood uric acid, a person is 11.02 times more likely to be "emergent" compared to "caution". The odds are also higher, at 1.82, for the blood uric acid to be "affected" compared "caution". The results of this study can help to prevent a large proportion of non-communicable diseases (NCDs) by reducing the most significant risk factor: blood uric acid. This study can contribute to the establishment of combined actions to improve disease management.

A Predictive Model for Height Tracking in an Adult Male Population in Bangladesh to Reduce Input Errors

The advancement of ICT and affordability of medical sensors enable healthcare data to be obtained remotely. Remote healthcare data is erroneous in nature. Detection of errors for remote healthcare data has not been significantly studied. This research aims to design and develop a software system to detect and reduce such healthcare data errors. Enormous research efforts produced error detection algorithms, however, the detection is done at the server side after a substantial amount of data is archived. Errors can be efficiently reduced if the suspicious data can be detected at the source. We took the approach to predict acceptable range of anthropometric data of each patient. We analyzed 40,391 records to monitor the growth patterns. We plotted the anthropometric items e.g., Height, Weight, BMI, Waist and Hip size for males and females. The plots show some patterns based on different age groups. This paper reports one parameter, height of males. We found three groups that can be classified with similar growth patterns: Age group 20–49, no significant change; Age group 50–64, slightly decremented pattern; and Age group 65–100, a drastic height loss. The acceptable range can change over time. The system estimates the updated trend from new health records.

Predictive, Personalized, Preventive and Participatory (4P) Medicine Applied to Telemedicine and eHealth in the Literature

The main objective of this work is to provide a review of existing research work into predictive, personalized, preventive and participatory medicine in telemedicine and ehealth. The academic databases used for searches are IEEE Xplore, PubMed, Science Direct, Web of Science and ResearchGate, taking into account publication dates from 2010 up to the present day. These databases cover the greatest amount of information on scientific texts in multidisciplinary fields, from engineering to medicine. Various search criteria were established, such as ("Predictive" OR "Personalized" OR "Preventive" OR "Participatory") AND "Medicine" AND ("eHealth" OR "Telemedicine") selecting the articles of most interest. A total of 184 publications about predictive, personalized, preventive and participatory (4P) medicine in telemedicine and ehealth were found, of which 48 were identified as relevant. Many of the publications found show how the P4 medicine is being developed in the world and the benefits it provides for patients with different illnesses. After the revision that was undertaken, it can be said that P4 medicine is a vital factor for the improvement of medical services. It is hoped that one of the main contributions of this study is to provide an insight into how P4 medicine in telemedicine and ehealth is being applied, as well as proposing outlines for the future that contribute to the improvement of prevention and prediction of illnesses.

Lessons Learned from Co-Design and Co-Production in a Portable Health Clinic Research Project in Jaipur District, India (2016–2018)

Co-design and co-production with non-academic stakeholders has been recognized as a key approach in transdisciplinary sustainability research. The majority of transdisciplinary studies have been conducted in Europe and North America, with a marked lack of such research in the Asian context—particularly with regard to healthcare. Utilizing a case study involving mobile health check-ups performed using a portable health clinic system in Jaipur, India, from March 2016 to March 2018, this study identifies key factors in co-design and co-production that should be considered to ensure the project’s sustainability. Thoroughly reviewing all of the documents and materials related to the case study’s co-design and co-production, this study identifies the following key factors: (1) mutual stakeholder agreement on a long-term research plan, protocol, and budget; (2) harmonizing research objectives, frames, and the scale of stakeholder expectations; (3) stakeholders’ commitment and a sense of ownership derived from their needs and priorities; (4) stakeholder trust; (5) effective coordinators; (6) personality type and characteristics of stakeholder leaders; (7) capacity building and the empowerment of local research staff and participants; and (8) continuous efforts to involve stakeholders throughout the co-design and co-production processes. Facilitating effective co-design and co-production, these factors will help ensure the future sustainability of projects.

The role of telehealth counselling with mobile self-monitoring on blood pressure reduction among overseas Koreans with high blood pressure in Vietnam

INTRODUCTION

Rapid globalization has produced a growing demand for the chronic care management of overseas populations living in medically underserved areas. This study investigated the utilization pattern of telehealth counselling among overseas Koreans with high blood pressure, and evaluated the relationships between mobile self-monitoring application and blood pressure reduction.

METHODS

A global chronic management programme consisting of lifestyle modification and self-monitoring blood pressure was launched to provide a telehealth counselling service for Koreans with high blood pressure living in Vietnam from August 2016 to December 2017. During the first telehealth session, doctors educated patients on lifestyle modifications using a mobile self-monitoring application and checked the change of blood pressure in a follow-up telehealth visit. We examined utilization patterns and compared the blood pressure change among the mobile self-monitoring group versus the control group using Wilcoxon signed rank tests.

RESULTS

A total of 234 patients with systolic blood pressure of more than 130 mmHg or diastolic blood pressure of more than 80 mmHg were registered, installed the mobile app and were provided with automated blood pressure devices with the telehealth counselling service by Korean doctors. A follow-up telehealth counselling session was provided at three months. Only 15% (36/234) received two or more telehealth counselling sessions. Significant differences were found in the mean change of systolic blood pressure at three months in the monitoring group and the non-monitoring group (-16.0 vs. -5.7, p = 0.008).

DISCUSSION

In this unique telehealth study, a mobile self-monitoring application was associated with significantly reducing systolic blood pressure levels in three months. Encouraging patients via a mobile application that includes a self-monitoring function might have the potential for self-managing chronic diseases, especially in resource-limited environments.