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Showing posts with label Public Health. Show all posts
Showing posts with label Public Health. Show all posts

Monday, March 23, 2020

Anxiety about coronavirus can increase the risk of infection — but exercise can help

Anxiety about coronavirus can increase the risk of infection — but exercise can help



Stress about the coronavirus pandemic can actually increase your risk of infection, but exercise can alleviate the immune system’s stress response. Above, a lone jogger in Ottawa, on March 17, 2020. THE CANADIAN PRESS/Adrian Wyld
Jennifer J. Heisz, McMaster University
Worried about COVID-19? You may be putting yourself at undue risk, because chronic anxiety suppresses the immune system and increases our risk for infection.
The psychological impact of the COVID-19 pandemic is causing incredible distress. I ran into a friend at the grocery store the other day. She was wiping down her cart with antiseptic. Under normal circumstance, this behaviour would seem bizarre, but in the current COVID-19 climate, it has become acceptable.
Although it is important to be prepared during this pandemic, we do not need to panic. Physical activity can help protect the immune system from the effects of stress.

Fear of the unknown

As an associate professor in the department of kinesiology at McMaster University, I direct a team of researchers in the NeuroFit Lab, where we’ve shown that psychological distress can compromise mental health.
Anxiety about the unknown (such as our risk of COVID-19) can hyperactivate the fear centre in the brain called the amygdala. In terms of evolution, this is one of the oldest parts of the brain and its operations are quite primitive; it acts like a trigger-happy alarm that interfaces with the stress system to keep our body and mind on high alert for as long as we are feeling anxious. Research shows that the mere suggestion of danger, even if it never is experienced, is enough to trigger the amygdala and activate the stress response. This is what keeps people awake at night, lying in bed worrying about COVID-19.
The problem is that chronic activation of the stress systems can damage our cells and upset many of the body’s functions. Our immune system bears the brunt. Although psychological stress is not pathogenic per se, the damage it causes to the body’s cells triggers an immune response that makes us more susceptible to a foreign pathogen. This may increase our risk for infection with SARS-CoV-2, the coronavirus that causes COVID-19.

Worried sick

The immune system acts like border security, patrolling the body for cells that are foreign and harmful to it. It works a lot like the Nexus or Global Entry programs for pre-approved travellers; anyone enrolled in the program has their iris scanned to quickly confirm their identity for fast border crossing. But instead of iris scanning, the immune system scans the outer surface of a cell for its biological passport, or what scientists call a motif.
The body’s cells have a motif (a “self” motif) that’s different from the “non-self” motif of foreign cells and pathogens, like SARS-CoV-2. This non-self motif is known as a pathogen-associated molecular pattern (PAMP).


Concerns about COVID-19 led crowds to stock up on supplies. Here, people line up at a Costco in Ottawa on March 13, 2020. THE CANADIAN PRESS/Justin Tang

Another type of motif is the “damaged self” motif, known as a damage-associated molecular pattern, or DAMP. This motif is expressed by a damaged or dying cell that no longer serves the body. Stress damages the body’s cells, transfiguring self motifs into damaged self motifs. This elevates inflammation throughout the body in a similar way as if it were infected. This response, in the absence of an actual infection, is called a sterile immune response.
Chronic over-worrying about COVID-19 can intensify our vulnerability to viruses by creating an imbalance in immune function. This is because the immune system reacts to multiple breaches in immunity in a similar way that airport security reacts to multiple breaches in safety, by escalating the response. Think back to how vigilant airport security became after 9/11, implementing the strictest screening procedures for all passengers and luggage.

Read more: Coronavirus weekly: expert analysis from The Conversation global network

Excessive anxiety about COVID-19 can trigger an immune response that increases inflammation and readies the immune system’s equivalent of special forces, known as inflammasomes. If SARS-CoV-2 acts like other viruses, then upon infection the inflammasomes will be called to action to escalate inflammation even further. But too much inflammation does more harm than good; it deregulates immune function, increasing our risk of a viral infection.
My lab recently demonstrated how quickly our health declines under chronic stress. We tracked sedentary but otherwise healthy students during the weeks leading up to their final exams, and we observed how six weeks of stress gave rise to the symptoms of depression.

Resisting the effects of anxiety

What can we do to prevent panic and bolster immune protection?
Physical activity can protect your body from chronic stress-induced inflammation.
In our study, during that same stressful six-week period, we enrolled some of the students in a new exercise program in which they cycled on a stationary bike at moderate intensity for approximately 30 minutes, three times per week. Moderate intensity exercise is about 40 per cent of maximum workload: the point at which someone can still talk, but can’t sing.
Blood samples were collected to track changes in inflammation. Although the exercisers were exposed to the same psychological stressors as the sedentary students, their inflammation remained low and their mood remained high with no increase in symptoms of anxiety or depression.
But the intensity of the exercise mattered. Higher intensity exercise was not as effective at protecting mental health or reducing inflammation. The vigorous nature of the intense exercise may have exacerbated an already stressed-out system, especially in individuals who were not accustomed to exercise.
The key take-away from our research: a brisk walk, jog or bike ride can help keep you calm and healthy during these uncertain times so you can be prepared without the panic.The Conversation
Jennifer J. Heisz, Associate Professor in Kinesiology and Associate Director (Seniors) of the Physical Activity Centre of Excellence, McMaster University
This article is republished from The Conversation under a Creative Commons license. Read the original article.

Friday, September 1, 2017

NIH’s All of Us Research Issues Initial Research Protocol

NIH’s All of Us Research Issues Initial Research Protocol

August 8, 2017
by Heather Landi
The National Institute of Health’s All of Us Research Program, previously called the Precision Medicine Initiative, released its initial research protocol, or research plan.
The All of Us Research Program’s 61-page protocol includes information on consent forms, the ethical issues associated with the project and explanations for how participants will be able to provide secure access to their electronic health records (EHRs).

The goal of the All of Us Research Program is to gather health-related information from one million or more diverse participants to detect association between genetic and environmental exposures and a wide variety of health outcomes.

The NIH states that longitudinal tracking of health outcomes through EHRs is an important component of the program. Through a consenting process, participants will be asked to authorize linkage of their EHR information. EHR data may be sent directly by the participant’s health care providers to the DRC or sent by the participant to the program through Sync for Science.

Access to EHR data will be repeated regularly throughout the life of the program. The initial data types to be included are demographics, visits, diagnoses, procedures, medications, laboratory tests, and vital signs, but may be expanded to all parts of the EHR, including health care provider notes. The feed may include mental health data, HIV status, substance abuse and alcohol data, and genomic information stored in the EHR

Participants may need to complete and sign a separate informed consent module to authorize access to their complete EHRs.

“We will create an informatics infrastructure to clean and standardize data from disparate EHR systems across the United States; this broadly applicable system will be a key contribution of the All of Us Research Program to health informatics research efforts nationwide. For participants enrolled by their health care provider organization, the site will extract data from the participant’s EHR, format it according to the DRC’s data model (based on the Observational Medical Outcomes Partnership [OMOP] Common Data Model version 5, and transfer it to the DRC using secure protocols,” NIH stated in a press release.
And, the NIH states that although obtaining EHR data from direct volunteers presents unique challenges, early pilot studies have demonstrated feasibility of such an approach. “For example, the Sync for Science (S4S) project launched by NIH and the Office of the National Coordinator for Health IT is creating a technology that aims to make it easy and safe for people to securely share their EHR data for research. S4S has been adopted by the All of Us Research Program and initially will be enabled in a small pilot for DV participants at S4S-enabled direct volunteer sites,” the NIH states.

All of Us Research Program direct volunteer participants who have enrolled at one of these pilot sites will be able to sign into their healthcare provider’s patient portal using the S4S workflow and authorize sharing their EHR data with the program. Their health care provider’s system will provide a secure application program interface (API), which is used by the research program, rather than the provider sending out data, and transmitted to the Us of All Research program.

And, NIH notes that this is just the first version of its protocol. In future versions, NIH intends to include plans to pilot test wearable devices for real-time data collection.
Get the latest information on EHR and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

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Friday, March 21, 2014

ImmunizeCA app helps people keep track of vaccinations

Ottawa Hospital researchers have developed a free app to help Canadians store, manage and access immunization information.
Dr. Kumanan Wilson of the Ottawa Hospital Research Institute said the ImmunizeCA app will also alert users if there's an issue in their area, such as the recent measles outbreak in Ottawa.

"So that would be in the outbreak section, they would see how close they are to the where the report is," he said.

"They could see if their family is up to date. They may say, 'Oh, time to get Johnny vaccinated. It's time to get catch up the vaccine.'"

The app is privacy-protected and not accessible to any health agency.
It's meant to empower people to control their own health by helping them keep track of when vaccinations, boosters and flu shots are due, Wilson said.

Wilson said the concept could also be reworked for similar public health applications.
"So another place I think it could be really helpful is in blood donations. And I think the blood donor app would be a really great idea to do booking online for their appointments, track donations, be notified when they can donate again," he said.

The Public Health Agency of Canada funded the app. It's available to residents in every province.

ImmunizeCA can be downloaded from iTunes, GooglePlay or BlackBerry World.

Tuesday, February 18, 2014

Korean Public Health for 400 years: Donguibogam

There are several versions of the Korean TV Drama Heo Jun, or Hur Jun (2013 version & 1999 version ) about the greatest physician in Korean history, the accredited author/editor of the Donguibogam (literally Mirror of Eastern Learning) (동의보감, 東醫寶鑑), Vol. 1-25. Not much is known about his life, and the TV dramas are largely fictional, but the legacy of the Donguibogam continues to live on after 400 years. The wood block movable type volumes have been reprinted 40 times in China where it is highly revered as the major classic of medicine, and more than several times in Japan. The original first two prints are still preserved in as good as new condition in several libraries in Seoul. The UNESCO report on it, which comes close to the announcement of the first good English translation of the 25 volumes, attest to it being the first state sponsored public health text and policy. This is unprecedented in public health and only makes me think of the time John Snow removed the pump handle on the cholrea ridden water in London in 19th century.

The remedies and cures promoted by Heo Jun in the Donguibogam are household common knowledge, and I can attest to being treated and restored by several during my years I lived in Korea. Almost any folk remedy, herbal medicine, acupuncture is attributed to him and the Donguibogam. Korea has two medical systems, the traditional and the modern. Today's naturopathic doctors would be more like this form of traditional medicine, which is very popular in Korea.

In this modern world of digital health, I look forward to one day trying to read the translations in English, though I totally lack knowledge of the medical systems it contains. I have looked through one of the online original text volumes just to see if it did have Hangul (Korean phonetic writing) and not just Han Mun (Chinese), because most of the Koreans at the time could not read Han Mun, only the upper class literati. I did see some Hangul, but it is largely in Chinese. I can only watch in amazement at the TV Korean dramas, which come with English subtitles (which are not always professional grade, but mostly acceptable by the way), and which continue to pass on this knowledge at the same time as it raises Heo Joon to the level of a saint. This is from the UNESCO nomination for "Memory of the World":

Bogam is the first-ever comprehensive book on medical principles and practice edited and distributed nationwide, according to the innovative order by state to proclaim the ideals of public health by the state and preventive medicine. 




Wednesday, January 29, 2014

Public Health Informatics or Consumer Health informatics

What is the difference between public health informatics and consumer health informatics? First a basic knowledge of the different kinds of healthcare governance systems used in the country where you are situated is needed for the right context. Being from Canada, I understand we essentially have a public supported healthcare system. Our next door neighbour has Obamacare. The land of our Mother Queen has the NHS, which is apparently one of the world's largest employers, right up there with the Chinese military.

I have seen textbooks on public health informatics, and I imagine there are some for consumer health, but most of the evidence points to consumer health information being everywhere. The informatics side of it is more difficult to contend with. And when you consider that most of the known world doesn't have public or government supported healthcare, you are really looking at private, for profit, or consumer health.

The evidence for "for profit" healthcare is that it is bad for your health and might kill you. This is to disregard for a second dangers to health in the ordinary run of the mill statistics on patient safety, medical errors, hospital viruses, etc. The hippocratic or medicine buddha vow universalistic compassionate purpose for free medical treatment also comes with a price tag in limited resources, skills, and knowledge. Humans helping humans out of love is after all the only principle worth trying to apply to improving quality of life as a return on investment.

With the push of IT into healthcare comes the warning that applying IT into standards of care and therapeutic interventions requires evidence that it works, is cost effective, and is generally worth the change management stress of the push factor. Would public health support more IT for patients as part of the general healthcare standard of care if it is proven to reduce hospital costs, improves quality of life, reduces errors, etc? You betcha. Probably though a lot of IT projects for healthcare start out experimental and are only available through private networks and citizens with deeper pockets. That is a consumer health choice.

Here is a Gunther Esyenbach definition of "Consumer Health Informatics" from a BMJ article:

Consumer health informatics is the branch of medical informatics that analyses consumers' needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers' preferences into medical information systems. Consumer informatics stands at the crossroads of other disciplines, such as nursing informatics, public health, health promotion, health education, library science, and communication science, and is perhaps the most challenging and rapidly expanding field in medical informatics; it is paving the way for health care in the information age.

That is all well and good of course, but it means almost anything. When you talk about Public Health Informatics, you have a more dedicated field of investigation into such things as infectious disease, pandemics, syndromic surveillance. It always makes me think of Google Flu, which is an insane way search queries on Google can predict disease outbreaks better than the CDC or other public health surveillance systems. And then there is the phenomenon like HealthMap, which really illustrates this well.




Speaking of maps, lets take a look at what a consumer health information map of medicine would look like. It just so happens that the NHS has exactly that, a Map of Medicine, or "See what your doctor can see with Map of Medicine Healthguides". When you first go to this website you need to accept a disclaimer. I didn't read it but I think it has to do with something like "you are about to read health information that only an expert like your family doctor knows anything about so for the love of Christ be careful from here on in". What the heck, I will try to copy and paste that disclaimer in here because it is so interesting (after the diabetes flowchart).

In reality, I was actually kind of shocked when I clicked on one of these healthguides and found it was a information flowchart right out of 1960s programming land. I will link to the one for Diabetes here. The sheer brilliance of the healthguide that makes it different from just your average consumer health information page (which it strongly asserts it is not meant to be for), is that when you click or mouse over the little "i" for "Information", you get a flash or javascript window with detailed information about that condition on the path for the flowchart stage. A PDF printable view will give you all the information bubbles from the flow chart. Here is only the flowchart:


Welcome to Map of Medicine Healthguides

Patients and carers

Disclaimer

The Map of Medicine is intended for use by healthcare professionals in a clinical setting. The Map of Medicine should not be used as a substitute for a healthcare professional's diagnosis or clinical decisions, by healthcare professionals or other users.
The treatment responsibility of a patient lies solely with the healthcare professional responsible for that treatment. The Map of Medicine is not exhaustive and may not reflect the most recent medical research. By continuing to access the Map of Medicine, you agree to accept our Terms and Conditions.

Healthcare professionals

If you are an NHS user in England, excluding London, please access the Map of Medicine using either your Athens login or your Smartcard. This will also provide access to care maps developed for use in your local area.
If you are a healthcare professional working in an area without a licence for the Map of Medicine, please register to access national care maps.
For more information about Map of Medicine licensing and access, please visit our website. Map of Medicine licensing







Thursday, January 16, 2014

Google broke Canada’s privacy laws with targeted health ads

This story is currently receiving a lot of media attention currently and I reposted they headline and story from The Globe and Mail:

http://www.theglobeandmail.com/technology/tech-news/google-broke-canadas-privacy-laws-with-targeted-ads-regulator-says/article16343346/?cmpid=rss1

I left the word "watchdog" off the headline because the Canadian Privacy Commissioner isn't a watchdog. There is no privacy police but there is a privacy policy. Not a police dog, but a policy dog. Google might pay a fine? No problem for Google probably. Not many privacy statutes have teeth is what they say.

This story reminds me again that I want to write more about the face-off between Public Health and Consumer Health. This is a prime illustration: Google is consumer health using targeted health ads based on your browsing search inquiries, and the Government of Canada is Public Health, the collective servant of protective measures based on principles that come somewhere other than making a profit - serving the common good by way of utilitarian ethics.

Most of the time when it comes to health information, I am highly sympathetic to "Dr. Google".  I will pick up this thread later because I want to say more about how I see the differences between Public Health and Consumer Health will have an impact on informatics.

If anyone wants me to remove the AdSense ads from this blog, because you are offended by the personally invasive use of targeted ads relating to your personal health search on Google, please let me know. That's the way the cookie crumbles, as they say.




Tuesday, August 27, 2013

Crowdsourcing rare diseases for patients - Crowdmed

I recently discovered two crowdsourcing sites for medicine after starting to wonder how it would work in an ehealth type of application. Strangely, they both have a similiar name and function if I am not mistaken, medcrowd.com and crowdmed.com.  I am going to talk a little about Crowdmed as it looks more interesting.


To my mind, this is a very powerful crowdsourcing site to fetch opinions on rare medical conditions without an IBM Dr. Watson nearby. Is is a trusted source of information? I wouldn't know, but I like the way the site works, according to this article in the new scientist:
Anyone can join CrowdMed and analyse cases, regardless of their background or training. Participants are given points that they can then use to bet on the correct diagnosis from lists of suggestions. This creates a prediction market, with diagnoses falling and rising in value based on their popularity, like stocks in a stock market. Algorithms then calculate the probability that each diagnosis will be correct.
Here is the welcome email from the founder and CEO Jared Heyman:

Here’s a quick refresher on how CrowdMed works:
  1. Patients complete a questionnaire, which collects information regarding their symptoms, medical history, family history, basic demographics, medications, and lifestyle.
  2. Once a case is submitted, CrowdMed invites hundreds of Medical Detectives (“MDs”) to recommend potential diagnoses and bet on the ones they think are most likely.
  3. CrowdMed’s patented prediction market technology harnesses ‘the wisdom of crowds’ and provides patients with a short list of the most likely diagnostic suggestions to discuss with their doctor.
I started CrowdMed because I watched my younger sister, Carly, suffer through three years of debilitating symptoms, visits to two dozen doctors and specialists, and over $100,000 in medical bills before she was finally diagnosed with a rare but treatable illness. She was CrowdMed’s first test case, and our phenomenal community of Medical Detectives collaborated to accurately solve her case in just a few days, proving that large crowds working to solve a problem are often smarter than even the most expert individual. I want to share CrowdMed with other patients so they don’t have the same experience Carly had. Read more about CrowdMed’s story.
To get started, log in to CrowdMed and choose ‘Solve a case’ or ‘Submit a case’. And don’t forget -- for every 1,000 points you win solving cases on CrowdMed, you can donate $1.00 to the patient of your choice on Watsi and potentially help save two lives at once.
We love to help bring patients one step closer to the right diagnosis and treatment, so please visit CrowdMed today!
Together, we can help save lives.
Jared Heyman
Founder, CrowdMed 

Tuesday, January 29, 2013

Leprosy and eHealth

I found this story  in my Google Reader I think because my search query for RSS news feeds is set on Health informatics and bioinformatics. The focus of the article is the fund raising of David Bousfield for leprosy. I think Google picked up that David was "an expert in biomedical publishing and informatics". Anyway, who doesn't think leprosy is a terrible disease? We don't see it much here in Canada, but I have seen it in Guatemala, South Korea, Nepal and quite up close in India. Seeing it in South Korea was very rare until I remembered that a friend of mine worked there with the Peace Corps in the 1980s helping treat persons with leprosy.  In India, one may meet persons with leprosy on almost any given day of the week, or so it might seem.

Maybe there can be an eHealth solution to assist in this cause, as David says:

“Being a repeat rider you become aware of how global healthcare is evolving. What Lepra originally did was distribute drugs, but these days it’s about information. The drugs are there but it has become more focused on making that link between somebody who has the disease, where the drug is and what you’ve got to do to get it.”

Just get some recycled cell phones, and a used computer to act as a messaging server, and an SMS system can really do wonders in terms of collecting information and helping to create a support structure. It has been done successfully by FrontlineSMS all over the world. Of course some persons with this disease are not going to be able to handle a cell phone, and that's were some other forms of adaptive technology might come in. For example, isn't Google Glass kind of a hands free voice activated system?

Yes, I know that lepers wearing Google Glass isn't going to happen overnight and Google Glass isn't on the market yet in order to create recycled items or competitive items to drive the price down - it is just a fact that new technologies kind of cycle this way and end up on the "bottom of the pyramid" at the same time as they start to support the structures above.

David's £50k helps the fight against leprosy

David Bousfield recently completed his 10th gruelling cycle ride in aid of a charity at the frontline in the fight against leprosy – taking his fundraising total to almost £50,000. He tells LOUISE MARTIN why it’s time to remove the stigma associated with the disease.
Riders and support crew
Riders and support crew
Every two minutes in the world, and every four minutes in India, someone is diagnosed with leprosy. One of the oldest and most stigmatised of diseases, leprosy is a chronic infection of the skin and nerves; left untreated it can lead to loss of sensation in hands and feet, ulcers and deformities, and can even result in blindness.
India is home to more than half of the world’s new cases of leprosy each year. The disease thrives in the country’s poor, overcrowded areas where the chronic condition is easily spread via coughing and sneezing. Every year, the international health charity Lepra transforms the lives of 73,000 people with leprosy by working at the frontline to treat, educate and rehabilitate those affected by leprosy – as well as other diseases associated with poverty and prejudice including TB, HIV, lymphatic filariasis and malaria.

As the world’s first ever leprosy prevention organisation Lepra’s work is crucial, but it can only continue its life-saving work with the support of dedicated fundraisers like Cambridge resident David Bousfield.

An expert in biomedical publishing and informatics, 63-year-old David got involved with the charity in January 1999. “I saw a tiny advert in The Guardian saying ‘Do you want to get fit? Do you want to go to Brazil? Do you want to do something worthwhile?’” he remembers.

“They were all things on my list of New Year resolutions so I thought I could tick them all off in one go.”

The trip to Brazil was based around a 450-mile group cycle ride which helped to raise vital funds for the charity, while visiting some of the communities it works to support. Although interested in the charity’s work, David admits at the time, for him, the real draw was the cycling. “Brazil kind of got me hooked on the bike rides but my attitude has slightly changed,” he says. “To begin with it was an opportunity to go with a group of people and cycle in a country that I wanted to know more about and what Lepra did was the bit on the side. But now, because of the work that I do, I’ve become more interested in how health information is used in developed countries, so it’s an interesting way to learn more about what’s happening in developing countries such as India and Brazil.”

A couple of months ago, David completed his 10th cycle ride for Lepra and took his fundraising total for the charity to almost £50,000. As part of a team of 12 cyclists, he accompanied a Lepra health education van across project sites on a 500km route in the state of India’s Madhya Pradesh. The team was visiting poverty-stricken rural villages, health centres and hospitals to give vital health education. The poor areas have low or no literacy rates so the education team teaches communities how to detect the symptoms of diseases through the forms of plays, puppet shows and films broadcasted from the back of rickshaws.

“Compared to many other diseases, there is relatively little known about the leprosy transmission process, apart from that there is a cocktail of drugs to cure it,” explains David.

David back home in Cambridge
David back home in Cambridge
“Being a repeat rider you become aware of how global healthcare is evolving. What Lepra originally did was distribute drugs, but these days it’s about information. The drugs are there but it has become more focused on making that link between somebody who has the disease, where the drug is and what you’ve got to do to get it.”

Lepra ’s aim is to make people aware of the symptoms and curability of leprosy and other diseases through education and increasing the charity’s visibility. The organisation has 26 leprosy and TB referral centres across India providing specialist services such as testing and treatment for people with TB and physiotherapy and reconstructive surgery for those with leprosy but, despite there being a cure for leprosy, there is no vaccine to prevent infection in the first place and there is still much prejudice associated with it.

One of the aims of the Lepra cycle rides is to help break the stigma associated with diseases such as leprosy. During the trip, David met a father and his two children who live under a tarpaulin on the side of a road. The mother left her husband and two young daughters, Sita and Gita, after they contracted leprosy. “You see all sorts of things which are absolutely horrific. If you remove the stigma that is associated with leprosy and other diseases so that the village actually helps, people in the village will know what the symptoms are and spot the symptoms and then instead of telling people to get out of the village they’ll tell people to get help. The stigma is still very much there but by acting quickly the infection can be stopped. You have to be pretty quick off the mark to come out with no lasting consequences, but you can stop the infection.”

The November trip was David’s fifth visit to India. Previous cycle rides have been in the Orissa region and this was only the second time the Madhya Pradesh route had been undertaken by a Lepra group and, according to David, it was a positive experience. “It was really great,” smiles David. “The weather was perfect – apart from on the last day when it was very hot – but we cyclists love to grumble and I think at the end of the day if you haven’t had a few really tough days then you don’t have stuff to go back and moan about at home!”
The keen cyclist is modest about his impressive achievement, but the living conditions and hazards on the road are not for the fainthearted. “We rode on some motorways but mostly it was on quiet rural roads. There were some that were very badly water eroded so there were lots of potholes, loose gravel and boulders,” explains David. “Indian driving looks a bit chaotic, and it was a bit hairy in places, but the lorry drivers in particular seemed to be very forgiving and would give us a wide berth.”

In order to cover as many miles as possible the days were long and there was no five-star hotel to relax in at the end of a gruelling stint in the saddle. Yet despite the tough conditions on the road, the team only had to deal with three punctures during the whole 500km route and, to reduce the risk of food poisoning, most meals were prepared by the support team. “The quality of the cooking was so good that it was difficult not to put on weight during the ride,” says David. “We start and end in reasonable hotels and then there are quite a number of government properties in between. There was one guest house which was very basic. There was one double bedroom where the four men were and there was a sitting room where most of the women went, but they had to spill over into the hall. There was only one loo which was in the one bedroom.
A family outside their ramshackle home.
A family outside their ramshackle home.
“You do forget the bad times but partly you do know they’re going to be there – there’s always going to be some horrible loo situation!”

David’s wife, Judy, and his two sons, Nick and John, are supportive of his charity work but they haven’t offered to join him on a ride just yet. “It’s just something I do and they absolutely don’t want to come with me,” he smiles.
David has seen first-hand how the vital money he has raised is making a difference and, despite saying that this year’s ride would quite possibly be his last, after just a couple of weeks back at home he is already thinking about next year’s Lepra trip.

“I’ve seen how the money is helping and I suspect if there is another one next year I’ll consider it.”

l For more information about Lepra or to make a donation visit www.leprahealthinaction.org.
louise.martin@cambridge-news.co.uk

40 million cases
40 million people are disabled by lymphatic filariasis. Items as simple as a bucket, soap and special shoes, together with simple techniques taught by Lepra, help people cope
India is home to more than half of the world’s new cases of leprosy each year.
£3 could pay for a special pair of shoes to restore dignity; £5 could pay for a self-care kit to help a patient manage their condition; £25 could pay for a healthworker to visit.
Last year LEPRA helped 700,000 people access diagnosis, treatment and testing.
More than 1.3 billion people worldwide are at risk from infection

Wednesday, January 9, 2013

The UK's "How are you?" personal health record


I was actually able to create a personal health record on the UK's National Health Service because it is free, and because I was allowed to skip my NHS number. So far, I like what I see. It is kind of a Google Health for NHS, with an emphasis on social networking and mobility apps, by the look of it. I entered some basic information about health conditions and I am automatically provided with news updates and other information from the BMJ. The user interface is excellent. Of course, I am interested in their privacy and security policy, which is well documented. I would highly recommend anyone interested in personal health records to check this out. The demo version has feedback from an NHS doctor Lisa Cuddy, and it took me a moment to realize she was a character in the House TV series - the boss of Dr. House. Here is the link to register and use the service: https://en-gb.howareyou.com/ Here is a link to their security policy: https://en-gb.howareyou.com/secure-data.html. I also wonder how secure it will be when the system is used in China at Sina.com. And here is an article about how brilliant this application is. Now it only remains to be seen if the public will use it:

YOU ARE HERE: BIOMEDTECH  GROUNDBREAKING ELECTRONIC HEALTH RECORD HITS THE CLOUD
www.cambridgehealthcare.org

GROUNDBREAKING ELECTRONIC HEALTH RECORD HITS THE CLOUD

Cambridge Healthcare CEO and founder, Dawson King
Cambridge Healthcare in the UK has today launched a ground breaking new electronic health record, available free to NHS patients and health professionals.
How are you?is an electronic health record, ‘free to the NHS’ which stores patients’ health information securely ‘in the cloud.’
The revolutionary technology solution is available online to both patients and health professionals and enabling policy-makers, clinicians and managers.
The objective is to achieve closer integration of care within the NHS, improving quality of care for patients and reducing costs through the use of technology to support more joined-up and efficient services.
The initial development was undertaken working with the former NHS East of England to explore the potential of an online portal and framework for personalised health planning and supported self-care – to enable patients and clinicians to better organise, track, monitor, and act on health information.
Dawson King, CEO and founder of Cambridge Healthcare, who is also having a great start to 2013 – with a Fellowship at The Royal Society of Medicine and nominated for a WEGO Health Trailblazer Award for 'Health Activist who is ahead of every curve' – exclusively told Business Weekly: “In 2012 we invested more than a million pounds in designing a revolutionary new electronic health record that manages complexities in health informatics standards to allow health providers to overcome interoperability barriers and enable longitudinal patient data to be shared across primary, secondary and social care.
“In 2013, a year later we’re excited to launch the world’s first patient-held medical record that allow patients to record their health information using patient friendly clinical terms as a subset of SNOMED CT and other approved standard clinical terminologies. The use of this coded information supports recording in a consistent and transferrable way and can be used across all care settings and all clinical domains.
“Clinical data is now presented as interactive health information, allowing patients to understand and influence their healthcare as well as view historical and real-time health record events on an interactive timeline which uses a colour coding 'traffic light' approach to highlight level of biometric risk.
“User interface and experience has been central to the design process, with the record picking up three industry design awards in its first week, our new health record is innovative both in terms of its design and technology.”
Cambridge Healthcare’s service – free to the NHS and supported by commercial licensing of its technology to international governments and customers – has already enjoyed success in China with an exclusive licensing agreement that will see its technology adopted in China by the largest consumer website and brand, Sina.com, with more than 500 million registered users – more than a third of China’s population.
The landmark agreement for the UK company will allow Sina to integrate Cambridge Healthcare’s technology directly into its health channel.
Business Weekly understands that another major fundraising and another highly significant commercial deal could be next on the agenda for the startup.
• PHOTOGRAPH SHOWS: Cambridge Healthcare CEO and founder, Dawson King

Monday, August 13, 2012

Public Health Syndromic Surveillance at the London 2012 Olympics

In my M.Sc. eHealth degree I took a course where I dipped my toes into the murky depths of public health informatics.  This article on syndromic surveillance at the London 2012 Olympics just touches on the panoply of data sources now available to track and predict disease outbreaks:
http://www.popsci.com/science/article/2012-07/how-it-works-worlds-largest-health-surveillance-system


How The Largest Health Surveillance System Ever Created Is Preventing An Olympic-Size Pandemic

How do you tell if a flu is dangerous enough to bring down the Olympics? Map diseases in real-time, throughout the entire country

From a Public Health Perspective, the Olympics Can Be a Dangerous Place Athlete's at the 2009 Mexican National Olympics wear masks to protect themselves from an outbreak of swine flu.

Right now in London and various sites around the UK, more than half a million international travelers are sharing stories, beers, doner kebabs, close living quarters and--let’s be frank--the occasional mattress. Roughly 17,000 athletes and officials from hundreds of countries are packed into the Olympic Village alone, and that doesn’t take into account the spectators--more than 8 million tickets will be punched at the Games--who have piled on top of greater London’s nearly 8 million inhabitants. Culturally speaking, it’s a marvel that we can do this and all get well enough along. Epidemiologically speaking, it’s a nightmare scenario.

An international gateway city like London is certainly no stranger to the comings and goings of large numbers of people, but when this many people settle into close proximity over an extended period--eating the same things and sharing the same spaces for several days or weeks at a time--it’s the perfect recipe for pathogen outbreaks. A microorganism that might be fairly benign in one part of the world can blossom among a population with low immune resistance. Food-borne illnesses threaten at every food stall. Something flu-like, that spreads through normal human contact, could potentially clean house.

The key to maintaining the public health during something as massive as the Olympic Games isn’t battling every individual bug but quickly containing any pathogen that does get loose in the population, and to do this the UK’s Health Protection Agency (HPA) has developed what is being billed as “the world’s largest health surveillance system.” By rapidly meshing many different streams of information pouring in from hospitals, general practitioners, clinics, infirmaries, and health care hotlines across the UK, the HPA has developed a way to measure and monitor the public health in near-realtime, ensuring that any pathogen outbreak is quickly identified, diagnosed, and contained before the whole of London comes down with the sniffles--or worse.

While the HPA’s system is imperfect, stitched together from a mash-up of pre-existing information channels (reports emailed and phoned in to regional health authorities), and newer, digital data streams (online systems that beam anonymized patient data from hospital databases to authorities automatically), it's likely the most ambitious public health monitoring system ever deployed. It’s not just a model for future Olympic Games, but for the future in general; as global populations continue to swell and our urban centers become both larger and more connected, systems like this will help cities and states keep vigilant watch on their people's collective health. Here’s how it works.

SYNDROMIC SURVEILLANCE

"In this kind of epidemiology, timeliness trumps complete data sets. The threat picture is constantly evolving."The HPA has collected certain kinds of data from hospitals, clinicians, and general practitioners for some time now, but to be truly useful the data needs to be centralized as quickly as possible. To that end, the HPA has automated as much of the data flow as was feasible for the 2012 games. Anonymized diagnostic data now pours in from emergency rooms and hospital labs in realtime via automated systems--when nurses and doctors enter a patient’s information into their in-house computer systems, an anonymized report is automatically generated and sent to the HPA immediately. The HPA has also asked doctors around the country to include a notation in such reports for Olympics links, designating the patient as an athlete or coach, a staffer, a spectator, or someone who has otherwise been in or around an Olympic venue. Even in cases where doctors cannot diagnose an infectious illness, the HPA has created a means of cataloging the symptoms and defining as much as possible the condition, allowing it to identify new or emerging infectious diseases that haven't been seen before.

This near-realtime clinical data builds the foundation of what becomes an evolving threat picture. The HPA models include data from hospital labs as it streams in over the Web via a secure system called CoSurv, but the models don't wait for lab work (which can take hours or days to process) to begin painting that picture. Clinicians have been put on alert for a spcific list of infectious diseases (authorities are actually particularly concerned about food borne illnesses, as stomach bugs can spread with impunity in close quarters like the Olympic village--just look at historical examples of cruise ship outbreaks for an example of this) as well as symptoms of chemical contamination. When they see symptoms of any of these they report them to the HPA immediately based on clinical (rather than lab) diagnosis. In this kind of epidemiology, timeliness trumps complete data sets. The threat picture is constantly evolving as more and better data comes in (from the lab, for instance), but that the HPA is always working from the most immediate information it can get.

For the HPA, that paints a pretty decent picture of what’s happening in hospital wards, but to fill in the holes in their canvas officials there wanted more data from alternative sources--general practitioners, walk-in clinics, or people calling into national health hotlines--that aren’t plugged into the same system. This data isn’t quite so automated--generally doctors or hotline operators have to phone or email it in to the HPA--but it adds another layer geographically-relevant symptomatic data to the HPA’s ongoing assessment.

IF THERE'S AN OUTBREAK


Say a clinic in East London begins showing a spike in incidences of extreme stomach pain and nausea that is considered above normal levels for this kind of illness. This symptom data passes through the HPA's regional office first, and a flag goes up. Perhaps it's an anomaly, but now it's on the authorities' radar. This data travels on to the HPA's West Midlands office where it is fed into an algorithm-based computing system that quickly extrapolates the overall public health picture of the UK at that moment. Here, the system notes that a spike in similar symptoms has been reported at Weymouth and Portland on the South Coast, where the sailing events are held. The system makes connections between the two; a potential outbreak of some kind of stomach-pain inducing pathogen is brewing. Health authorities are now on alert.

As one day turns over to the next, more data comes streaming in from both regions. In East London, it turns out several members of a large tour group dining at the hotel restaurant got ahold of some salmonella. On the south coast, a bout of stomach flu is circulating among some locals unrelated to the Olympics--a blessing, since Olympic athletes, staff, and spectators are doing a lot of traveling around. The cases are unrelated and crisis is averted, but the important thing is that the HPA and other health authorities were able to connect the dots almost immediately and take precautions. By centralizing symptom and diagnostic data and running it through these algorithms, the HPA can not only monitor the entire UK at once, but can identify trends, outliers, and abnormalities in the public well being with unprecedented speed.

Computationally speaking, this is tough work. A very small and mostly harmless incidence of a rare pathogen might raise an immediate statistical flag while a potentially hazardous symptomatic change in a known pathogen might fall within the statistical “safe zone” while actually representing the greater threat. The algorithms try to mitigate for these kinds of statistical problems, and as algorithms do, they will get better via time and testing. For now, they provide the best rolling picture of an entire nation’s realtime health that authorities have ever seen.


The Health Protection Agency is Monitoring the UK's Health Around the Clock for the Olympics:  Courtesy Health Protection Agency

BETTER DATA, BETTER HEALTH


While the HPA’s system is far from flawless--relying on general physicians and nurses to phone in symptom reports not only opens the door to under-reporting but also pulls them away from their primary jobs--it is an ambitious attempt to leverage the power of Big Data into better public health. It’s a fairly strong argument for the digitization of the medical field in general, and with more information fed automatically into the loop, future systems built on this model could be powerful tools for threat prediction and preventative care.

A system where nationwide, anonymized symptom data flowed freely and automatically to centralized computing centers like that at the HPA’s West Midlands office could revolutionize the ability of authorities to rapidly respond to emerging threats. But the HPA isn’t even tapping some of the richest data streams available--those provided freely by citizens themselves. We’ve seen how systems like Google Flu Trends can accurately predict incidences of flu outbreak in a given area simply by trolling search terms for indicators of flu activity. And just this week we learned about an algorithm that scanned geotagged tweets in NYC to accurately predict which users were about to get sick up to eight days before they even showed symptoms. That kind of data is everywhere, and it’s ideal for taking the pulse of large groups of people--the same kind of large groups currently tweeting so much from London that Olympic organizers have asked them to tone it down (it’s disrupting television coverage apparently). That’s why the UK plans to leave large parts of its health surveillance system in place after the Games are overwith (it will likely scale back the frequency of some kinds of reporting, though it will keep the technology in place to ramp it back up during an emergency). As global populations continue to swell and our metropolises become bigger, denser, more diverse, and better connected, epidemiological situations like that presented by the Olympics will become less the exception and more the norm. The ability to quickly crunch disparate data streams into a perfect picture of public health will be the difference between staying out in front of emerging biological threats and constantly trying to chase them down from behind.

Monday, May 7, 2012

Paramedic ehealth - bringing out the dead?

I started watching a movie on TVO called "Bringing Out the Dead".  Nicholas Cage was playing the role of a burnt out paramedic in the Hells Kitchen area of New York city - a really run down, high crime area of the city.  Looked like a great movie but I never had time to watch it all so I went online to my public library to place a hold on the DVD.  Turns out they didn't have the DVD, but they did have the book, written by Joe Connelly.  So now I am reading the book and it turns out that Joe Connelly was a paramedic for 10 years in New York, and is writing from front line experience. I have heard that the work of paramedics is an area that is in need of ehealth technologies. I know several researchers personally from my ehealth studies who work in this area. One is studying the messaging systems from the ambulances to the hospitals.  The other developed a mobile app that will allow anyone to locate the nearest public Automatic External Defibrillators (AEDs) . This latter study is more like public health but it was developed by a former paramedic. < Here > is a link to the paper on it.

Tuesday, April 24, 2012

The Guardian Informatics Section

It would appear that the UK Guardian has a section on Health Informatics.  Quite interesting that this should be a "normal" section of one's daily reading.  Perusing the articles, you come across a series by the Patient from Hell - Dick Vinegar, who writes articles on EMR implementations, public health, the NHS, etc.

Wednesday, March 28, 2012

Open Medicine Journal

The Open Medicine Journal is one of the wonders of our times. And so is a recent article on drug policy by some of the leading Public Health officials in the country. Ideology vs. Medicine vs. Morality.