Effect of non-invasive brain stimulation on behavior and serum brain-derived neurotrophic factor and insulin-like growth factor-1 levels in autistic patients.

Aberrant neural connectivity and intra-cortical inhibitory dysfunction are key features of autism. Non-invasive brain stimulation (NIBS) protocols have been proposed that modulate this aberrant plasticity. However, additional investigations are needed to evaluate the impact of this intervention on biological biomarkers of the disease. We recently demonstrated alterations in serum insulin-like growth factor-1 (IGF-1) and brain-derived neurotrophic factor (BDNF) immunoreactivity in subjects with autism compared to controls. The aim of this pilot study was to explore the change in serum levels of the neurotrophic factors BDNF and IGF-1 in patients undergoing NIBS therapy. Sixteen subjects with autism spectrum disorder (ASD) were tested 1 week before and 1 week after NIBS to determine the short-term outcome on behavior using the total score on the autism behavior checklist, autism treatment evaluation checklist, clinical global impression severity and the autism diagnostic interview. ASD subjects younger than 11 years old (n = 11) were treated with transcranial direct current stimulation (tDCS), and those 11 years and older (n = 5) were treated with repetitive transcranial magnetic stimulation (rTMS). Serum levels of BDNF and IGF-1 were evaluated by Enzyme-Linked Immuno-Sorbent Assay before and after the intervention with NIBS. A significant reduction in scores on the clinical behavioral scales was observed in patients treated with NIBS (ABC-T p = .002, CGI-S p = .008, ADI-T and ATEC-T p < .0001). There was a trend towards reduced serum BDNF levels after NIBS (p = .061), while there was no change in IGF-1 levels. These data support further studies on the potential of BDNF as a biomarker to measure the effectiveness of NIBS in autism.

HealthRecSys: A semantic content-based recommender system to complement health videos.

BACKGROUND: The Internet, and its popularity, continues to grow at an unprecedented pace. Watching videos online is very popular; it is estimated that 500 h of video are uploaded onto YouTube, a video-sharing service, every minute and that, by 2019, video formats will comprise more than 80% of Internet traffic. Health-related videos are very popular on YouTube, but their quality is always a matter of concern. One approach to enhancing the quality of online videos is to provide additional educational health content, such as websites, to support health consumers. This study investigates the feasibility of building a content-based recommender system that links health consumers to reputable health educational websites from MedlinePlus for a given health video from YouTube. METHODS: The dataset for this study includes a collection of health-related videos and their available metadata. Semantic technologies (such as SNOMED-CT and Bio-ontology) were used to recommend health websites from MedlinePlus. A total of 26 healths professionals participated in evaluating 253 recommended links for a total of 53 videos about general health, hypertension, or diabetes. The relevance of the recommended health websites from MedlinePlus to the videos was measured using information retrieval metrics such as the normalized discounted cumulative gain and precision at K. RESULTS: The majority of websites recommended by our system for health videos were relevant, based on ratings by health professionals. The normalized discounted cumulative gain was between 46% and 90% for the different topics. CONCLUSIONS: Our study demonstrates the feasibility of using a semantic content-based recommender system to enrich YouTube health videos. Evaluation with end-users, in addition to healthcare professionals, will be required to identify the acceptance of these recommendations in a nonsimulated information-seeking context.

Thermal Transmission through Existing Building Enclosures: Destructive Monitoring in Intermediate Layers versus Non-Destructive Monitoring with Sensors on Surfaces.

Opaque enclosures of buildings play an essential role in the level of comfort experienced indoors and annual energy demand. The impact of solar radiation and thermal inertia of the materials that make up the multi-layer enclosures substantially modify thermal transmittance behaviour of the enclosures. This dynamic form of heat transfer, additionally affected by indoor HVAC systems, has a substantial effect on the parameters that define comfort. It also has an impact on energy demand within a daily cycle as well as throughout a one-year use cycle. This study describes the destructive monitoring of an existing block of flats located in Alicante. Once the enclosure was opened, sensors of temperature (PT100), air velocity, and relative humidity were located in the different layers of the enclosure, as well as in the interior and exterior surfaces. A pyranometer was also installed to measure solar radiation levels. A temperature data correction algorithm was drawn up to address irregularities produced in the enclosure. The algorithm was applied using a Raspberry Pi processor in the data collection system. The comparative results of temperature gradients versus non-destructive monitoring systems are presented, providing measures of the transmittance value, surface temperatures and indoor and outdoor air temperatures. This remote sensing system can be used in future studies to quantify and compare the energy savings of different enclosure construction solutions.

Clinical Phenotypes and Mortality Biomarkers: A Study Focused on COVID-19 Patients with Neurological Diseases in Intensive Care Units.

Purpose: To identify clinical phenotypes and biomarkers for best mortality prediction considering age, symptoms and comorbidities in COVID-19 patients with chronic neurological diseases in intensive care units (ICUs). Subjects and Methods: Data included 1252 COVID-19 patients admitted to ICUs in Cuba between January and August 2021. A k-means algorithm based on unsupervised learning was used to identify clinical patterns related to symptoms, comorbidities and age. The Stable Sparse Classifiers procedure (SSC) was employed for predicting mortality. The classification performance was assessed using the area under the receiver operating curve (AUC). Results: Six phenotypes using a modified v-fold cross validation for the k-means algorithm were identified: phenotype class 1, mean age 72.3 years (ys)-hypertension and coronary artery disease, alongside typical COVID-19 symptoms; class 2, mean age 63 ys-asthma, cough and fever; class 3, mean age 74.5 ys-hypertension, diabetes and cough; class 4, mean age 67.8 ys-hypertension and no symptoms; class 5, mean age 53 ys-cough and no comorbidities; class 6, mean age 60 ys-without symptoms or comorbidities. The chronic neurological disease (CND) percentage was distributed in the six phenotypes, predominantly in phenotypes of classes 3 (24.72%) and 4 (35,39%); χ² (5) 11.0129 p = 0.051134. The cerebrovascular disease was concentrated in classes 3 and 4; χ² (5) = 36.63, p = 0.000001. The mortality rate totaled 325 (25.79%), of which 56 (17.23%) had chronic neurological diseases. The highest in-hospital mortality rates were found in phenotypes 1 (37.22%) and 3 (33.98%). The SSC revealed that a neurological symptom (ageusia), together with two neurological diseases (cerebrovascular disease and Parkinson's disease), and in addition to ICU days, age and specific symptoms (fever, cough, dyspnea and chilliness) as well as particular comorbidities (hypertension, diabetes and asthma) indicated the best prediction performance (AUC = 0.67). Conclusions: The identification of clinical phenotypes and mortality biomarkers using practical variables and robust statistical methodologies make several noteworthy contributions to basic and experimental investigations for distinguishing the COVID-19 clinical spectrum and predicting mortality.

Assessing and responding in real time to online anti-vaccine sentiment during a flu pandemic.

The perceived safety of vaccination is an important explanatory factor for vaccine uptake and, consequently, for rates of illness and death. The objectives of this study were (1) to evaluate Canadian attitudes around the safety of the H1N1 vaccine during the fall 2009 influenza pandemic and (2) to consider how public health communications can leverage the Internet to counteract, in real time, anti-vaccine sentiment. We surveyed a random sample of 175,257 Canadian web users from October 27 to November 19, 2009, about their perceptions of the safety of the HINI vaccine. In an independent analysis, we also assessed the popularity of online flu vaccine-related information using a tool developed for this purpose. A total of 27,382 unique online participants answered the survey (15.6% response rate). Of the respondents, 23.4% considered the vaccine safe, 41.4% thought it was unsafe and 35.2% reported ambivalence over its safety. Websites and blog posts with anti-vaccine sentiment remained popular during the course of the pandemic. Current public health communication and education strategies about the flu vaccine can be complemented by web analytics that identify, track and neutralize anti-vaccine sentiment on the Internet, thus increasing perceived vaccine safety. Counter-marketing strategies can be transparent and collaborative, engaging online "influencers" who spread misinformation.

Participatory storytelling online: a complementary model of patient satisfaction.

Measuring patient satisfaction is an important quality improvement technique. The World Wide Web offers new approaches to understanding patient satisfaction and stories about healthcare encounters. In this paper, we suggest that there is a wealth of patients' stories being told online, in real time, on social networking and on social rating websites. This patient-generated, publicly available information can complement existing patient satisfaction data and can provide insights into patients' values, perspectives and expectations - and can suggest ways to improve the patient's experience along the continuum of care.

Modelling the thermal behaviour of a building facade using deep learning.

This article aims to model the thermal behaviour of a wall using deep learning techniques. The Fourier theoretical model which is traditionally used to model such enclosures is not capable of considering several factors that affect a prediction that is often incorrect. These results motivate us to try to obtain a better thermal model of the enclosure. For this reason, a connexionist model is provided capable of modelling the behaviour of the enclosure from actual observed temperature data. For the training of this model, several measurements have been obtained over the course of more than one year in a specific enclosure, distributing the readings among the different layers of it. In this work, the predictions of both the theoretical model and the connexionist model have been tested, contrasting them with the measurements obtained previously. It has been observed that the connexionist model substantially improves the theoretical predictions of the Fourier method, thus allowing better approximations to be made regarding the real energy consumption of the building and, in general, the prediction of the energy behaviour of the enclosure.

Modelling multi-rotor UAVs swarm deployment using virtual pheromones.

In this work, a swarm behaviour for multi-rotor Unmanned Aerial Vehicles (UAVs) deployment will be presented. The main contribution of this behaviour is the use of a virtual device for quantitative sematectonic stigmergy providing more adaptable behaviours in complex environments. It is a fault tolerant highly robust behaviour that does not require prior information of the area to be covered, or to assume the existence of any kind of information signals (GPS, mobile communication networks …), taking into account the specific features of UAVs. This behaviour will be oriented towards emergency tasks. Their main goal will be to cover an area of the environment for later creating an ad-hoc communication network, that can be used to establish communications inside this zone. Although there are several papers on robotic deployment it is more difficult to find applications with UAV systems, mainly because of the existence of various problems that must be overcome including limitations in available sensory and on-board processing capabilities and low flight endurance. In addition, those behaviours designed for UAVs often have significant limitations on their ability to be used in real tasks, because they assume specific features, not easily applicable in a general way. Firstly, in this article the characteristics of the simulation environment will be presented. Secondly, a microscopic model for deployment and creation of ad-hoc networks, that implicitly includes stigmergy features, will be shown. Then, the overall swarm behaviour will be modeled, providing a macroscopic model of this behaviour. This model can accurately predict the number of agents needed to cover an area as well as the time required for the deployment process. An experimental analysis through simulation will be carried out in order to verify our models. In this analysis the influence of both the complexity of the environment and the stigmergy system will be discussed, given the data obtained in the simulation. In addition, the macroscopic and microscopic models will be compared verifying the number of predicted individuals for each state regarding the simulation.

Comorbilidad del trastorno del espectro autista y la epilepsia en edades pediátricas

Introducción: La comorbilidad entre la epilepsia y el trastorno del espectro autista alcanza un alto porcentaje en pacientes pediátricos. Objetivo: Caracterizar la comorbilidad del trastorno del espectro autista y la epilepsia en pacientes pediátricos. Métodos: Estudio observacional, descriptivo, de corte transversal, en una población de 23 sujetos. Resultados: Predominaron los pacientes del sexo femenino (n = 14; 60,9 %). La totalidad de los individuos acudió a la primera consulta, fue diagnosticado con trastorno del espectro autista y sufrió la primera crisis epiléptica con 9 años de edad o menos. El 78,3 % (n= 18) nació entre las 38 y 42 semanas de gestación, y el 65,2 % (n= 15) fue diagnosticado con trastorno de déficit intelectual. Lo más común fue la inexistencia de factores de riesgo (n= 14; 60,9 %). Las crisis epilépticas generalizadas fueron las más frecuentes (n= 12; 52,17 %). Predominaron los individuos con trastorno del espectro autista congénito (n= 16; 69,57 %) e idiopático (n= 8; 64,78) En el 56,5 % (n= 13), la primera crisis epiléptica antecedió al diagnóstico del trastorno del espectro autista. Conclusiones: En la población estudiada, la comorbilidad entre epilepsia y trastorno del espectro autista se produce fundamentalmente en el sexo femenino, antes de la primera década de la vida, con coexistencia de un trastorno de déficit intelectual y la ausencia de factores de riesgo, en el contexto de crisis epilépticas generalizadas y un trastorno del espectro autista congénito, profundo, idiopático y con diagnóstico posterior al de la epilepsia.

Introduction: The comorbidity between epilepsy and autism spectrum disorder reaches a high percentage of pediatric patients. Objective: To characterize the comorbidity of autism spectrum disorder and epilepsy in pediatric patients. Methods: Observational, descriptive, cross-sectional study in a population of 23 subjects. Results: Female patients predominated (n= 14; 60.9%). All of the individuals attended the first consultation, were diagnosed with autism spectrum disorder and suffered the first epileptic seizure at 9 years or younger. 78.3% (n= 18) were born between 38 and 42 weeks of gestation, and 65.2% (n= 15) were diagnosed with intellectual disability disorder. The absence of risk factors was the most common characteristic (n= 14; 60.9 %). Generalized seizures were the most frequent (n= 12; 52.17%). Individuals with congenital (n= 16; 69.57%) and idiopathic (n= 8, 64.78) autism spectrum disorder predominated. In 56.5% (n= 13), the first epileptic seizure preceded the diagnosis of autism spectrum disorder. Conclusions: In the population studied, the comorbidity between epilepsy and autism spectrum disorder occurs mainly in females, before the first decade of life, with coexistence of an intellectual disability disorder and the absence of risk factors, in the context of generalized epileptic seizures and a congenital, profound, idiopathic autism spectrum disorder, and diagnosed after epilepsy.

Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients.

BACKGROUND: Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care. METHODS: Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system's development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements. RESULTS: The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians' reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (+/-13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective. CONCLUSIONS: The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.

Telemanagement of hypertension: a qualitative assessment of patient and physician preferences.

BACKGROUND: Prevalence surveys have consistently found that the blood pressure control rate among people with hypertension is less than 25%. Studies of telemedicine as a means of providing care to hypertensive patients have shown that this approach is effective in lowering blood pressure. Major design flaws and high operating costs, however, have hindered its adoption by physicians and patients. OBJECTIVES: In the present commentary, the field of telemedicine, as it pertains to hypertension management, is reviewed, and the investigators' experiences in developing a new telemedicine system are outlined. METHODS: An applied qualitative case study approach was used to determine the information needs for the design of a telemedicine system. Opinions were elicited separately from type 2 diabetic patients with hypertension (n=24) and family practitioners in active clinical practice (n=18). RESULTS: Physician and patient focus group meetings provided key information that led to changes in the prototype system. The low level of computer and Internet use by patients in everyday life and by physicians in practice-related activities precluded their inclusion in the design of the system for information retrieval and receiving clinical alerts. For patients, the mobile phone appeared to be an acceptable alternative. The only practical, automated means to disseminate reports and alerts to physicians was by fax, which was the most universally available device in a doctor's office. CONCLUSION: This tightly focused qualitative study led to the development of design principles for a prototype system, increasing the likelihood of user acceptance and improving its effectiveness.

Web-based asynchronous teleconsulting for consumers in Colombia: a case study.

BACKGROUND: Fourteen years after the reform to Colombia's health system, the promises of universality, improved equity, efficiency, and better quality of care have not materialized. Remote areas remain underserved and access to care very limited. Recognizing teleconsultation as an effective way to improve access to health care and health information, a noncommercial open-access Web-based application for teleconsultation called Doctor Chat was developed. OBJECTIVE: The objective was to report the experience of the Center for Virtual Education and Simulation eHealth (Centro de Educación Virtual y Simulación e-Salud) with open-access Web-based asynchronous teleconsultation for consumers in Colombia. METHODS: A teleconsultation service in Spanish was developed and implemented in 2006. Teleconsultation requests were classified on three axes: (1) the purpose of the query, (2) the specialty, and (3) the geographic area of the query. Content analysis was performed on the free-text queries submitted to Doctor Chat, and descriptive statistics were gathered for each of the data categories (name, email, city, country, age, and gender). RESULTS: From September 2006 to March 2007, there were 270 asynchronous teleconsultations documented from 102 (37.8%) men and 168 (62.2%) women. On average, 1.4 requests were received per day. By age group, the largest number of requests (n = 80; 30%) were from users 24-29 years, followed by users (n = 66; 24%) 18-23 years. Requests were mainly from Colombia (n = 204; 75.6%) but also from Spain (n = 17; 6.3%), Mexico (n = 11; 4.1%), and other countries. In Colombia, 137 requests (67.2%) originated in Bogotá, the nation's capital, 25 (12.4%) from other main cities of the country, 40 (19.7%) from intermediate cities, and 2 (0.7%) from remote areas. The purpose of the majority of requests was for information about symptoms, health-related problems, or diseases (n = 149; 55.2%) and medications/treatments (n = 70; 25.9%). By specialty, information was most requested for gynecology and obstetrics (n = 71; 26%), dermatology (n = 28; 10%), urology (n = 22; 8%), and gastroenterology (n = 18; 7%), with anesthesiology, critical care, physical medicine and rehabilitation, and pathology being the least requested (n = 0; 0%). Overall, sexual and reproductive health (n = 93; 34%) issues constituted the main query subject. The average time to deliver a response was 120 hours in 2006 and 59 hours in 2007. Only 19 out of 270 users (7%) completed a survey with comments and perceptions about the system, of which 18 out of 19 (95%) corresponded to positive perceptions and 1 out of 19 (5%) expressed dissatisfaction with the service. CONCLUSION: The implementation of a Web-based teleconsulting service in Colombia appeared to be an innovative way to improve access to health care and information in the community and encouraged open and explicit discussion. Extending the service to underserved areas could improve access to health services and health information and could potentially improve economic indicators such as waiting times for consultations and the rate of pregnancy among teenagers; however, cultural, infrastructural, and Internet connectivity barriers are to be solved before successful implementation can derive population-wide positive impacts.

Internet use by end-stage renal disease patients.

Information on the prevalence and predictors of use of the Internet by patients can be applied to the design and promotion of healthcare Internet technologies. To our knowledge, few studies on Internet use by end-stage renal disease (ESRD) patients have been reported. The objectives of this study are to ascertain the prevalence and predictors of Internet use by ESRD patients among different dialysis modalities. A questionnaire surveying Internet use was delivered in person to 199 conventional hemodialysis patients (57 returned), and mailed to 170 peritoneal dialysis (PD) patients (42 returned), and 65 nocturnal home hemodialysis (NHD) patients (43 returned). Of the respondents, most (58%) have used the Internet to find information on their health condition. The strong majority (76%) of these patients have easy access to the Internet. A higher proportion of NHD patients (86%) used the Internet compared with the PD patients (60%) (p=0.02). Internet use was found to be more prevalent with younger (p<0.001), more educated (p=0.001), and Canadian-born patients (p=0.005). The high prevalence of Internet use and easy access to the Internet by ESRD patients suggest that future Internet information and communication systems for healthcare management in ESRD will likely be well adopted by this patient population.

Grado de riesgo biológico al manipular toxina botulínica como medicamento / Degree of Biohazard When Handling Botulinum Toxin as A Medication

Introducción: El uso de la toxina como medicamento constituye un riesgo biológico, debido a la presencia de la toxina, así como al uso indebido que se le puede dar. Objetivo: Evaluar el grado de riesgo biológico al manipular toxina botulínica como medicamento. Métodos: Estudio descriptivo transversal en el Centro Internacional de Restauración Neurológica, La Habana, Cuba, en 2017. Se aplicó una lista de chequeo de riesgo biológico a 6 profesionales del área de tratamiento de toxina botulínica. El resultado integrado de la lista de chequeo se analizó a través del método semicuantitativo "ERBIO". Resultados: La probabilidad se catalogó de "media", el cumplimiento de medidas de contención como "aceptable" y la exposición se consideró como "muy frecuente". Conclusiones: Se constató un grado de riesgo biológico "tolerable" al manipular la toxina botulínica como medicamento en el Centro Internacional de Restauración Neurológica. Esto implica que se deben considerar mejoras que no supongan una carga económica importante, que requerirán de comprobaciones periódicas para asegurar el mantenimiento de la eficacia de las medidas de control establecidas(AU)

Introduction: The use of the toxin as a medication constitutes a biological risk, due to the presence of the toxin, as well as the potential improper use. Objective: To evaluate the degree of biological risk when Handling botulinum toxin as a medication. Methods: A cross-sectional descriptive study was carried out at the International Center for Neurological Restoration, Havana, Cuba, in 2017. A biological risk checklist was applied to six professionals from the botulinum toxin treatment area. The integrated result of the checklist was analyzed through ERBIO semi-quantitative method. Results: The probability was classified as medium. Compliance with containment measures was assessed as acceptable and the exposure was considered as very frequent. Conclusions: A tolerable degree of biological risk was found when manipulating botulinum toxin as a medication at the International Center for Neurological Restoration. This implies that improvements should be considered not to imply a significant economic burden, which will require periodic checks to ensure the maintenance of the effectiveness of the established control measures(AU)

Peripheral Inflammatory Markers Contributing to Comorbidities in Autism.

This study evaluates the contribution of peripheral biomarkers to comorbidities and clinical findings in autism. Seventeen autistic children and age-matched typically developing (AMTD), between three to nine years old were evaluated. The diagnostic followed the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DMS-IV) and the Childhood Autism Rating Scale (CARS) was applied to classify the severity. Cytokine profile was evaluated in plasma using a sandwich type ELISA. Paraclinical events included electroencephalography (EEG) record. Statistical analysis was done to explore significant differences in cytokine profile between autism and AMTD groups and respect clinical and paraclinical parameters. Significant differences were found to IL-1ß, IL-6, IL-17, IL-12p40, and IL-12p70 cytokines in individuals with autism compared with AMTD (p < 0.05). All autistic patients showed interictalepileptiform activity at EEG, however, only 37.5% suffered epilepsy. There was not a regional focalization of the abnormalities that were detectable with EEG in autistic patients with history of epilepsy. A higher IL-6 level was observed in patients without history of epilepsy with interictalepileptiform activity in the frontal brain region, p < 0.05. In conclusion, peripheral inflammatory markers might be useful as potential biomarkers to predict comorbidities in autism as well as reinforce and aid informed decision-making related to EEG findings in children with Autism spectrum disorders (ASD).

What is eHealth (3): a systematic review of published definitions.

CONTEXT: The term eHealth is widely used by many individuals, academic institutions, professional bodies, and funding organizations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organizations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. OBJECTIVE: To report the results of a systematic review of published, suggested, or proposed definitions of eHealth. DATA SOURCES: Using the search query string "eHealth" OR "e-Health" OR "electronic health", we searched the following databases: Medline and Premedline (1966-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1966-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004). In addition, we searched dictionaries and an Internet search engine. STUDY SELECTION: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion. DATA EXTRACTION: We retrieved relevant reports, articles, references, letters, and websites containing definitions of eHealth. Two of us qualitatively analyzed the definitions and coded them for content, emerging themes, patterns, and novel ideas. DATA SYNTHESIS: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified 2 universal themes (health and technology) and 6 less general (commerce, activities, stakeholders, outcomes, place, and perspectives). CONCLUSIONS: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organizations that use the term.

What Internet services would patients like from hospitals during an epidemic? Lessons from the SARS outbreak in Toronto.

BACKGROUND: International health organizations and officials are bracing for a pandemic. Although the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto did not reach such a level, it created a unique opportunity to identify the optimal use of the Internet to promote communication with the public and to preserve health services during an epidemic. OBJECTIVE: The aim of the study was to explore patients' attitudes regarding the health services that might be provided through the Internet to supplement those traditionally available in the event of a future mass emergency situation. METHODS: We conducted "mask-to-mask" surveys of patients at three major teaching hospitals in Toronto during the second outbreak of SARS. Patients were surveyed at the hospital entrances and selected clinics. Descriptive statistics and logistic regression models were used for the analysis. RESULTS: In total, 1019 of 1130 patients responded to the survey (90% overall response rate). With respect to Internet use, 70% (711/1019) used the Internet by themselves and 57% (578/1019) with the help of a friend or family member. Of the Internet users, 68% (485/711) had already searched the World Wide Web for health information, and 75% (533/711) were interested in communicating with health professionals using the Internet as part of their ongoing care. Internet users expressed interest in using the Web for the following reasons: to learn about their health condition through patient education materials (84%), to obtain information about the status of their clinic appointments (83%), to send feedback to the hospital about how to improve its services (77%), to access screening tools to help determine if they were potentially affected by the infectious agent responsible for the outbreak (77%), to renew prescriptions (75%), to consult with their health professional about nonurgent matters (75%), and to access laboratory test results (75%). Regression results showed that younger age, higher education, and English as a first language were predictors of patients' interest in using Internet services in the event of an epidemic. CONCLUSION: Most patients are willing and able to use the Internet as a means to maintain communication with the hospital during an outbreak of an infectious disease such as SARS. Hospitals should explore new ways to interact with the public, to provide relevant health information, and to ensure continuity of care when they are forced to restrict their services.

What is eHealth?: a systematic review of published definitions.

CONTEXT: The term eHealth is widely used by many individuals, academic institutions, professional bodies and funding organisations. It has become an accepted neologism despite the lack of an agreed-upon clear or precise definition. We believe that communication among the many individuals and organisations that use the term could be improved by comprehensive data about the range of meanings encompassed by the term. OBJECTIVE: To report the results of a systematic review of published, suggested or proposed definitions of eHealth. DATA SOURCES: Using hte search query string 'eHealth' OR 'e-Health' OR 'electronic health', we searched the following databases: Medline and Premedline (1996-June 2004), EMBASE (1980-May 2004), International Pharmaceutical Abstracts (1970-May 2004), Web of Science (all years), Information Sciences Abstracts (1996-May 2004), Library Information Sciences Abstracts (1969-May 2004), and Wilson Business Abstracts (1982-March 2004), In addition, we searched dictionaries and an Internet search engine. STUDY SELECTION: We included any source published in either print format or on the Internet, available in English, and containing text that defines or attempts to define eHealth in explicit terms. Two of us independently reviewed titles and abstracts of citations identified in the bibliographic databases and Internet search, reaching consensus on relevance by discussion. DATA EXTRACTION: We retrieved relevant reports, articles, references, letters and websites containing definitions of eHealth. Two of us qualitatively analysed the definitions and coded them for content, emerging themes, patterns and novel ideas. DATA SYNTHESIS: The 51 unique definitions that we retrieved showed a wide range of themes, but no clear consensus about the meaning of the term eHealth. We identified two universal themes (health and technology) and six less general (commerce, activities, stakeholders, outcomes, place, and perspectives). CONCLUSIONS: The widespread use of the term eHealth suggests that it is an important concept, and that there is a tacit understanding of its meaning. This compendium of proposed definitions may improve communication among the many individuals and organisations that use the term.

Funcionamiento familiar y esfuerzo percibido por el cuidador primario de niños con enfermedades neurológicas / Family functioning and perceived effort by the primary caregiver of children with neurological diseases

RESUMEN Fundamento: Las investigaciones que intentan relacionar el funcionamiento familiar y el esfuerzo percibido por el cuidador primario de niños con enfermedades neurológicas, documentan resultados divergentes e insuficientes. Objetivo: identificar la relación entre el funcionamiento familiar y el esfuerzo percibido por el cuidador primario de niños con enfermedades neurológicas. Métodos: estudio de serie de casos, realizado en el Servicio de Neuropsicología, del Centro Internacional de Restauración Neurológica, en el segundo semestre de 2018. Los participantes fueron 12 cuidadores de niños entre uno y seis años de edad. Se aplicó entrevista estructurada, índice de esfuerzo del cuidador, escala de funcionamiento familiar/FF-SIL, inventario de características familiares de riesgo y análisis documental. Se utilizó estadística descriptiva, comparación de medias y correlación de Spearman. Resultados: el 92 % de los cuidadores no había recibido información de cómo cuidarse, ni de cómo cuidar a su hijo. El índice de esfuerzo del cuidador manifestó iguales proporciones para los niveles elevado y bajo (50 % respectivamente). Se observó relación entre edad de los cuidadores y edad de desarrollo de los niños y el funcionamiento familiar (r=0,71, r=0,67); así como entre el índice de esfuerzo del cuidador y el inventario de riesgos familiares (r=0,72). Conclusión: Los cuidadores primarios estudiados carecen de información de autocuidado y del cuidado de su hijo; una criticidad elevada y un índice de esfuerzo del cuidador heterogéneo, lo cual se relaciona con los riesgos familiares. La edad de los cuidadores y la edad de desarrollo de los niños influyen en el funcionamiento familiar.

ABSTRACT Foundation: Research that attempts to relate family functioning and the effort perceived by the primary caregiver of children with neurological diseases, documents divergent and insufficient results. Objective: to identify the relationship between family functioning and the effort perceived by the primary caregiver of children with neurological diseases. Methods: case series study, conducted at the Neuropsychology Service, of the International Center for Neurological Restoration, in the second half of 2018. The participants were 12 children caregivers between one and six years old. Structured interview, caregiver effort index, family functioning scale / FF-SIL, inventory of family risk characteristics and documentary analysis were applied. Descriptive statistics, comparison of means and Spearman correlation were used. Results: 92% of caregivers had not received information on how to take care of themselves, or how to care for their child. The caregiver effort index showed equal proportions for the high and low levels (50% respectively). The relationship between caregivers´ age, children´s development age and family functioning was observed (r = 0.71, r = 0.67); as well as between the caregiver's effort index and the family risk inventory (r = 0.72). Conclusion: The primary caregivers studied lack self-care information and care of their child; a high criticality and an effort index of the heterogeneous caregiver, which is related to family risks. The age of caregivers and the age of children´s development influence family functioning.

Measuring symptom response to pharmacological interventions in patients with COPD: a review of instruments used in clinical trials.

OBJECTIVES: To identify and evaluate the instruments used to measure the effect of pharmacological intervention on symptoms of chronic obstructive pulmonary disease (COPD) in clinical trials. DESIGN: An extensive literature search was conducted for articles published in English in a peer-reviewed journal from 1995 to March 2002 which described a randomised controlled clinical trial measuring symptoms of COPD in response to pharmacological interventions. PATIENTS: Patients with any severity of COPD. INTERVENTIONS: Any pharmacological intervention for treatment of COPD. MEASUREMENTS AND RESULTS: A total of 43 eligible articles were identified. The individual symptoms most frequently measured were dyspnoea/breathlessness, chest tightness or discomfort and exacerbations. There was considerable variability in the methods, terminology and symptom measurement instruments used. The most widely used instruments for measuring dyspnoea were the Borg scale, the Baseline Dyspnoea Index and the Transitional Dyspnoea Index. None of the instruments used had published evidence of rigorous psychometric testing. CONCLUSIONS: Numerous methods have been employed to assess the symptoms of COPD in clinical trials, making it difficult to compare the results of different trials. No single measurement instrument predominates, and none of the measures identified in the review have undergone rigorous psychometric testing in this patient population. There is a clear need for a fully developed and validated tool for measuring the effects of therapeutic interventions on symptoms in COPD in clinical trials.