Screens for infants and preschool children: Assessment of medical prevention with parents and assessment of exposure.

BACKGROUND: Regarding the massive increase of interactive mobile screen household equipment and the omnipresence of television, many recommendations are in favor of a limitation of use, especially among the youngest. OBJECTIVE: We aimed to evaluate the proportion of parents who report having discussed the subject of their child's exposure to screens during a consultation with a health professional. We also aimed to assess preschool exposure to television and mobile media devices, and to explore parents' views on the benefits and risks of exposing their children under 3 years old. METHODS: A questionnaire was administered to parents of children aged 6 months to 3 years in a pediatric emergency ward and several nurseries. This observational, cross-sectional and multicenter study was conducted from January to May 2019. RESULTS: We included 451 responses in the analyses. Only 99 (22.7%; 95% CI: 18.7-26.6) parents reported having discussed their child's exposure to screens with a doctor, on the initiative of the parents themselves for 52 households (53.1%; 95% CI: 43.2-62.9). Feelings of a benefit of screens on child learning concerned 134 (34.5%; 95% CI: 29.8-39.3) parents; 300 (68.5%; 95% CI: 64.1-72.8) said they were sufficiently informed about benefits and risks. In a typical week, 240 (53.7%; 95% CI: 49.1-58.3), 160 (35.8%; 95% CI: 31.3-40.2), and 58 (13.0%; 95% CI: 9.9-16.1) children were exposed at least once a week to television, smartphones, and tablets, respectively. CONCLUSIONS: Our study showed that the theme of exposure to screens was hardly addressed by physicians in consultation. Our findings help target prevention messages, including fighting the widespread belief that media are beneficial to child development, emphasizing the importance of screen-free time (eating, going to bed, after waking up) and encouraging support and interaction during exposure in families who choose to expose their children.

The musculoskeletal problems and psychosocial status of teachers giving online education during the COVID-19 pandemic and preventive telerehabilitation for musculoskeletal problems.

BACKGROUND: Musculoskeletal and psychosocial problems have tended to increase during the COVID-19 pandemic. OBJECTIVE: To evaluate the changes in musculoskeletal problems and psychosocial status of teachers during the COVID-19 pandemic due to online education and to investigate the effects of preventive telerehabilitation applications for musculoskeletal problems. METHODS: Forty teachers who conducted online education during the pandemic volunteered to participate in the study. All assessments were performed via online methods. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), ProFitMap-Neck questionnaire, Oswestry Disability Index (ODI), and Upper Extremity Functional Index (UEFI) were used to evaluate musculoskeletal problems; the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used to evaluate anxiety and depression, respectively; and the Work-Life Balance Scale (WLBS) was used to evaluate how well individuals achieve this balance. Information about before online education, during online education, and after training was obtained with the assessments. After the first assessment, telerehabilitation, which involved presentations and brochures, was applied to 18 participants willing to participate in the training. RESULTS: The ProFitMap, UEFI, and WLBS scores during the online education decreased significantly, while the scores of the CMDQ, ODI, BDI, and BAI during the online education increased significantly compared to the pre-online education scores (p < 0.05). In addition, the total CMDQ, ProFitMap, and ODI scores improved significantly after the training (p < 0.05). CONCLUSION: Musculoskeletal and psychosocial problems increased in teachers during online education. Preventive telerehabilitation methods will be beneficial for individuals who do not have access to face-to-face physiotherapy.

Pressure ulcer Cat. II-IV incidence on the CuroCell S.A.M. PRO powered reactive air support surface in a high-risk population: A multicentre cohort study in 12 Belgian nursing homes.

The primary objective was to study pressure ulcer (PU) category II-IV (including suspected deep tissue injury and unstageable PUs) cumulative incidence and PU incidence density, in a 30day observation period, associated with the use of the CuroCell S.A.M. PRO powered reactive air support surface in nursing home residents at risk for PU development. Secondary objectives were to study (a) PU category I cumulative incidence and PU incidence density and (b) user (caregivers and residents) experiences and perceptions of comfort associated with the use of the support surface under study. A multicentre cohort study was set up in 37 care units of 12 Belgian nursing homes. The sample consisted of 191 residents at risk of PU development (Braden score ≤ 17). The cumulative PU incidence was 4.7% (n = 9). The PU incidence density was 1.7/1000 observation days (9 PU/5370 days). The experience and perceptions of comfort analysis revealed that the CuroCell S.A.M. PRO powered reactive air support surface was comfortable for daily use. The mode of action and the quietness of the pump function had a positive impact on sleep quality. Patient comfort and sleep quality are essential criteria in the selection of a support surface.

Development of a Tool for Health Screening and Assessment in Orphanages in Lesotho.

In low- and middle-income countries that have high burdens of disease, simple interventions such as health screenings can have a significant impact on health outcomes. Among vulnerable children, orphans in particular, deaths are often caused by conditions preventable through early identification and provision of basic health and nutritional needs. After consulting local preventative care guidelines and medical providers, a health screening tool for use in orphanages was created. This tool was used to screen children in two orphanages in Lesotho. Overall, the tool was found to be easy, efficient, and valuable in identifying both preventable and immediately treatable conditions in orphans. As a result, orphans with long-term medical needs were linked to community-based providers by developing individualized care plans in collaboration with orphanage colleagues. This preventative tool offers a screening strategy that directly aligns with the United Nations Agency for Development's Sustainable Development Goals and helps to advance the goal of universal health coverage.

How we use the Internet matters for health: The relationship between various online health-related activities and preventive dietary behaviors.

This study identified specific types of online health-related activities that may promote preventive dietary behaviors. Two cycles (Cycles 1 and 3) of the Health Information National Trends Survey 4 were analyzed (N = 2606 and 2284, respectively; Internet users only). Similar types of activities were grouped to create three types of online activities: information seeking, engagement in health information technology, and social media use. In both cycles, online health information seeking and the engagement in health information technology were positively associated with two dietary behaviors (fruit/vegetable consumption and using menu information on calories) but not with soda consumption. Individuals may be exposed to new information or become more aware of their current health status through information seeking or health information technology engagement. However, social media use for health was not related to any of the dietary behavior. The results suggest that "how we use the Internet" may make a difference in health outcomes.

Utility of a sensor-based technology to assist in the prevention of pressure ulcers: A clinical comparison.

Detection of subcutaneous tissue damage before it is visible can trigger early intervention and decrease hospital-acquired pressure ulcer (HAPU) rates. The objective of this two-phase study was to evaluate the clinical utility of the Sub-Epidermal Moisture (SEM) Scanner (Bruin Biometrics (BBI), LLC), a hand-held device that assesses increases in interstitial fluid or subepidermal moisture, indicating early tissue damage. Phase 1: Patients were provided standard-of-care risk assessment and interventions and were scanned with the SEM Scanner, but the resulting SEM scores were not used to determine interventions. This gave a baseline pressure ulcer incidence rate. Phase 2: This phase is the same as Phase 1 except the resulting SEM scores were used in conjunction with risk assessment scores to determine appropriate interventions and care planning. In Phase 1, 12 of the 89 subjects or 13.5% developed visible pressure ulcers-4 Stage I's, 6 Stage II's, 1 Stage III, and 1 deep tissue injury. In Phase 2, 2 of the 195 subjects or 1.0% developed visible pressure ulcers-1 Stage I and 1 Stage II. Patients in Phase 2 were more incontinent, less mobile, and had longer lengths of stay than those in Phase 1. Use of the Scanner resulted in a 93% decrease in HAPU. No deep injuries developed in Phase 2.

Impact of a patient engagement tool on preventive service uptake.

BACKGROUND: We studied whether integrating the US Department of Health and Human Services' myHealthfinder tool, an interactive tool that recommends preventive services, into CVS Health's digital platforms could increase preventive service uptake at its retail clinic, MinuteClinic. METHODS: We used a quasi-experimental, pre-post, difference-in-differences design. In a web-based campaign, consumers in "exposed" states visiting CVS pharmacy and MinuteClinic websites could view and use the myHealthfinder tool. Consumers in "unexposed" states could not. A September 26, 2015 email campaign to registered MinuteClinic patients in exposed states described and included links to the myhealthfinder tool. We assessed consumer engagement with the myHealthfinder tool via number of website visits, myHealthfinder sessions, and myHealthfinder recommendations delivered. Using the difference-in-differences approach, we assessed mean changes in influenza, pneumococcal, and/or hepatitis A vaccine uptake, as well as other preventive services, per clinic, per month at MinuteClinics. RESULTS: In exposed states, 39,225 (1.6%) website visits included myhealthfinder use, and 13,688 personalized recommendations for preventive services were delivered. The web-based campaign was associated with an increase in mean pneumococcal vaccines (1.19 vaccines per clinic per month; 95% CI, 0.11-2.28). The email campaign resulted in a 5% increase in influenza vaccines (74.83 vaccines per clinic per month; 1.65-148.02). The myhealthfinder campaigns did not significantly change preventive service uptake for any of the other services at MinuteClinics. CONCLUSIONS: Our findings highlight the potential role of personalized patient education tools and public-private partnerships to communicate about preventive care. Getting patients to act on these recommendations was more difficult.

Cost Analysis of Prevention Research Centers: Instrument Development.

The 2014-2019 Prevention Research Centers (PRC) Program Funding Opportunity Announcement stated that "all applicants will be expected to collaborate with CDC to collect data to be able to perform cost analysis." For the first time in the 30-year history of the PRC Program, a cost indicator was included in the PRC Program Evaluation and a cost analysis (CA) instrument developed. The PRC-CA instrument systematically collects data on the cost of the PRC core research project to eventually answer the CDC PRC Program Evaluation question: "To what extent do investments in PRCs support the scalability, sustainability, and effectiveness of the outcomes resulting from community-engaged efforts to improve public health?" The objective of this article is to briefly describe the development of the PRC-CA instrument. Data obtained from the PRC-CA instrument can be used to generate cost summaries to inform decision making within the PRC Program and each individual PRC.

Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents.

PURPOSE: This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. METHODS: Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. FINDINGS: After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P < .001). Additionally, individuals with a USC had higher odds of having at least 1 dental checkup per year (OR = 1.76, 95% CI: 1.59-1.95, P < .001). Among both rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. CONCLUSIONS: Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas.

The Role of Technology in Healthy Living Medicine.

Health care consumers are taking control of their health information and desire a greater role in managing their health. Approximately 77% of Americans now own a smartphone and the use of health apps have doubled over the past two years. These effects are particularly notable in patients with chronic disease, now representing half the adult population and responsible for 86% of United States health care (HC) costs and 70% of deaths. New opportunities exist as a result of recent advances in home-based wireless devices, apps, wearables, and interactive systems enabling health delivery systems to monitor, advise and treat disease near real time and engage patients in healthy living medicine. These technologies will provide a new framework for patient engagement and care delivery that will enhance clinical outcomes and generate precision interventions that ultimately reduce HC costs.

Prevention screening and counseling: strategy for integration into medical education and practice.

Providing optimal preventive services across the life span is integral to improving the nation's health. However, teaching future health professionals evidence-based prevention screening and counseling has notable limitations. Applying the U.S. Preventive Services Task Force (Task Force) preventive services recommendations is necessary but not sufficient to teach comprehensive and practical preventive services delivery. Certain important health topics have not yet been investigated by the Task Force; other Task Force health topics have insufficient evidence or nonspecific recommendations. The purpose of the current paper is to provide a strategy and develop a tool to educate future healthcare professionals in recommendations for prevention screening and counseling. Age-specific preventive history charts for children and adults were created using a total of 60 recommendations from the following sources (with number of recommendations shown): the Task Force (n=37); four primary care professional organizations (n=15); and a representative panel of experts (n=8). Using a systematic approach that incorporates other accredited organizations and inclusion criteria (as described) yielded a practical tool that is applicable in both educational and clinical settings.

Multi-signal bathroom scale to assess long-term trends in cardiovascular parameters.

This paper describes the circuits and signal processing techniques that convert an electronic bathroom scale intended for bioimpedance analysis (BIA) into a compact system to acquire the electrocardiogram (ECG), the ballistocardiogram (BCG), and the impedance plethysmogram (IPG) using only plantar measurements. The signal processing methods proposed rely on the higher quality of the IPG as compared to the ECG and BCG and they enhance the signal-to-noise ratio (SNR) of these two signals, which otherwise could be too poor in non-controlled environments. The system is suitable for long-term periodic monitoring of cardiovascular function.

Tailor-made preventive medicine integrating amino acid checkup and its application toward disaster-stricken areas.

ICT technologies for healthcare are useful in myriad locations for people with lifestyle-related illnesses and health irregularities. When symptoms turn into actual illnesses, it is difficult for them to be managed, and this situation is relevant for managing the health of victims after large-scale disasters; it is important to keep people healthy to prevent them from acquiring illness. This paper proposes a system of personalized preventive medicine for individuals to maintain their health and receive evidence-based feedback. We introduce general medical checkups, ubiquitous sensing, and plasma amino acid analysis as the system's core components. We evaluate these elements and discuss their applicability toward the disaster-stricken Tohoku area of Japan. This is an initial evaluation, but some functions are being used in the area. There are gaps between research results and actually deployable technologies, but it is important to use and improve the quality of life of victims who are ultimately forced to live in temporary housing for more than five years.

Accuracy of ankle-brachial index using an automatic blood pressure device to detect peripheral artery disease in preventive medicine.

BACKGROUND: Previously, we validated determination of ankle-brachial index using an automatic blood pressure device. AIM: To test the feasibility and accuracy of the automatic method in assessing pathological ankle-brachial indexes in routine preventive examinations. METHODS: Two physicians enrolled 354 subjects (74% men) randomly for automatic ankle-brachial index measurements using an OMRON HM 722 device. Ankle-brachial index was calculated by dividing the highest value obtained at each ankle by the highest arm value. Each subject with an abnormal (less than 0.90) automatic index and the six subsequent subjects underwent Doppler index determination. RESULTS: Automatic ankle-brachial index determination was possible in both ankles in 350 subjects (99%; mean time 8.1+/-2.1 minutes). The incidence of abnormal automatic ankle-brachial index was 8% (n=28). Correlations between the automatic and Doppler methods were good in left and right legs (r=0.84 and 0.78, respectively; p<0.001). In subjects with an abnormal automatic index, correlations with Doppler indexes were good in both legs (r=0.67, p<0.001). In terms of detecting an abnormal index in a routine preventive examination, the automatic method had good sensitivity (92%), specificity (98%), positive predictive value (86%), negative predictive value (99%) and accuracy (97% compared with the Doppler method). Good results were obtained in subjects with an abnormal index in terms of agreement and concordance with the Doppler method (kappa=0.87). CONCLUSIONS: The use of a commercially available automatic blood pressure device to detect peripheral artery disease appears feasible and quick in routine medical examinations.

[Prevention of heel pressure sores with a foam body-support device. A randomized controlled trial in a medical intensive care unit]. / Efficacité de supports anatomiques en mousse pour la prévention des escarres de talons. Etude contrôlée randomisée en réanimation médicale.

BACKGROUND: To assess in a prospective controlled study the efficacy and safety of a specific foam body-support device designed as to prevent heel pressure ulcers. METHODS: A randomization table was used to allocate 70 patients into 2 groups. The control group was treated with our standard pressure sore prevention protocol (half-seated position, water-mattress and preventive massages 6 times a day); the experimental group was treated with the same standard protocol as well as with the foam body-support device being evaluated. Patients were included if their Waterlow score was >10, indicating a high risk of developing pressure ulcers and if they had no skin lesion on the heels. Foam devices, covered with jersey, were constructed for the legs and allowed the heels to be free of any contact with the bed; another foam block was arranged perpendicularly to the first, in contact with the soles, to prevent ankles from assuming an equinus position (to prevent a dropfoot condition). The principal criterion for efficacy was the number of irreversible skin lesions on the heel (that is, beyond the stage of blanching hyperemia, reversible after finger pressure); these lesions were assessed every day until the end of the study (up to 30 days). FINDINGS: The number of irreversible heel pressure ulcers was lower in the experimental (3 patients, 8.6%) than in the control group (19 patients, 55.4%) (p<0.0001). Mean time without any pressure ulcer was higher in the experimental group (5.6 days, compared with 2.8 days, p=0.01). The groups did not differ in the number of pressure sores on the sacrum and leg. CONCLUSION: An anatomical foam body-support is effective in preventing heel pressure ulcers in patients on a medical intensive care unit and is well tolerated.

New advances in nanomedicine: diagnosis and preventive medicine.

This article describes the use of nanobiologic techniques in diagnosis and preventive medicine. It discusses the engineering of fluorescent and bioluminescent proteins to visualize biologic functions; single-molecule measurements of protein structure and function; two-photon microscopy for molecular imaging of the structure and function in living cells and tissues; and imaging ligand-induced protein conformations and interactions by fluorescence in single living cells.

Incidence of new brain lesions after carotid stenting with and without cerebral protection.

BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) may be a useful tool to evaluate the efficacy of cerebral protection devices in preventing thromboembolic complications during carotid angioplasty and stenting (CAS). The goals of this study were (1) to compare the frequency, number, and size of new DWI lesions after unprotected and protected CAS; and (2) to determine the clinical significance of these lesions. METHODS: DWI was performed immediately before and within 48 hours after unprotected or protected CAS. Clinical outcome measures were stroke and death within 30 days. RESULTS: The proportion of patients with any new ipsilateral DWI lesion (49% versus 67%; P<0.05) as well as the number of new ipsilateral DWI lesions (median=0; interquartile range [IQR]=0 to 3 versus median=1; IQR=0 to 4; P<0.05) were significantly lower after protected (n=139) than unprotected (n=67) CAS. The great majority of these lesions were asymptomatic and less than 10 mm in diameter. Although there were no significant differences in clinical outcome between patients treated and not treated with protection devices (7.5% versus 4.3%, not significant), the number of new DWI lesions was significantly higher in patients who developed a stroke (median=7.5; IQR=1.5 to 17) than in patients who did not (median=0; IQR=1 to 3.25; P<0.01). CONCLUSIONS: The use of cerebral protection devices significantly reduces the incidence of new DWI lesions after CAS of which the majority are asymptomatic and less than 10 mm in diameter. The frequent occurrence of these lesions and their close correlation with the clinical outcome indicates that DWI could become a sensitive surrogate end point in future randomized trials of unprotected versus protected CAS.

A randomized outpatient trial of a decision-support information technology tool.

BACKGROUND: Decision-support information technology is often adopted to improve clinical decision making, but it is rarely rigorously evaluated. Congress mandated the evaluation of Problem-Knowledge Couplers (PKC Corp, Burlington, Vt), a decision-support tool proposed for the Department of Defense's new health information network. METHODS: This was a patient-level randomized trial conducted at 2 military practices. A total of 936 patients were allocated to the intervention group and 966 to usual care. Couplers were applied before routine ambulatory clinic visits. The primary outcome was quality of care, which was assessed based on the total percentage of any of 24 health care quality process measures (opportunities to provide evidence-based care) that were fulfilled. Secondary outcomes included medical resources consumed within 60 days of enrollment and patient and provider satisfaction. RESULTS: There were 4639 health care opportunities (2374 in the Coupler group and 2265 in the usual-care group), with no difference in the proportion of opportunities fulfilled (33.9% vs 30.7%; P = .12). Although there was a modest improvement in performance on screening/preventive measures, it was offset by poorer performance on some measures of acute care. Coupler patients used more laboratory and pharmacy resources than usual-care patients (logarithmic mean difference, 71 dollars). No difference in patient satisfaction was observed between groups, and provider satisfaction was mixed. CONCLUSION: This study provides no strong evidence to support the utility of this decision-support tool, but it demonstrates the value of rigorous evaluation of decision-support information technology.