The future of Connected Health in preventive medicine.

Over the last decade, Connected Health (CH) has shown great value in the management of chronic disease (CD), but has limited application in preventing these diseases that remain a huge burden to the society. Technological advances have made determination of genetic predisposition to disease possible and have gained wide use in oncology to develop more effective and individualized treatment strategies-Personalized Medicine. There is growing interest in the application of these genetic tests in predicting risk for complex genetic diseases; even, direct-to-consumer tests are increasingly becoming available and affordable. CH has shown great potential in collecting phenotypic data, which can be overlaid on genomic data to deliver a more precise and personalized preventive care that better engages patients. The goal of a CH program that uses genetic data would be to monitor individuals' risk factors and predict the onset of CD. This prediction would be coupled with coaching to delay or prevent the onset of disease. However, the challenge remains that many CDs are due to complex interaction between genes and modifiable environmental risk factors that are still under-studied.

Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa--a systematic review.

BACKGROUND: Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. METHODS: PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). RESULTS: Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs; and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times average annual income for income earners in the income-poorest 20% of the population. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. CONCLUSION: TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. For many households, TB treatment and care-related costs were considered to be catastrophic because the patient costs incurred commonly amounted to 10% or more of per capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.