Revealing the Mysteries of Population Mobility Amid the COVID-19 Pandemic in Canada: Comparative Analysis With Internet of Things-Based Thermostat Data and Google Mobility Insights.

BACKGROUND: The COVID-19 pandemic necessitated public health policies to limit human mobility and curb infection spread. Human mobility, which is often underestimated, plays a pivotal role in health outcomes, impacting both infectious and chronic diseases. Collecting precise mobility data is vital for understanding human behavior and informing public health strategies. Google's GPS-based location tracking, which is compiled in Google Mobility Reports, became the gold standard for monitoring outdoor mobility during the pandemic. However, indoor mobility remains underexplored. OBJECTIVE: This study investigates in-home mobility data from ecobee's smart thermostats in Canada (February 2020 to February 2021) and compares it directly with Google's residential mobility data. By assessing the suitability of smart thermostat data, we aim to shed light on indoor mobility patterns, contributing valuable insights to public health research and strategies. METHODS: Motion sensor data were acquired from the ecobee "Donate Your Data" initiative via Google's BigQuery cloud platform. Concurrently, residential mobility data were sourced from the Google Mobility Report. This study centered on 4 Canadian provinces-Ontario, Quebec, Alberta, and British Columbia-during the period from February 15, 2020, to February 14, 2021. Data processing, analysis, and visualization were conducted on the Microsoft Azure platform using Python (Python Software Foundation) and R programming languages (R Foundation for Statistical Computing). Our investigation involved assessing changes in mobility relative to the baseline in both data sets, with the strength of this relationship assessed using Pearson and Spearman correlation coefficients. We scrutinized daily, weekly, and monthly variations in mobility patterns across the data sets and performed anomaly detection for further insights. RESULTS: The results revealed noteworthy week-to-week and month-to-month shifts in population mobility within the chosen provinces, aligning with pandemic-driven policy adjustments. Notably, the ecobee data exhibited a robust correlation with Google's data set. Examination of Google's daily patterns detected more pronounced mobility fluctuations during weekdays, a trend not mirrored in the ecobee data. Anomaly detection successfully identified substantial mobility deviations coinciding with policy modifications and cultural events. CONCLUSIONS: This study's findings illustrate the substantial influence of the Canadian stay-at-home and work-from-home policies on population mobility. This impact was discernible through both Google's out-of-house residential mobility data and ecobee's in-house smart thermostat data. As such, we deduce that smart thermostats represent a valid tool for facilitating intelligent monitoring of population mobility in response to policy-driven shifts.

Health Monitoring Using Smart Home Technologies: Scoping Review.

BACKGROUND: The Internet of Things (IoT) has become integrated into everyday life, with devices becoming permanent fixtures in many homes. As countries face increasing pressure on their health care systems, smart home technologies have the potential to support population health through continuous behavioral monitoring. OBJECTIVE: This scoping review aims to provide insight into this evolving field of research by surveying the current technologies and applications for in-home health monitoring. METHODS: Peer-reviewed papers from 2008 to 2021 related to smart home technologies for health care were extracted from 4 databases (PubMed, Scopus, ScienceDirect, and CINAHL); 49 papers met the inclusion criteria and were analyzed. RESULTS: Most of the studies were from Europe and North America. The largest proportion of the studies were proof of concept or pilot studies. Approximately 78% (38/49) of the studies used real human participants, most of whom were older females. Demographic data were often missing. Nearly 60% (29/49) of the studies reported on the health status of the participants. Results were primarily reported in engineering and technology journals. Almost 62% (30/49) of the studies used passive infrared sensors to report on motion detection where data were primarily binary. There were numerous data analysis, management, and machine learning techniques employed. The primary challenges reported by authors were differentiating between multiple participants in a single space, technology interoperability, and data security and privacy. CONCLUSIONS: This scoping review synthesizes the current state of research on smart home technologies for health care. We were able to identify multiple trends and knowledge gaps-in particular, the lack of collaboration across disciplines. Technological development dominates over the human-centric part of the equation. During the preparation of this scoping review, we noted that the health care research papers lacked a concrete definition of a smart home, and based on the available evidence and the identified gaps, we propose a new definition for a smart home for health care. Smart home technology is growing rapidly, and interdisciplinary approaches will be needed to ensure integration into the health sector.

Effect of COVID-19 pandemic on home delivery of contraceptives by community health workers in India: Time to (re) evaluate and innovate.

The World Health Organization (WHO) declared COVID-19 a global health emergency in January 2020, leading to a nationwide lockdown in India. It has been an experience from other outbreaks that governments cannot maintain the essential health services and guarantee health services. Due to COVID-19-related case management, all health schemes, including FP services, have been disrupted globally regarding availability, accessibility, appropriateness of service delivery, adequacy, and continuity of care. The impact of the pandemic on FP services listed includes disruptions in supply chain management, enhanced gender inequity, communication barriers, fear of going outside and buying contraceptives, discontinuity of ASHA capacity building, increased time spent with all family members, reverse migration of workers, and increased need of contraceptive commodities. Evidence shows the consequence of non-supply of logistics, social distancing, inadequate human resources, and inability to access services might result in 26 million couples in unmet need for contraception, resulting in 2.4 million unintended pregnancies and 1.45 million abortions, which may lead to unsafe abortions. Potential solutions to these problems include telephonic service delivery, maintaining a record, using video communication and other technological solutions using a smartphone, combining routine immunization with FP services, and installing self-dispensing machines for contraceptives at accessible places. The limitation of this work is that this is wholly experienced-based work and not based on primary findings from the field level data. These findings highlight the importance of reproductive health needs during the pandemic and guide policymakers.

Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review.

Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary-screening programs can be made universal or targeted just for the high-risk population.

Out-of-pocket expenditure and drug adherence of patients with diabetes in Odisha.

INTRODUCTION: The burden of diabetes mellitus (DM) is increasing in India and across states. Given the chronic and progressive nature of the disease, it implicates huge financial burden on patients. Given this, the objectives of this study are to estimate the out-of-pocket (OOP) expenditure on diabetes care and assess the magnitude of medication adherence among patients in a public hospital. MATERIALS AND METHODS: A cross-sectional survey was conducted among 206 patients with age ≥25 years visiting the outpatient department of a tertiary care hospital in Odisha. Cost data were collected from April to June 2016 using a structured questionnaire, and drug adherence was assessed using the Morisky Medication Adherence Scale. RESULTS: The average total expenditure per patient per month was INR 1265 (95% confidence interval 1178-1351), of which medical expenditure was INR 993 (95 confidence interval 912-1075) and that of nonmedical expenditure was INR 271 (95 confidence interval 251-292). Expenditure on medicine constituted around 65% of total medical expenditure. The other drivers of medical expenditure were diagnostics services constituting 13.2% and transportation (11.8%). Overall, only 15% of the patients reported high adherence to medication. DISCUSSION: This study generated evidence on OOP expenditure on diabetics in Odisha which are comparable to many Indian studies. One of the critical findings of this study was that a majority of patients visiting public hospitals had to spend OOP on medicine and diagnostic services. These findings could be used to design appropriate financing strategies to protect the interest of the poor who largely use public health facility in Odisha.

Out-of-Pocket health expenditure and sources of financing for delivery, postpartum, and neonatal health in urban slums of Bhubaneswar, Odisha, India.

BACKGROUND: Out-of-pocket expenditure (OOPE) is an obstacle in the path of getting universal health coverage in India. OBJECTIVE: This study aimed to explore the OOPE, sources of funding, and experience of catastrophic expenditure (CE) for healthcare related to delivery, postpartum, and neonatal morbidity. METHODS: A community-based, cross-sectional survey was conducted among a sample of 240 recently delivered women from the slums of Bhubaneswar, Odisha. Information on background, details of delivery, expenditure on delivery and on morbidities, and sources of funding was collected using a structured interview schedule. RESULTS: Only 29.6% of the households incurred OOPE, and the others incurred either nil OOPE or had a net income because of benefits received from Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojana (JSY), and "Mamata" schemes of the government. The median total OOPE was found to be 2100 INR (100-38,620). Multivariate analysis found parity, place of delivery, type of delivery, and presence of morbidity to be significantly associated with incurring any OOPE. Nearly 15% of the households incurred OOPE exceeding 40% of the reported monthly household income including 9%, whose OOPE was 100% or more of the reported household monthly income. CONCLUSION: While mechanisms such as JSSK, JSY, and Mamata had benefitted the vast majority, around half of those who did incur OOPE experienced CE. Additional insurance facility for cesarean section delivery might reduce the excessive financial burden on households.

Out of pocket expenditure on surgical and nonsurgical conditions in Odisha.

BACKGROUND: Out of pocket expenditure (OOPE) for any illness is still a major problem in India. Several evidence is available regarding growing OOPE and its impact on household poverty. However, limited evidence is there regarding OOPE on multiple disease conditions in public hospitals. AIM: To estimate the OOPE for various hospitalized conditions at the secondary level of care in Odisha and find out various financial coping mechanisms adopted by the patients. METHODS: The primary survey was done in the secondary care hospitals in the two districts of Odisha using a semi-structured interview schedule. Data were collected from 284 subjects (212 males, 72 females) in 2014 on the socioeconomic status and OOPE on multiple disease conditions. Descriptive statistics using Stata Version 11 were used to estimate the results. RESULTS: The mean total OOPE was Indian Rupees (INR) 2107 (95% confidence interval [CI]: 1788-2426) for single episode of hospitalization out of which medical expenditure was INR 1530 (95% CI: 1238-1821) and nonmedical expenditure was INR 577 (95% CI: 501-653). The OOPE on surgical conditions was 1.7 times more than the nonsurgical conditions. Drugs and diagnostics were the major components of hospital expenditure, whereas the share of transportation expenditure was more in the nonmedical expenditure. Further, most of the patients had to face hardship financing due to limited financial protection measures. CONCLUSIONS: With the growing debate on the rolling out of universal health insurance scheme in India, this study assumes significance by providing critical information for designing public financing strategies to protect the interest of the poor in public health care institutions.

Care seeking pathways of older adults with hip fracture in India: exploratory study protocol.

BACKGROUND: The incidence of hip fractures in older adults in India is likely to increase dramatically in the coming decades as a result of an aging population and increasing life expectancy. Currently, more than 600,000 adults over 60 years of age suffer a hip fracture annually in India. This paper outlines a protocol for a qualitative study investigating the care seeking behavior of older adults with hip fractures: to determine the processes in decision making, identify causes for delay in obtaining care, and identify potential barriers and facilitators to seeking appropriate care in time. METHODS AND DESIGN: The planned study will consider Odisha, an eastern state in India with limited health care facility, as a suitable case study. It is proposed to conduct 30 in-depth interviews in two administrative districts of Odisha. The participants will be patient and their carers in seven health facilities- four public hospitals, two private hospitals and one traditional bone-setting facility. The study relies on a purposive sampling strategy. Ethics permission will be sought from each participating institution and participants. The participants will be adults aged 50 years or older of both sexes arriving at the recruiting centers with a history of fall or injury, pain in the hip region and inability to walk and X-ray confirmed diagnosis of proximal femoral fracture and their primary carer. Trained qualitative research team will conduct these interviews. A thematic framework approach will be used to analyze the data using NVivo 9 software. The data collected from the interviews will be analysed to explore the cause of the hip fracture, events following the injury, the experiences of patients from the time of sustaining the injury, pain relief measures, decision to seek care, understanding of the urgency for treatment, causes for delay in receiving treatment, funding sources, cost liabilities for the family, financing mechanisms for out of pocket expenditure and the burden for caring. DISCUSSION: The findings of this study will provide an increased understanding of the care seeking behaviors of older adults with hip fracture, and inform contextually appropriate changes in healthcare program and policy aimed at improving health outcomes.