Talk Time Differences Between Interregional and Intraregional Calls to a Crisis Helpline: Statistical Analysis.

Background: National suicide prevention strategies are general population-based approaches to prevent suicide by promoting help-seeking behaviors and implementing interventions. Crisis helplines are one of the suicide prevention resources available for public use, where individuals experiencing a crisis can talk to a trained volunteer. Samaritans UK operates on a national scale, with a number of branches located within each of the United Kingdom's 4 countries or regions. objectives: The aim of this study was to identify any differences in call duration across the helpline service in order to determine whether service varied interregionally and intraregionally and to determine the impact of calls answered in the same region as the caller, compared with calls answered in a different region on the duration of calls made from landlines to Samaritans UK. Methods: Calls may be routed by Samaritans, wherein the telephony system sends the call to the next available volunteer, irrespective of location; therefore, individuals may be routed to a branch within the same region as the caller's current region (intraregional calls) or routed to a branch that is in a different region from that of the caller's current region (interregional calls). The origin of calls by region was identified using the landline prefix of the anonymized caller identifier, along with the region of the destination branch (as branch details are recorded in the call details record). First, a Levene's test of homogeneity of variance was carried out for each condition, that is, England calls and Scotland calls. Thereafter, for each condition, a one-way ANOVA or one-way analysis of means was carried out to evaluate any significant differences in call duration. Results: ANOVA results showed that there are significant differences in call durations between intraregional calls and interregional calls (P<.001). Across all conditions within this study, callers stayed on the phone for a shorter period of time when routed to a branch that is within the same region as the call origin than if they were put through to a branch within a different region than the call origin. Conclusions: Statistical analyses showed that there were significant differences between interregional and intraregional calls. On average, callers to crisis helplines stayed on the phone for a shorter period of time if they were routed to a branch within the same region in which the call originated than if they were routed to a branch in a different region of origin. The findings from this study have practical applications, which may allow crisis helplines to manage their resources more effectively and improve caller satisfaction with the service.

Uso de la telefonía móvil en el proceso de enseñanza aprendizaje de la oftalmología / The Usage of Mobile Telephony in the Teaching-Learning Process of Ophthalmology

Introducción: La oftalmología es la ciencia de la medicina que se encarga del estudio del sistema visual y el órgano de la visión, así como de sus anexos. Para ello es dotada de un conjunto de tecnologías de avanzada que permite describir las múltiples patologías que tienen los pacientes. En la actualidad se nutre del uso de los dispositivos móviles, fundamentalmente en la gestión del conocimiento, pero no se explotan sus otras dimensiones. Objetivo: Identificar los referentes que fundamentan el uso de la telefonía móvil en el proceso de enseñanza aprendizaje del residente de oftalmología. Métodos: Se realizó una investigación de desarrollo tecnológico en el campo de la educación médica superior. Se utilizaron como métodos teóricos el histórico-lógico, el analítico-sintético y el método sistémico estructural funcional. Resultados: La telefonía móvil constituye una nueva tendencia en la educación superior cubana y en la educación médica como alternativa para desarrollar los procesos de enseñanza aprendizaje, a través de su uso para la socialización, la comunicación entre los estudiantes, y la gestión de la información, como medio de enseñanza aprendizaje y herramienta de trabajo. Conclusiones: Existe una contradicción entre la formación que deben tener los residentes en oftalmología en cuanto al uso de las tecnologías, y la preparación que poseen para su utilización en función de su especialidad. A pesar de que existen varios estudios que demuestran la importancia del uso de la telefonía móvil en la formación de los residentes de oftalmología, como objeto de estudio y herramienta de trabajo, no se ha establecido la vía para incluirla como una de las tecnologías dentro de la residencia de oftalmología en Cuba(AU)

Introduction: Ophthalmology is the medical science dealing with the study of the visual system and the organ of vision, as well as its annexes. For this purpose, it is equipped with a set of advanced technologies that allow describing the multiple pathologies presented by patients. Nowadays, it is nourished by the use of mobile devices, mainly in knowledge management, but its other dimensions are not exploited. Objective: To identify the references that support the use of mobile telephony in the teaching-learning process of ophthalmology residents. Methods: A technological development research was carried out in the field of higher medical education. As theoretical methods, the historical-logical, the analytical-synthetic, and the systemic-structural-functional methods were used. Results: Mobile telephony is a new trend in Cuban higher education, as well as in medical education, as an alternative to develop teaching-learning processes, through its use for socialization, communication among students, and information management, as a teaching-learning means and a work tool. Conclusions: There is some contradiction between the training that ophthalmology residents should receive with respect to the use of technologies and the preparation that they have for their usage in accordance with their specialty. Although there are several studies that demonstrate the importance of using mobile telephony in the training of ophthalmology residents, as an object for studying and a work tool, there has not been a way to include it as one of the technologies within the ophthalmology residency in Cuba(AU)

Respecifying social change: the obsolescence of practices and the transience of technology.

This article proposes that social change, a fundamental topic in sociological theory, can be productively revisited by attending to studies in ethnomethodology and conversation analysis (EM/CA). We argue that the corpus of EM/CA research, from the 1960s until the present day, provides details of the constitutive and identifying aspects of practices and activities that gradually transform into descriptions of obsolescent practices and activities, and that this corpus can be revisited to learn about the ways people used to do things. Taking landline and mobile telephony as a case in point, we show that the subtle details of conversational practices are anchored in the technology used as part of the contemporary lifeworld, and that they stand for the particularities of routine social structures of their time period. We also discuss the temporal aspects of the competences required on the part of members and analysts to make sense of encountered practices in terms of their ordinary recognizability and interactional consequentiality, pointing to the anchoring of social life in its historical time. Finally, we conclude by considering different ways of respecifying social change by attending to various kinds of historicity and obsolescence of social praxis.

An EQ-5D-5L value set for Italy using videoconferencing interviews and feasibility of a new mode of administration.

OBJECTIVES: To test the feasibility of using videoconferencing (VC) administered interviews and to derive an EQ-5D-5L value set for Italy. METHODS: Preferences were collected using the EuroQol standardized valuation protocol (EQ-VT) administered via VC. Two valuation methods were employed, composite time trade-off (cTTO) and discrete choice experiment (DCE). Technical, organizational and protocol feasibility were tested in a pilot of 198 interviews. Upon positive assessment, data collection continued with a target sample of 1000-1200 participants including the pilot. Quality control (QC) procedures were employed to monitor interviewers' performance during the pilot and the data collection. Data were modelled using GLS, Tobit, Logit and Hybrid models with different error specifications. Monotonicity of coefficients, statistical significance, and theoretical considerations informed the model choice. RESULTS: Dropouts and technical problems occurred in less than 5% of the 198 pilot interviews. Protocol compliance was demonstrated with significant improvements in QC parameters and limited interviewers' effects, for all interviewers. Overall, interviewers were satisfied with this mode of administration, highlighting it allows flexibility and efficient scheduling. Based on these results, VC was deemed as a feasible mode of administration. The study collected preferences for 1182 responders, including the pilot interviews. The demographic characteristics of the sample were representative of the Italian general population for age, gender and geographical macro-areas. The hybrid Tobit heteroscedastic model without constant estimated on the full sample (including pilot) was selected for the derivation of the value set. Values ranged from -0.571 for the worst health state (55555) to 1 for the best health state (11111). Pain/discomfort registered the largest decrement, followed by mobility, anxiety/depression, self-care, and usual activities. 523 health states were worse than dead. CONCLUSIONS: VC is viable for the conduct of valuation interviews. The Italian value set for the EQ-5D-5L can be used for value determinations of health technologies.

Reducing Loneliness in Stationary Geriatric Care with Robots and Virtual Encounters-A Contribution to the COVID-19 Pandemic.

The bans on visiting nursing homes during the COVID-19 pandemic, while intended to protect residents, also have the risk of increasing the loneliness and social isolation that already existed among the older generations before the pandemic. To combat loneliness and social isolation in nursing homes, this trial presents a study during which social networks of nursing home residents and elderly hospital patients were maintained through virtual encounters and robots, respectively. The observational trial included volunteers who were either residents of nursing homes or patients in a geriatric hospital. Each volunteer was asked to fill in a questionnaire containing three questions to measure loneliness. The questionnaire also documented whether video telephony via the robot, an alternative contact option (for example, a phone call), or no contact with relatives had taken place. The aim was to work out the general acceptance and the benefits of virtual encounters using robots for different roles (users, relatives, nursing staff, facilities). Seventy volunteers with three possible interventions (non-contact, virtual encounters by means of a robot, and any other contact) took part in this trial. The frequency of use of the robot increased steadily over the course of the study, and it was regularly used in all facilities during the weeks of visitor bans (n = 134 times). In the hospital, loneliness decreased significantly among patients for whom the robot was used to provide contact (F(1,25) = 7.783, p = 0.01). In the nursing homes, no demonstrable effect could be achieved in this way, although the subject feedback from the users was consistently positive.

The voice of the radiologist: Enabling patients to speak directly to radiologists.

Patients and patient advocates express a desire to speak directly with radiologists, who are ideally suited to answer imaging-related questions and recommend for further imaging or testing. While web-based patient portals have improved patient access to reports of radiology examinations, they do little to help patients understand the report, and rarely facilitate contact with their radiologists. We implemented an alias phone number that forwarded to the smartphone of each participating radiologist and embedded it in 3896 reports over 8 months. It was embedded as an invitation to the individual viewing the report to call with questions. For each call received, we logged parameters such as call duration, call reason, and required radiologist time/resources. Finally, the call was documented in the electronic medical record. Radiologists received 27 calls exclusively about cross-sectional exams: 22 from patients or caregivers, and 5 from physicians. The reasons for the calls included term definitions, correction of dictation errors, findings not specifically mentioned, and clinical impact of findings. Time spent on the phone with patients averaged 8.6 min. When including the time spent reviewing the images, patient chart, and/or literature; the total radiologist time per call was approximately 13.9 min. Averaged over all of the exams in the study, this service added 5 s to each exam. While the total call rate was low, implementation of this program required minimal effort. The aliased phone number masked the radiologist's phone number and allowed scheduled consultation hours. Even when called, the time to address questions appears to be minimal.

The categorisation of hearing loss through telephony in inter-war Britain.

The telephone in inter-war Britain was an important tool in both the identification and categorisation of individual hearing loss. Between 1912 and 1981, the British Post Office had control over a nationalised telephone system. Linkage between telephony and hearing has long been noted by historians of sound and science, and Post Office engineers in the inter-war period had considerable expertise in both telecommunications and hearing assistive devices. This article first demonstrates how the inter-war Post Office categorised different kinds of hearing loss through standardizing the capacity of its users to engage effectively with the telephone, and secondly investigates how successful it was in doing so. By utilising the substantial but little used material held by BT Archives, we can trace the development of the Post Office's 'telephone for deaf subscribers' and explore how it was used to manage and standardise the variability of hearing and hearing loss within the telephone system.

Data analytics of call log data to identify caller behaviour patterns from a mental health and well-being helpline.

This work presents an analysis of 3.5 million calls made to a mental health and well-being helpline, seeking to answer the question, what different groups of callers can be characterised by specific usage patterns? Calls were extracted from a telephony informatics system. Each call was logged with a date, time, duration and a unique identifier allowing for repeat caller analysis. We utilized data mining techniques to reveal new insights into help-seeking behaviours. Analysis was carried out using unsupervised machine learning (K-means clustering) to discover the types of callers, and Fourier transform was used to ascertain periodicity in calls. Callers can be clustered into five or six caller groups that offer a meaningful interpretation. Cluster groups are stable and re-emerge regardless of which year is considered. The volume of calls exhibits strong repetitive intra-day and intra-week patterns. Intra-month repetitions are absent. This work provides new data-driven findings to model the type and behaviour of callers seeking mental health support. It offers insights for computer-mediated and telephony-based helpline management.

A Technical Approach to the Evaluation of Radiofrequency Radiation Emissions from Mobile Telephony Base Stations.

During the last two decades, the number of macrocell mobile telephony base station antennas emitting radiofrequency (RF) electromagnetic radiation (EMR) in residential areas has increased significantly, and therefore much more attention is being paid to RF EMR and its effects on human health. Scientific field measurements of public exposure to RF EMR (specifically to radio frequency radiation) from macrocell mobile telephony base station antennas and RF electromagnetic field (EMF) intensity parameters in the environment are discussed in this article. The research methodology is applied according to the requirements of safety norms and Lithuanian Standards in English (LST EN). The article presents and analyses RF EMFs generated by mobile telephony base station antennas in areas accessible to the general public. Measurements of the RF electric field strength and RF EMF power density were conducted in the near- and far-fields of the mobile telephony base station antenna. Broadband and frequency-selective measurements were performed outside (on the roof and on the ground) and in a residential area. The tests performed on the roof in front of the mobile telephony base station antennas in the near-field revealed the presence of a dynamic energy interaction within the antenna electric field, which changes rapidly with distance. The RF EMF power density values on the ground at distances of 50, 100, 200, 300, 400, and 500 m from the base station are very low and are scattered within intervals of 0.002 to 0.05 µW/cm². The results were compared with international exposure guidelines (ICNIRP).

Study of potential health effects of electromagnetic fields of telephony and Wi-Fi, using chicken embryo development as animal model.

The objective of this study is to investigate possible biological effects of radiofrequency electromagnetic fields (RF-EMF) as used in modern wireless telecommunication in a well-controlled experimental environment using chicken embryo development as animal model. Chicken eggs were incubated under continuous experimental exposure to GSM (1.8 GHz), DECT (1.88 GHz), UMTS (2.1 GHz), and WLAN (5.6 GHz) radiation, with the appropriate modulation protocol, using a homogeneous field distribution at a field strength of approximately 3 V/m, representing the maximum field level in a normal living environment. Radiation-shielded exposure units/egg incubators were operating in parallel for exposed and control eggs in a climatized homogeneous environment, using 450 eggs per treatment in three successive rounds per treatment. Dosimetry of the exposure (field characteristics and specific absorption rate) were studied. Biological parameters studied included embryo death during incubation, hatching percentage, and various morphological and histological parameters of embryos and chicks and their organs, and gene expression profiles of embryos on day 7 and day 18 of incubation by microarray and qPCR. No conclusive evidence was found for induced embryonic mortality or malformations by exposure to the used EMFs, or for effects on the other measured parameters. Estimated differences between treatment groups were always small and the effect of treatment was not significant. In a statistical model that ignored possible interaction between rounds and exposure units, some of the many pairwise comparisons of exposed versus control had P-values lower than 0.05, but were not significant after correction for multiple testing. Bioelectromagnetics. 38:186-203, 2017. © 2017 Wiley Periodicals, Inc.

Mobile pastoralists in Central and West Africa: between conflict, mobile telephony and (im)mobility.

The livelihoods of the Fulani mobile pastoralists in the Sahel, West and Central Africa are characterised by mobility (related to the needs of their animals), extensive social networks, and a focus on social ties as the basis of status and influence ('wealth in people'). The Sahel environment in which many Fulani nomads live has become embroiled in jihadism, conflict, and violence; at the same time, this region has experienced an increase in opportunities to connect through the wireless mobile communication system. This paper analyses the triangle of mobility, communication, and insecurity in order to understand the present-day situation of the nomadic and semi-nomadic Fulani pastoralists and their identity dynamics. The Fulani find themselves caught in between these conflicts, which end their mobility and often lead to the loss of their herds. Will they be able to keep their mobile lifestyle and identity? This article is based on qualitative case studies and the biographical narratives of nomadic and semi-nomadic pastoralists who have lived through conflict and violence in Cameroon, Chad and Mali. These case studies show that, despite the fact that mobile pastoralism has become difficult as a consequence of the conflicts and loss of cattle, the 'mobile' identity is very present and reinforced with the help of mobile telephony, through which social networks and 'wealth in people' are sustained.

Au Sahel et en Afrique centrale et de l'Ouest, les moyens de subsistance des pasteurs nomades peuls se définissent par la mobilité (liée aux besoins de leurs troupeaux), par des réseaux sociaux extensifs et par l'importance des liens sociaux en tant que base du prestige et de l'influence des individus (le « patrimoine relationnel ¼ fondé sur les liens personnels). Le Sahel où vivent nombre de nomades peuls se trouve actuellement entraîné dans le djihadisme, les conflits et la violence ; en même temps, cette région offre désormais bien plus de possibilités de se connecter grâce à la technologie de la communication mobile non filaire. Les auteurs analysent les interactions entre la mobilité, la communication et l'insécurité afin de mieux comprendre la situation actuelle des pasteurs peuls nomades et semi-nomades ainsi que leur dynamique identitaire. Les Peuls se retrouvent au coeur de conflits qui mettent fin à leur mobilité et entraînent souvent la destruction de leurs troupeaux. Pourront-ils garder leur mode de vie et leur identité nomade ? L'analyse présentée dans cet article repose sur des études de cas qualitatives et des récits de vie recueillis auprès de pasteurs nomades et semi-nomades qui ont été confrontés à des conflits et à la violence, au Cameroun, au Tchad et au Mali. Il ressort de ces études que si le pastoralisme nomade devient plus difficile en raison des conflits et des pertes de bétail, l'identité « mobile ¼ (ou nomade) reste très présente et se voit renforcée par la téléphonie mobile qui permet notamment de pérenniser les liens à la base du patrimoine relationnel ainsi que les réseaux sociaux.

Los medios de sustento de los pastores nómadas Fulani (o peul, o fulbe) del Sahel, África Central y África Occidental se caracterizan por la movilidad (ligada a las necesidades de sus animales), por extensas redes de sociabilidad y por el lugar central que ocupan los vínculos sociales como fundamento del rango y la influencia de la persona («grado de riqueza en gente¼). El medio saheliano en el que viven muchos nómadas fulani se ha convertido hoy en un avispero de jihadismo, conflictos y violencia. Al mismo tiempo, la región conoce ahora un auge de las posibilidades de conexión gracias a los sistemas móviles de comunicación inalámbrica. Los autores analizan el triángulo formado por la movilidad, la comunicación y la inseguridad con el fin de aprehender la situación actual de los pastores fulani nómadas y seminómadas y su dinámica identitaria. El hecho de que los fulani se vean atrapados en esos conflictos coarta su movilidad y acarrea a menudo la pérdida de sus rebaños. ¿Serán capaces de mantener su modo de vida y su identidad, enraizados en el nomadismo? Los autores se basan aquí en estudios monográficos cualitativos y en historias biográficas recogidas entre y con pastores nómadas y seminómadas del Camerún, el Chad y Malí que han tenido que convivir con conflictos y violencia. Estos estudios monográficos evidencian que, si bien el pastoreo móvil resulta hoy una actividad difícil debido a los conflictos y a la pérdida de ganado, la identidad 'móvil' sigue estando muy presente y cobrando vigor gracias a la telefonía móvil, que permite especialmente mantener la 'riqueza' en gente y redes de sociabilidad.

Mobile Interventions Targeting Risky Drinking Among University Students: A Review.

Mobile interventions based on text messages, automated telephone programs (interactive voice response (IVR)), and smartphone apps offer a new approach targeting hazardous alcohol use in university students. This review covers seven recent studies involving college or university students that evaluated intervention efficacy in comparison to controls: four using text messages, one using IVR, and two smartphone apps. Only the study evaluating IVR reported positive results for the primary outcome. Two of the text message studies reported positive results on secondary outcomes, while the other two reported no differences in comparison to control groups. For smartphone apps, one study reported positive results on secondary outcomes, while the other showed no differences in comparison to controls for a web-based app and negative results for a native app. Further development of mobile interventions is needed for this at-risk population, both in terms of intervention content and use of robust research designs.

Effects of mobile phone exposure (GSM 900 and WCDMA/UMTS) on polysomnography based sleep quality: An intra- and inter-individual perspective.

BACKGROUND: Studies on effects of radio frequency-electromagnetic fields (RF-EMF) on the macrostructure of sleep so far yielded inconsistent results. This study investigated whether possible effects of RF-EMF exposure differ between individuals. OBJECTIVE: In a double-blind, randomized, sham-controlled cross-over study possible effects of electromagnetic fields emitted by pulsed Global System for Mobile Communications (GSM) 900 and Wideband Code-Division Multiple Access (WCDMA)/Universal Mobile Telecommunications System (WCDMA/UMTS) devices on sleep were analysed. METHODS: Thirty healthy young men (range 18-30 years) were exposed three times per exposure condition while their sleep was recorded. Sleep was evaluated according to the American Academy of Sleep Medicine standard and eight basic sleep variables were considered. RESULTS: Data analyses at the individual level indicate that RF-EMF effects are observed in 90% of the individuals and that all sleep variables are affected in at least four subjects. While sleep of participants was affected in various numbers, combinations of sleep variables and in different directions, showing improvements but also deteriorations, the only consistent finding was an increase of stage R sleep under GSM 900MHz exposure (9 of 30 subjects) as well as under WCDMA/UMTS exposure (10 of 30 subjects). CONCLUSIONS: The results underline that sleep of individuals can be affected differently. The observations found here may indicate an underlying thermal mechanism of RF-EMF on human REM sleep. Nevertheless, the effect of an increase in stage R sleep in one third of the individuals does not necessarily indicate a disturbance of sleep.

Electromagnetic fields from mobile phone base station - variability analysis.

The article describes the character of electromagnetic field (EMF) in mobile phone base station (BS) surroundings and its variability in time with an emphasis on the measurement difficulties related to its pulse and multi-frequency nature. Work also presents long-term monitoring measurements performed recently in different locations in Poland - small city with dispersed building development and in major polish city - dense urban area. Authors tried to determine the trends in changing of EMF spectrum analyzing daily changes of measured EMF levels in those locations. Research was performed using selective electromagnetic meters and also EMF meter with spectrum analysis.

Effect of long-term (2 years) exposure of mouse brains to global system for mobile communication (GSM) radiofrequency fields on astrocytic immunoreactivity.

This study was designed to determine whether long-term (2 years) brain exposure to mobile telephone radiofrequency (RF) fields produces any astrocytic activation as these glia react to a wide range of neural perturbations by astrogliosis. Using a purpose-designed exposure system at 900 MHz, mice were given a single, far-field whole body exposure at a specific absorption rate of 4 W/kg on five successive days per week for 104 weeks. Control mice were sham-exposed or freely mobile in a cage to control any stress caused by immobilization in the exposure module. Brains were perfusion-fixed with 4% paraformaldehyde and three coronal levels immunostained for glial fibrillary acidic protein (GFAP). These brain slices were then examined by light microscopy and the amount of this immunomarker quantified using a color deconvolution method. There was no change in astrocytic GFAP immunostaining in brains after long-term exposure to mobile telephony microwaves compared to control (sham-exposed or freely moving caged mice). It was concluded that long-term (2 years) exposure of murine brains to mobile telephone RF fields did not produce any astrocytic reaction (astrogliosis) detectable by GFAP immunostaining.

Automated conversation system before pediatric primary care visits: a randomized trial.

BACKGROUND AND OBJECTIVES: Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical settings via spoken language. The objective of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians. METHODS: English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were randomly assigned to groups by the system at the time of the call. Parents' spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit. Data were transferred to the electronic health records for review during visits. The study occurred in an urban hospital-based pediatric primary care center. Participants were called after the visit to assess (1) comprehensiveness of screening and counseling, (2) assessment of medications and their management, and (3) parent and clinician satisfaction. RESULTS: PHP was able to identify and counsel in multiple areas. A total of 9.7% of parents responded to the mailed invitation. Intervention parents were more likely to report discussing important issues such as depression (42.6% vs 25.4%; P < .01) and prescription medication use (85.7% vs 72.6%; P = .04) and to report being better prepared for visits. One hundred percent of clinicians reported that PHP improved the quality of their care. CONCLUSIONS: Systems like PHP have the potential to improve clinical screening, counseling, and medication management.

A European network of email and telephone help lines providing information and support on rare diseases: results from a 1-month activity survey.

BACKGROUND: Information on rare diseases are often complex to understand, or difficult to access and additional support is often necessary. Rare diseases helplines work together across Europe to respond to calls and emails from the public at large, including patients, health care professionals, families, and students. Measuring the activity of helplines can help decision makers to allocate adequate funds when deciding to create or expand an equivalent service. OBJECTIVE: Data presented are referred to a monthly user profile analysis, which is one of the activities that each helpline has to carry out to be part of the network. This survey aimed to explore the information requests and characteristics of users of rare diseases helplines in different European countries. Another aim was to analyze these data with respect to users' characteristics, helpline characteristics, topics of the inquiries, and technologies used to provide information. With this survey, we measure data that are key for planning information services on rare diseases in the context of the development of national plans for rare diseases. METHODS: A survey was conducted based on all calls, emails, visits, or letters received from November 1 to 30, 2012 to monitor the activity represented by 12 helplines. Data were collected by a common standardized form, using ORPHA Codes for rare diseases, when applicable. No personal data identifying the inquirer were collected. It was a descriptive approach documenting on the number and purpose of inquiries, the number of respondents, the mode of contact, the category of the inquirer in relation to the patient, the inquirer's gender, age and region of residence, the patient's age when applicable, the type and duration of response, and the satisfaction as scored by the respondents. RESULTS: A total of 1676 calls, emails, or letters were received from November 1 to 30, 2012. Inquiries were mostly about specific diseases. An average of 23 minutes was spent for each inquiry. The inquirer was a patient in 571/1676 inquiries (ie, 34.07% of all cases; 95% CI 31.8-36.3). Other inquirers included relatives (520/1676, 31.03%; 95% CI 28.9-33.3), health care professionals (354/1676, 21.12%; 95% CI 19.2-23.1), and miscellaneous inquirers (230/1676, 13.72%; 95% CI 12.1-15.4). Telephone remained the main mode of contact (988/1676, 58.95%; 95% CI 56.6-61.3), followed by emails (609/1676, 36.34%; 95% CI 34.0-38.6). The three main reasons of inquiries were to acquire about information on the disease (682/2242, 30.42%; 95% CI 27.8-32.1), a specialized center/expert (404/2242, 18.02%; 95% CI 15.9-19.6), and social care (240/2242, 10.70%; 95% CI 9.1-12.0). CONCLUSIONS: The helplines service responds to the demands of the public, however more inquiry-categories could be responded to. This leaves the possibility to expand the scope of the helplines, for example by providing assistance to patients when they are reporting suspected adverse drug reactions as provided by Directive 2010/84/EU or by providing information on patients' rights to cross-border care, as provided by Directive 2010/24/EU.

Morbilidad percibida por pobladores del Bañado Sur previa a la implementación de la Vigilancia Comunitaria del Síndrome Febril Agudo, utilizando las Tecnologías de la Información y Comunicación (TICs) / Morbidity perceived by residents of Bañado Sur previous to the implementation of the Community Surveillance of acute febrile syndrome, using Information and Communication Technologies (ICTs)

El Ministerio de Salud Pública y Bienestar Social conjuntamente con la Universidad Nacional de Asunción, con el apoyo técnico de la Universidad del País Vasco de España, han desarrollado un sistema de vigilancia comunitaria para Síndrome Febril Agudo llamado BONIS, implementado en forma piloto en el área del Bañado Sur de Asunción-Paraguay en la Unidad de Salud Familiar (USF) de Centro de Ayuda Mutua y Salud para Todos (CAMSAT). Previa a la implementación del sistema se realizó una encuesta telefónica del 18 al 28 de Febrero de 2010 para establecer una línea de base sobre aspectos de la salud de la población. Trescientos sesenta y seis jefes de hogares fueron encuestados, de los cuales el 76,2% era del sexo femenino. En 246 hogares (70%) se reportó por lo menos una persona con alguna enfermedad. De las 438 personas enfermas reportadas, el 36,3% declaró tener hipertensión arterial, 13,5% alergias, 12,8% síndrome metabólico, 10% enfermedad del corazón, 7,8% asma, 6,8% diabetes y 5,9% síndrome respiratorio agudo. Un bajo número de personas reportó síntomas compatibles con síndromes febriles como el dengue. Las patologías que afectan a esta comunidad son similares al resto del país. Se puso en evidencia la necesidad de fortalecer los programas de promoción dirigidas a identificar y notificar los casos sospechosos de dengue. Así mismo, se pudo percibir la buena predisposición de los pobladores para colaborar en la solución de problemas relacionados a su salud, lo que propicia la implementación de la vigilancia comunitaria basada en las TICs.

The Ministry of Public Health and Social Welfare in conjunction with the National University of Asuncion, under the technical support of the University of the Basque Country of Spain, have developed a system of community surveillance for acute febrile syndrome called BONIS, established as a pilot project in the area of Bañado Sur in Asuncion, Paraguay in the the Health Family Unit Mutual Aid Center and Health for All (CAMSAT). In order to establish a baseline on the health aspects of the population; previous to the implementation of the system, a telephone survey was conducted from 18 to 28 February 2010. Three hundred and sixty six householders were surveyed, of which 76.2% were female. In 246 households (70%), at least one person with a disease was reported, yielding a total of 438 people with a disease. In this group, hypertension was the most frequent condition reported (36.3%), followed by allergies (13.5%), metabolic syndrome (12.8%), heart disease (10%), asthma (7,8%), diabetes (6.8%) and acute respiratory syndrome (5.9%). Few people reported symptoms consistent with syndromic fevers such as dengue. The pathologies that affect this community are similar to the rest of the country with a high frequency of chronic conditions. We highlight the need to strengthen community programs addressed to the identification and report of suspected cases of dengue. The community shows good attitude to collaborate in solving their own health problems, which facilitates the implementation of community surveillance based on ICTs.

Efectos de la radiación electromagnética no ionizante sobre lasalud y el caso específico de los efectos en la salud humana de la telefonía celular / Health effects of non-ionizing electromagnetic radiation, and the specific case of the effects of mobile telephony

Los efectos en salud de la radiación electromagnética ionizante son bien conocidos; sin embargo hay menos reconocimiento de los efectos en salud causados por exposición a radiación electromagnética no ionizante. La primera parte del presente trabajo se refiere a los efectos en salud de las radiaciones electromagnéticas no ionizantes, independiente de su origen, puesto que no hay diferencias apreciables entre los efectos producidos por los diversos tipos de radiación electromagnética no ionizante y por lo tanto, son también válidas para aquellas emitidas por la telefonía celular. Se describe una asociación estadísticamente significativa de varias enfermedades a radiación electromagnética de frecuencia baja (ELF) proveniente de tendidos o transformadores de alta tensión, radiación electromagnética ELF del tendido eléctrico domiciliario y de artefactos electrodomésticos, exposición ocupacional a radiación electromagnética principalmente ELF, y radiación electromagnética de radiofrecuencia (RF) proveniente de antenas de transmisión de televisión. A continuación se analizan los efectos ya demostrados de la telefonía celular (los teléfonos y sus antenas repetidoras). Luego se analizan los grados de certeza de un estudio del Estado de California (USA) para relacionar las diversas enfermedades causadas por radiación electromagnética no ionizante. Este estudio confirmó la alta o mediana probabilidad de una relación causa-efecto de la radiación electromagnética con las siguientes enfermedades: leucemia en adultos y niños, cáncer cerebral en adultos y niños, cáncer de mama femenino y masculino, abortos espontáneos, suicidio, enfermedad de Alzheimer, esclerosis lateral amiotrófica y enfermedades cardiovasculares incluyendo infarto del miocardio. Se describen cuales son estas enfermedades de acuerdo al origen de estas radiaciones y se analizan cuales pueden ser los mecanismos biológicos que determinan la génesis de éstas...

The health effects of ionizing electromagnetic radiation are well known; neverthless there exist less recognition on the health effects of exposure to non-ionizing electromagnetic radiation. The first part of the present report refers to health effects of non-ionizing electromagnetic radiation, independently of its origin, since there are not important differences among effects caused by the different kind of non-ionizing radiations, therefore, they are valid for those emmited by the mobile telephony. A statistically significant association is described among various diseases and extremely low frequency electromagnetic radiation (ELF) from high tension electric conductors or transformers, intradomiciliary electric lines or electrodomestic appliances, occupational exposure to electromagnetic fields, mainly ELF, and radiofrequency (RF) electromagnetic radiation from television transmission. Already demonstrated effects of mobile telephony (cellular telephones and their antenas). The degrees of certainty from a study of the State of California (USA) is analyzed to relate various diseases caused by non-ionizing radiation. This study confirmed high or moderate probability of a cause-effect relationship for adult and child leukemia, brain cancer in adults and children, female and male breast cancer, spontaneous abortions, suicide, Alzheimer disease, amiotrophic lateral sclerosis and cardiovascular diseases including myocardial infarction. Various diseases are related to the different origin of the radiation, and the biological mechanisms involved in disease generation are analyzed. Research performed in the USSR and afterwards in Russia on health effects of mobile telephony are summarized, these investigations originated the regulation in this country and afterwards in West Europe, and influenced the decisions of WHO on its carcinogenicity...

Sistema de vigilancia epidemiológica comunitaria bonis: estado actualy proyecciones futuras / Community epidemiological surveillance system bonis: current status and future projections

El sistema actual de vigilancia epidemiológica en la zona del Centro de Ayuda Mutua y Salud para Todos (CAMSAT) del Bañado Sur, de Asunción, se basa en la búsqueda rutinaria de posibles casos febriles mediante visitas domiciliarias, realizadas por las agentes comunitarias adscritas a la Unidad de Salud Familiar (USF). Cada una de las diezagentes comunitarias de CAMSAT tiene asignada 150 hogares, y los resultados de susvisitas domiciliarias quedan recogidos en planillas que se reportan mediante medios tradicionales (papel, correo interno, fax, etc.) a la DGVS del Ministerio de Salud. La consecuencia de este modo de trabajo es que muchas veces las acciones de bloqueo de la transmisión llegan tarde con el coste social y económico que ello significa. El sistema Bonis introduce la telefonía móvil como elemento catalizador para transformar la búsqueda rutinaria de posibles casos febriles en una acción proactiva, y también la utilización de tecnologías web y bases de datos para el registro de pacientes y su correspondiente seguimiento por el personal sanitario. La utilización de estas tecnologíasde la información y comunicación (TICs) transforman el sistema de vigilancia epidemiológica en un caso de estudio de e-Salud en Paraguay. Se describe el estado actual y proyecciones futuras del sistema de vigilancia epidemiológica comunitaria “Bonis”,que utiliza las TICs para prevenir, alertar, supervisar y controlar la expansión de síndromes febriles en un área de influencia del Hospital Barrio Obrero (HBO), en la Unidad de Atención Primaria en Salud del Centro de Ayuda Mutua y Salud para Todos, Asunción,Paraguay.

The current system of epidemiologic surveillance in the area of Mutual Aid Centre and Health for All (CAMSAT in Spanish) in the “Bañado Sur” in Asuncion is based on routine screening of possible febrile cases through home visits made by community agents fromthe Primary Health Care Unit (USF in Spanish). Each of the ten community agents are assigned to 150 households and the results of these home visits are recorded on sheets that are reported through traditional means (paper, internal mail, fax, etc.) to the DGVSof the Ministry of Health. The consequence of this working system is that often the blocking actions arrive late with the social and economic costs that this implies. The Bonis system uses the mobile phone as a catalyst to transform the routine screening ofpotential feverish cases in a proactive action and the web technology and databases for patient records and appropriate follow-up by health personnel. The use of theseinformation and communication technologies of (ICTs) transforms the Epidemiological Surveillance System in a study case of e-Health in Paraguay. This document describes the current status and future projections of the community epidemiological surveillancesystem Bonis which uses Information and Communication Technologies (ICTs) to prevent, warn, monitor and control the spread of febrile syndromes in a catchment area of Barrio Obrero Hospital (HBO), Unit of Primary Health Care Center Mutual Aid and Health for All, Asuncion, Paraguay.