Home care delivery through the mobile telecommunications platform: the Citizen Health System (CHS) perspective.

Health delivery practices are shifting towards home care. The reasons are the better possibilities for managing chronic care, controlling health delivery costs, increasing quality of life and quality of health services and the distinct possibility of predicting and thus avoiding serious complications. For the above goals to become routine, new telemedicine and information technology (IT) solutions need to be implemented and integrated in the health delivery scene, and these solutions need to be assessed through evidence-based medicine in order to provide solid proof for their usefulness. Thus, the concept of contact or call centers has emerged as a new and viable reality in the field of IT for health and telemedicine. In this paper we describe a generic contact center that was designed in the context of an EU funded IST for health project with acronym Citizen Health System (CHS). Since the generic contact center is composed by a number of modules, we shall concentrate in the modules dealing with the communication between the patient and the contact center using mobile telecommunications solutions, which can act as link between the internet and the classical computer telephony communication means. We further elaborate on the development tools of such solutions, the interface problems we face, and on the means to convey information from and to the patient in an efficient and medically acceptable way. This application proves the usefulness of wireless technology in providing health care services all around the clock and everywhere the citizen is located, it proves the necessity for restructuring the medical knowledge for education delivery to the patient, and it shows the virtue of interactivity by means of using the limited, yet useful browsing capabilities of the wireless application protocol (WAP) technology.

Communication infrastructure in a contact center for home care monitoring of chronic disease patients.

The Citizen Health System (CHS) is a European Commission (EC) funded project in the field of IST for Health. Its main goal is to develop a generic contact center which in its pilot stage can be used in the monitoring, treatment and management of chronically ill patients at home in Greece, Spain and Germany. Such contact centers, which can use any type of communication technology, and can provide timely and preventive prompting to the patients are envisaged in the future to evolve into well-being contact centers providing services to all citizens. In this paper, we present the structure of such a generic contact center and in particular the telecommunication infrastructure, the communication protocols and procedures, and finally the educational modules that are integrated into this contact center. We discuss the procedures followed for two target groups of patients where two randomized control clinical trials are under way, namely diabetic patients with obesity problems, and congestive heart failure patients. We present examples of the communication means between the contact center medical personnel and these patients, and elaborate on the educational issues involved.

Fiber intake and childhood appendicitis.

In order to investigate the possible role of fiber in the etiology of acute appendicitis, 203 consecutive appendectomized children with histologically proved appendicitis and 1922 controls were studied by the diet history method. Statistics were performed by multivariate analysis of variance, discriminant analysis and chi 2. Appendectomized children had statistically significant lower mean daily intake of fiber (17.4 g versus 20.4 g, P < 0.001) including all fiber fractions: cellulose, uronic acid, pentose, exose and lignin. No statistical difference was found for energy, protein, carbohydrate and fat intake. Discriminant analysis proved that only cellulose and exose are independently correlated to appendicitis and lower fiber intake is thought to be the cause in 70% of the cases. Recurrent abdominal pain, chronic constipation and positive family history of appendectomy were more frequent in appendectomized children (P < 0.001). This study gives evidence that low fiber intake could play an important role in the pathogenesis of appendicitis.

Diet and chronic constipation in children: the role of fiber.

BACKGROUND: Chronic constipation is one of the most common disorders in Western countries and despite numerous clinical, pathophysiologic, and epidemiologic studies its cause is still unclear. Several hypotheses have been proposed and according to experimental studies and clinical observation, fiber intake could play a role in its pathogenesis. The purpose of this case-control study was to examine the possible correlation of idiopathic chronic constipation in children and dietary intake, particularly fiber intake. METHODS: A randomized sample of children (291 children with constipation and 1602 controls) aged 2 to 14 years was taken from three of the 52 counties of Greece. Stratification was performed on the basis of urban, rural, or suburban location and socioeconomic status. The nutritional data were obtained from a 3-day dietary record and a dietary history. Statistical analysis was performed with multivariate tests, multivariate analysis of variance, discriminant analysis, and chi-square analysis according to the characteristics of the correlated variables. RESULTS: Constipated children had a lower caloric and nutrient intake (p < 0.001), lower body weight/height (p < 0.001), and higher prevalence of reported anorexia (p < 0.001). Discriminant analysis indicated that dietary fiber alone was independently negatively correlated with chronic constipation, despite the age and the age of onset of constipation. Relative risk also had a negative correlation with fiber intake (p < 0.001). Of the main fiber fractions only cellulose and pentose were independently correlated with chronic constipation. CONCLUSIONS: Lack of fiber may play an important role in the etiology of chronic idiopathic constipation in children.

Nutritional survey in Greek children: nutrient intake.

The aim of the survey was to record the food habits and nutrient intake of Greek children. Data was obtained by a 3 d household measured diet record from a random stratified sample (1936 children aged 2-14 y). Mean daily protein intake was much higher than PRI and none of the children had lower intake than AR. Mean energy intake from protein was 15%, carbohydrate 44% and fat 41%. Eighty-four percent of children had energy intake from fat higher than the AR. Saturated fatty acids (SFA) provided approximately 15%, monounsaturated (MUFA) 17% and polyunsaturated (PUFA) 6% of energy. Eighty-seven percent of children had higher intake of SFA than the AR. Six percent of children had SFA intake lower than the AR and 50% higher than the AR. None of the children had PUFA intake lower than PRI and 0.3% higher than the maximum limit. 4.2% of children had calcium intake lower than LTI and 88% higher or equal to PRI. All children had phosphorus intake higher than PRI and less than the lower safe ratio of Ca/P; 50% of them had P intake higher than 1.5 g/d. The majority of children had sufficient iron intake with the exception of menstruated girls. Mean vitamin A intake was higher than PRI and lower than the toxic levels. All children had vitamin C intake higher than LTI. Median vitamin D intake varied from 1.7-2.1 micrograms. Median energy intake was higher than the AR in preschool children, but lower in the older children. We conclude that Greek children do not underintake energy and protein, overintake SFA, have safe intake of PUFA, vitamin A and C and high intake of MUFA, underintake carbohydrates, have adequate Ca, but a considerably high P intake. Vitamin D is low in small children, but the biological available vitamin D is obviously higher due to sunlight.