A Personalized Health Monitoring System for Community-Dwelling Elderly People in Hong Kong: Design, Implementation, and Evaluation Study.

BACKGROUND: Telehealth is an effective means to assist existing health care systems, particularly for the current aging society. However, most extant telehealth systems employ individual data sources by offline data processing, which may not recognize health deterioration in a timely way. OBJECTIVE: Our study objective was two-fold: to design and implement an integrated, personalized telehealth system on a community-based level; and to evaluate the system from the perspective of user acceptance. METHODS: The system was designed to capture and record older adults' health-related information (eg, daily activities, continuous vital signs, and gait behaviors) through multiple measuring tools. State-of-the-art data mining techniques can be integrated to detect statistically significant changes in daily records, based on which a decision support system could emit warnings to older adults, their family members, and their caregivers for appropriate interventions to prevent further health deterioration. A total of 45 older adults recruited from 3 elderly care centers in Hong Kong were instructed to use the system for 3 months. Exploratory data analysis was conducted to summarize the collected datasets. For system evaluation, we used a customized acceptance questionnaire to examine users' attitudes, self-efficacy, perceived usefulness, perceived ease of use, and behavioral intention on the system. RESULTS: A total of 179 follow-up sessions were conducted in the 3 elderly care centers. The results of exploratory data analysis showed some significant differences in the participants' daily records and vital signs (eg, steps, body temperature, and systolic blood pressure) among the 3 centers. The participants perceived that using the system is a good idea (ie, attitude: mean 5.67, SD 1.06), comfortable (ie, self-efficacy: mean 4.92, SD 1.11), useful to improve their health (ie, perceived usefulness: mean 4.99, SD 0.91), and easy to use (ie, perceived ease of use: mean 4.99, SD 1.00). In general, the participants showed a positive intention to use the first version of our personalized telehealth system in their future health management (ie, behavioral intention: mean 4.45, SD 1.78). CONCLUSIONS: The proposed health monitoring system provides an example design for monitoring older adults' health status based on multiple data sources, which can help develop reliable and accurate predictive analytics. The results can serve as a guideline for researchers and stakeholders (eg, policymakers, elderly care centers, and health care providers) who provide care for older adults through such a telehealth system.

Fraudulent antibiotic products on the market for aquaculture use.

Antibiotics in aquaculture are used to treat bacterial infections. In order for these products to work effectively fish need to be properly dosed. One of the emerging issues in aquaculture is under-dosing large populations of fish with antibiotics. This happens inadvertently for a number of reasons including the use of fraudulent medications. In this study we evaluated 17 antibiotic products (8 florfenicol and 9 oxytetracycline brands purchased in Asia) by HPLC to determine if the product labels accurately reflected the active pharmaceutical ingredient (API) in the package. We determined authenticity scores for different batches of products at two separate laboratories by comparing the observed API to the label API concentration. We found that 48 % of the antibiotic batches had authenticity scores below 80 % (i.e. observed API in package was at least 20 % less than the label API concentration). Further, there were 9 or the 31 batches of drugs tested had no measureable API. Some products had variation in their authenticity scores between batches making it difficult to rely on a brand. The price of florfenicol products may help identify products with low authenticity scores, but in the case of oxytetracycline, the price of all the products tested was relatively similar. The findings in this study suggest that not all florfenicol and oxytetracycline antibiotic products on the market in Asia have API concentrations indicated on their labels. This could be problematic for medicating fish on aquaculture farms.

Monitoring data quality for telehealth systems in the presence of missing data.

BACKGROUND: All-in-one station-based health monitoring devices are implemented in elder homes in Hong Kong to support the monitoring of vital signs of the elderly. During a pilot study, it was discovered that the systolic blood pressure was incorrectly measured during multiple weeks. A real-time solution was needed to identify future data quality issues as soon as possible. METHODS: Control charts are an effective tool for real-time monitoring and signaling issues (changes) in data. In this study, as in other healthcare applications, many observations are missing. Few methods are available for monitoring data with missing observations. A data quality monitoring method is developed to signal issues with the accuracy of the collected data quickly. This method has the ability to deal with missing observations. A Hotelling's T-squared control chart is selected as the basis for our proposed method. FINDINGS: The proposed method is retrospectively validated on a case study with a known measurement error in the systolic blood pressure measurements. The method is able to adequately detect this data quality problem. The proposed method was integrated into a personalized telehealth monitoring system and prospectively implemented in a second case study. It was found that the proposed scheme supports the control of data quality. CONCLUSIONS: Data quality is an important issue and control charts are useful for real-time monitoring of data quality. However, these charts must be adjusted to account for missing data that often occur in healthcare context.

Preliminary Agreement on Tracking Sleep Between a Wrist-Worn Device Fitbit Alta and Consensus Sleep Diary.

Background: Sleep is related to various kinds of health outcomes. Many studies traditionally collect data on sleep using questionnaires or sleep diaries. An increasing popular alternative is a wrist-worn device. The accuracy of these devices is uncertain, and assessment of this accuracy is important.Introduction: The purpose of this study is to compare consensus sleep diary (CSD) and an actigraphy-based wrist-worn device (Fitbit Alta™ [Fitbit, San Francisco, CA]) measurements of total sleep time (TST), sleep onset latency, wake time after sleep onset, number of awakenings, and sleep efficiency.Materials and Methods: Ten healthy young adults (50% female, 100% Asian) in the age range between 20 to 24 years old wore a Fitbit Alta around their nondominated hand during seven consecutive nights. The participants also filled in a CSD every day.Results: On average, the wrist-worn device (Fitbit Alta) recorded a TST per night of 437.15 min, which is 5.46 min shorter on average than the CSD recorded (442.61 min). Bland-Altman plots indicate that there is large variance in the sleep recorded between Fitbit™ (Fitbit, San Francisco, CA) and CSD. For example, Fitbit recorded 2.15 more awakenings per night than CSD, which is equal to 13.09 min on average longer wake time after sleep onset.Conclusion: Fitbit and CSD show significant differences in recording sleep. We find that for most sleep metrics, the level of disagreement is small enough for the devices to be interchangeably used except for recording wakes during the night.