Community Health Workers and Disease Surveillance in Tanzania: Promoting the Use of Mobile Technologies in Detecting and Reporting Health Events.

This cross-sectional study was conducted in the Kilosa, Morogoro Urban, Ngorongoro, and Ulanga districts of Tanzania to investigate the practices of community health workers (CHWs) related to disease surveillance functions and to establish their needs and technology capacities. We also established the strength of mobile phone networks and internet connections in the study areas to inform the feasibility of using mobile-based applications in community-based disease surveillance. A total of 135 CHWs from 85 villages participated in the study. Health events captured at the community level were entirely paper-based. CHWs submitted reports to higher-level health authorities mainly on foot (100%), but they also used public transport (65%) and telephone calls (56%). The median number of days between the onset of a suspected disease outbreak at the community level and reporting to a primary healthcare facility was 10 days (interquartile range [IQR] 2-30). The median number of days between submitting a report and receiving a response was 7 days (IQR 2-30). Of the 53 CHWs who reported the most recent health events to a higher-level health authority, 39 (74%) never received feedback. All 85 villages had a reliable mobile phone network and 74 (87%) had a mobile phone internet connection that was strong enough to support data transmission using digital technology. Almost all (n = 132, 98%) of the CHWs owned mobile phones. The practices related to detection and reporting of health events could be improved to enhance early warning disease surveillance. Reliable mobile networks and internet connections and the ownership of mobile phones among CHWs in the study areas present opportunities to strengthen community event-based surveillance using mobile-based solutions.

Connecting humanity: assessing investment needs of connecting humanity to the Internet by 2030

Nearly half the global population aged 10 years and over ­ equating to some three billion people ­ has never used the Internet. Many of the unconnected live in rural and remote areas, where connectivity remains a challenge. A disproportionate number are women, particularly in Africa and South Asia, where the digital gender divide is particularly marked. And of course most are poor, lack basic literacy and, with only limited digital exposure, see little value in getting online. With just ten years remaining to meet the SDGs, this timely new report asks: What will it take to connect the world? How much investment is needed, where are the global 'pain points', and how can we mobilize the unprecedented levels of financing needed to extend networks to unserved communities?

Evaluating critical success factors in implementing E-learning system using multi-criteria decision-making.

Learning using the Internet or training through E-Learning is growing rapidly and is increasingly favored over the traditional methods of learning and teaching. This radical shift is directly linked to the revolution in digital computer technology. The revolution propelled by innovation in computer technology has widened the scope of E-Learning and teaching, whereby the process of exchanging information has been made simple, transparent, and effective. The E-Learning system depends on different success factors from diverse points of view such as system, support from the institution, instructor, and student. Thus, the effect of critical success factors (CSFs) on the E-Learning system must be critically analyzed to make it more effective and successful. This current paper employed the analytic hierarchy process (AHP) with group decision-making (GDM) and Fuzzy AHP (FAHP) to study the diversified factors from different dimensions of the web-based E-Learning system. The present paper quantified the CSFs along with its dimensions. Five different dimensions and 25 factors associated with the web-based E-Learning system were revealed through the literature review and were analyzed further. Furthermore, the influence of each factor was derived successfully. Knowing the impact of each E-Learning factor will help stakeholders to construct education policies, manage the E-Learning system, perform asset management, and keep pace with global changes in knowledge acquisition and management.

Google Trends as a Tool for Evaluating Public Interest in Facial Cosmetic Procedures.

BACKGROUND: The utility of Google Trends (GT) in analyzing worldwide and regional patient interest for plastic surgery procedures is becoming invaluable to plastic surgery practices. GT data may offer practical information to plastic surgeons pertaining to seasonal and geographic trends in interest in facial cosmetic procedures. OBJECTIVES: The authors sought to analyze geographic and temporal trends between GT search volumes and US surgery volumes using univariate analysis. METHODS: The "related queries" feature of GT generated potential search terms. GT data were compiled for cheek implants, mentoplasty, otoplasty, blepharoplasty, rhytidectomy, forehead lift, hair transplantation, lip augmentation, lip reduction, platysmaplasty, and rhinoplasty from January 2004 to December 2017. Annual volumes for respective procedures were obtained from annual statistics reports of the American Society of Plastic Surgeons (ASPS) from 2006 to 2017 and American Society of Aesthetic Plastic Surgery (ASAPS) from 2004 to 2017. RESULTS: Geographical and temporal variations in search volume were detected during the study. Search volume trends that correlated significantly with both ASPS and ASAPS surgery volume trends were: "eyelid plastic surgery" (ASPS R2 = 0.336, P = 0.048; ASAPS R2 = 0.661, P = 0.001); "facelift" (ASPS R2 = 0.767, P ≤ 0.001; ASAPS R2 = 0.767, P = 0.001); "lip injections" (ASPS R2 = 0.539, P = 0.007; ASAPS R2 = 0.461, P = 0.044); and "rhinoplasty surgery" (ASPS R2 = 0.797, P ≤ 0.001; ASAPS R2 = 0.441, P = 0.01). Several search terms demonstrated no significant relationships or were significant with only one database. CONCLUSIONS: GT may provide a high utility for informing plastic surgeons about the interest expressed by our patient population regarding certain cosmetic search terms and procedures. GT may represent a convenient tool for optimizing marketing and advertising decisions.

[Use of new technologies by adolescents in the search for health information]. / Uso de Internet por los adolescentes en la búsqueda de información sanitaria.

OBJECTIVE: To describe Internet sources used by adolescents to consult health information and their sociodemographic characteristics, as well as to identify the variables that influence the choice of Internet site. DESIGN: Cross-sectional descriptive study. Survey adapted from the questionnaire validated by Rideout. PARTICIPANTS AND LOCATION: Adolescents aged 12-18 from 4schools in rural municipalities. RESULTS: The study included a total of 405 adolescents, of whom 51.6% were female, age 14.9 ± 1.2 years. Most of them (87.25%) live with both parents, and 93.6% have computers at home, with 45.2% in their rooms, and a mean of 2.1 computers/home. The large majority (85.2%) have Internet at home, with 76.3% in their room. A total of 53.8% sought health information 0.71 ± 0.91 h/week, seeking mainly information on: cancer (89.9%), addictions (67.7%), STIs and HIV (49.6%), pregnancies/contraception (21, 5%), mental illness (40%), heart disease and diabetes mellitus (53.6%), and eating disorders (39.3%). Google was chosen by 63.2%, and only 11.9% chose medical websites. Information was shared on social networks by 12.8% (70.3% Facebook). The information found led to a change of behaviour in 70.7%. Just over half (56.05%) preferred to use the Internet for: speed, 34.8%, privacy, 15.8%, reliability, 13.6%, and more information, 17.6%. CONCLUSIONS: Adolescents seek information mainly through Google, with no knowledge of systems that accredit content quality, but consider it useful and reliable, changing their behaviour patterns according to the information found. All this carries a risk in this age group with very sensitive characteristics. Therefore, we believe that we should continue along the line of designing other alternative communication channels adapted to their current reality.

Are There Gender-Dependent Study Habits of Medical Students in Times of the World Wide Web?

This study evaluates how medical students rate the different types of teaching materials and methods available as well as possible gender-specific differences in the use of such materials. In this descriptive, cross-sectional study a questionnaire with short, one-dimensional questions with a 4-step Likert scale was developed by a presurvey within 493 students (4th year) at a University Medical School (January-December 2015). The anonymous survey was performed from July 2016 to February 2017 with 252 students within an orthopaedic surgery course at University Medical School. After exclusion of (1) nonnative speakers and (2) incomplete forms, 233 samples were included. Practical education was regarded as the most important (n=160/68.7%) teaching method followed by Internet research (n=147/63.1%) as the most important teaching material, while traditional frontal teaching (n=19/8.2%) and e-books (n=11/4.7%) ranked last. The evaluation of gender-specific differences in the use of teaching materials showed that female students prefer to highlight text (p<0.0001) as well as a trend to Internet research (p=0.053) and small-group teaching (p=0.057). Despite some gender-specific differences, traditional learning methods retain their importance besides new learning possibilities such as Internet research.

Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use.

RATIONALE: Low physical activity is highly prevalent among COPD patients and is associated with increased healthcare utilization and mortality and reduced HRQL. The addition of a website to pedometer use is effective at increasing physical activity; however, the timeline of change and impact of environmental factors on efficacy is unknown. METHODS: U.S. Veterans with COPD were randomized (1:1) to receive either (1) a pedometer and website which provided goal-setting, feedback, disease-specific education, and an online community forum or (2) pedometer alone for 3 months. Primary outcome was change in daily step count. Secondary outcomes included 6MWT distance, HRQL, dyspnea, depression, COPD knowledge, exercise self-efficacy, social support, motivation, and confidence to exercise. Generalized linear mixed-effects models evaluated the effect of the pedometer plus website compared to pedometer alone. RESULTS: Data from 109 subjects (98.5% male, mean age 68.6 ± 8.3 years) were analyzed. At 13 weeks, subjects in the pedometer plus website group had significant increases daily step count from baseline relative to the pedometer alone group (804 ± 356.5 steps per day, p = 0.02). The pedometer plus website group had significant improvements in daily step count from baseline beginning in week 3 which were sustained until week 13. In subgroup analyses, the pedometer plus website attenuated declines in daily step count during the transition from summer to fall. No significant differences in secondary outcomes were noted between groups. CONCLUSIONS: A website added to pedometer use improves daily step counts, sustains walking over 3 months, and attenuates declines in physical activity due to season.

What Can the National Broadband Map Tell Us About the Health Care Connectivity Gap?

PURPOSE: Internet connection speeds are generally slower in rural areas, and this issue is rising in importance for health care facilities as technologies such as Electronic Health Records and Health Information Exchanges become more common. However, the extent of the rural-urban divide in terms of health care connectivity has not been fully quantified. This report uses data compiled from the National Broadband Map (NBM) to compare levels of health care facility connectivity across metropolitan and nonmetropolitan counties. METHODS: The number of health and medical entries in the Community Anchor Institution (CAI) data collected as part of the NBM grew from 35,000 to 63,000 between 2010 and 2014. About one-fifth provided information on the speed of their connections in 2014. Comparisons across metro and nonmetro counties and over time provide insight into trends associated with the health care connectivity gap. FINDINGS: The data clearly show that health-related institutions in nonmetro counties connect with lower speeds than do their more urban counterparts. At the aggregate level, over 55% of metro institutions who provided speed information had download speeds in excess of 50 megabytes per second in 2014, compared with only 12% of nonmetro institutions (P < .001). More importantly, the connectivity gap has grown significantly during 2010-2014, particularly for nonhospital facilities. CONCLUSIONS: The NBM CAI data are a publicly available and easy to use asset that rural health advocates should be aware of. The fact that the connectivity gap increased during 2010-2014, despite policies focusing on this issue, is a cause for concern.

Digital Health in Francophone Sub-Saharan Africa: Catching Up!

Digital health has the potential to strengthen health systems and empower patients to prevent ill health and manage their own care. To confirm this potential, however, it is urgent to shift from pilot studies to the implementation of programs at a sufficient scale, with interoperable solutions and integrated into the national health system, while respecting human rights. It is also important to plan for studies to demonstrate the impact and produce the necessary evidence. Francophone sub-Saharan Africa can catch up in this area.

Quality and accuracy of publicly accessible cancer-related physical activity information on the Internet: a cross-sectional assessment.

In this study, we assessed the quality of publicly available cancer-related physical activity (PA) information appearing on reputable sites from Canada and other English-speaking countries. A cross-sectional Internet search was conducted on select countries (Canada, USA, Australia, New Zealand, UK) using Google to generate top 50 results per country for the keywords "'physical activity' AND 'cancer'". Top results were assessed for quality of PA information based on a coding frame. Additional searches were performed for Canadian-based sites to produce an exhaustive list. Results found that many sites offered cancer-related PA information (94.5%), but rarely defined PA (25.2%). Top 50 results from each country did not differ on any indicator examined. The exhaustive list of Canadian sites found that many sites gave information about PA for survivorship (78.3%) and prevention (70.0%), but rarely defined (6.7%) or referenced PA guidelines (28.3%). Cancer-related PA information is plentiful on the Internet but the quality needs improvement. Sites should do more than mention PA; they should provide definitions, examples and guidelines. With improvements, these websites would enable healthcare providers to effectively educate their patients about PA, and serve as a valuable resource to the general public who may be seeking cancer-related PA information.

Social Network Analysis and Mining to Monitor and Identify Problems with Large-Scale Information and Communication Technology Interventions.

The published literature reveals several arguments concerning the strategic importance of information and communication technology (ICT) interventions for developing countries where the digital divide is a challenge. Large-scale ICT interventions can be an option for countries whose regions, both urban and rural, present a high number of digitally excluded people. Our goal was to monitor and identify problems in interventions aimed at certification for a large number of participants in different geographical regions. Our case study is the training at the Telecentros.BR, a program created in Brazil to install telecenters and certify individuals to use ICT resources. We propose an approach that applies social network analysis and mining techniques to data collected from Telecentros.BR dataset and from the socioeconomics and telecommunications infrastructure indicators of the participants' municipalities. We found that (i) the analysis of interactions in different time periods reflects the objectives of each phase of training, highlighting the increased density in the phase in which participants develop and disseminate their projects; (ii) analysis according to the roles of participants (i.e., tutors or community members) reveals that the interactions were influenced by the center (or region) to which the participant belongs (that is, a community contained mainly members of the same region and always with the presence of tutors, contradicting expectations of the training project, which aimed for intense collaboration of the participants, regardless of the geographic region); (iii) the social network of participants influences the success of the training: that is, given evidence that the degree of the community member is in the highest range, the probability of this individual concluding the training is 0.689; (iv) the North region presented the lowest probability of participant certification, whereas the Northeast, which served municipalities with similar characteristics, presented high probability of certification, associated with the highest degree in social networking platform.

The Online Availability of Multilingual Health Promotion Materials Produced by Local Health Departments: an Information Assessment.

OBJECTIVES: Local Health Departments (LHDs) are a key source of health promotion information. For ethnically and culturally diverse communities, it becomes important to provide minorities with language appropriate health information. This project sought to assess the availability of multilingual health promotion materials on LHD websites in Washington State (WA), USA. METHODS: We performed a cross-sectional study of all 34 LHD websites in WA. We collected and classified health promotion documents available to the public, specifically, whether translated versions were available. We also assessed the extent of document sharing between LHDs. RESULTS: We identified 1,624 documents across 34 LHDs. Topics most frequently covered were communicable diseases and emergency preparedness. Fewer than 10% of documents were available in non-English languages. We found little evidence of document sharing between LHDs; only 5% of all documents were shared between LHDs. CONCLUSIONS: WA LHDs provide a variety of health promotion materials for the public, but few multilingual materials are available online. New technologies for facilitating document sharing and machine translation may improve the present landscape.

The Use of Applications in Distance Education Specialization Course as a Support Tool for Students Living in Remote Areas Without Internet.

The world is experiencing the popularization of mobile devices. This was made possible by the increasing technological advances and the advent of the Internet as a communication and information tool. These facts demonstrate that the development of applications compatible with such devices is an effective way to provide content to diverse audiences. In the educational field, these devices can be seen as technological support artifacts for distance education, serving as strategy for continuous and permanent education for health professionals. The Open University of Brazilian National Health System (UNA-SUS) offers distance learning courses, including specializating on free access. In order to increase the public reach, UNA-SUS developed mobile applications as supporting material for students. These applications can be accessed in offline mode, increasing the accessibility and therefore, improving the efficiency of the material. The 28 applications developed with responsive online books format currently reached the milestone of over 6,000 downloads. This number shows the positive acceptance of the format used, accentuated by the ease of having material downloaded from the device, not requiring the user to be connected to access content.

[Provision of assistive devices in amyotrophic lateral sclerosis. Analysis of 3 years case management in an internet-based supply network]. / Hilfsmittelversorgung bei der amyotrophen Lateralsklerose. Analyse aus 3 Jahren Fallmanagement in einem internetunterstützten Versorgungsnetzwerk.

BACKGROUND: The provision of assistive devices (PAD) is a key element of care in amyotrophic lateral sclerosis (ALS). Since 2011, assistive devices (AD) have been coordinated in an internet-supported care network at university-based ALS centers in Berlin, Bochum, Hannover and Jena. The digitization of PAD processes has facilitated the evaluation of real-life ALS care. OBJECTIVES: Orthotics (OT), augmentative and alternative communication (AAC), supported treadmill (ST) and powered wheelchair (PW) were the PAD groups analyzed for delivery rates (proportion of delivered AD vs. medically indicated AD), rejection by patients and payers and latency of provision of care. RESULTS: Between June 2011 and October 2014 a total of 1479 patients and 12,478 AD were coordinated, among which 3313 PAD were related to OT, AAC, ST or EM. The median delivery rate was 64.3 %. The mean rejection rate by patients was 9.8 % (OT 5.4 %, AAC 9.8 %, ST 10.2 % and PW 15.6 %). Marked differences were noted in the rejection rate by payers and in care provision latency: OT (16.2 %, 68 days, n = 734), AAC (30.4 %, 96 days, n = 392), ST (34.8 %, 113 days, n = 164) and PW (35.6 %, 129 days, n = 259). Analysis of rejection rates showed significant differences among insurers. CONCLUSION: Only two thirds of the medically indicated AD reached the patients. Rejection rates by patients and payers and latency of provision of care were high. The PAD can substantially vary among health insurance companies. The establishment of consented criteria for PAD and their integration into treatment regimens and guidelines are crucial tasks for the future.