Constructive Health™ » Technologies in Health

Inflammation in Cardiovascular disease

admin — Thu, 23 Jul 2009 22:26:04 +0000

Top Innovations in Medical Area by Time Magazine-

Half of all heart attacks in the U.S. occur in people with normal cholesterol levels. Baffled? So were doctors, until November. That’s when Dr. Paul Ridker at Boston’s Brigham and Women’s Hospital confirmed a separate, perhaps equally powerful, risk factor for heart disease: inflammation, the same culprit behind arthritis and other autoimmune diseases. Smaller studies had hinted at the link in the past, but Ridker’s recent research, published in the New England Journal of Medicine, showed that when people with normal cholesterol and high levels of CRP — a protein marker for inflammation in the blood — took statins, their CRP levels plummeted and their heart attack risk fell 54%. Compare that to the 20% reduced risk in people who take statins to lower cholesterol alone. Doctors say cholesterol and fatty plaques are still the main indicators of heart disease, but inflammation may be just as important, playing a key role as a trigger: It increases the instability of plaques, making them more likely to rupture, block heart vessels and cause a heart attack.

Health and Mobile

admin — Wed, 15 Jul 2009 11:00:39 +0000

In our previous post,we discussed about how mobile platform is now gaining ground for applications in health.

http://www.techgadgets.in

As health care of an individual is always changing,and mobile phones are now a part of our life,it is but natural,applications about health management on mobile phones become a part of our lives in upcoming years.

Mayo clinic is now forging on its Mobile startegy,in a interview on Mobile health news-Scott Eising discuss about Mayo Clinic group Mobile road map

There are two strategies there — we have a referring physician portal today that is a secure portal where a physician who wants to refer a patient to Mayo logs in, fill out a profile on that patient, submit it and upload things like medical records that may be necessary for the referral. The patient may or may not end up coming to Mayo, but if they do, then the portal is where we refer back to that referring physician the status of the visit and the opinion or the outcome of it. So we are doing some user research right now and asking that group which aspects of that referring physician portal might be of more value if they were accessible via mobile devices. Certainly, you could imagine an alert or a reminder sent to the referring physician when new information was pushed to their portal. Maybe we could provide them some sort of preview into that information via mobile device or a way to put in a simple request for a referral from their device. So, we have a user survey out to that group so we can find out how we can better optimize that experience for those users. Obvioulsy being a tertiary destination medical center, referrals are a big part of where our patient base comes from. They are looking for that specialty expertise that Mayo provides and that they can’t get in their community. Referring physicians are an important partner for bringing patients to Mayo or for patients finding their way to Mayo.

Swine flu and Health 2.0

admin — Sun, 12 Jul 2009 15:39:12 +0000

The recent outbreak of swine flu or H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in Mexico in April 2009. Other countries, including the United States and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.

The current WHO phase of pandemic alert is 6.

In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature.

In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.

Source:WHO GLOBAL ALERT RESPONSE

US Department of Health and Human Services has created a 2009 Flu Prevention PSA Contest,visit the contest site for more details.

Create a video Public Service Announcement with the message of preventing or dealing with the flu, post it on YouTube, and you could win a $2,500 cash prize!

Health Care reform and Wifi

admin — Sat, 11 Jul 2009 11:41:17 +0000

Health care reform is the major topic of discussion in the media today,reforming health system in US is a complex undertaking,wherein currently significant proportion of the population are bombarded with high health care costs,with addition of lack of access to health care facilities among the uninsured.Changing the system overnight will not be possible,yet a gradual progression to change will indeed be welcome. Technologies have played a crucial role in progress of our world and Health care industry is no expectation,but the utilization of technologies in a conservative health industry is slow.Telecommunication technologies like Pagers,Cellphones and now smart phones have indeed changed the way health care is delivered in the last decade.But,today newer technologies like Wi-Fi enabled devices have made forays into health care life.

Devices which are tethered to a single system will be like an Island,but devices which can send information across electronic health record portals,could indeed change the way medicine is practised in the next couple of years,

In a recent forecast by published in Computer world – ABI Research forecasts that Wi-Fi-enabled health care products will hit sales of nearly $5 billion globally in 2014, up 70% from 2009.

Health Education in 2010

admin — Fri, 10 Jul 2009 10:27:16 +0000

WHO definies health education in 1997 as

“compris[ing] [of] consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health.”

Fast forward to 2009,internet has played an very important role in shaping of our lives-either in commerce,arts or even in science.The growth of internet has lead to creation of several interesting websites like (patientslikeme.com)-which enable patients with similar disease to discuss about their health.

According to the founders of the website:Our goal is to enable people to share information that can improve the lives of patients diagnosed with life-changing diseases. To make this happen, we’ve created a platform for collecting and sharing real world, outcome-based patient data (patientslikeme.com) and are establishing data-sharing partnerships with doctors, pharmaceutical and medical device companies, research organizations, and non-profits.

The changing needs of the population,growth of technology needs to addressed specifically by governmental organizations,in order to enable them to meet the needs of not only healthy people but also patients with newly diagnosed disease and also chronically ill subjects.

Self help needs like when In the context of health promotion, actions taken by lay persons (i.e. non health professionals) to mobilize the necessary resources to promote, maintain or restore the health of individuals or communities will definetely help in growth of patient communities and help in better health resources management.Adopting newer technologies and also using tools like Internet,Mobile technologies and Wireless technologies are some of the methods of developing self help techniques.

Ref:WHO Documents [pdf]

Note: There is a poll embedded within this post, please visit the site to participate in this post's poll.

In the context of health promotion, actions taken by lay persons (i.e. non health

professionals) to mobilize the necessary resources to promote, maintain or restore

the health of individuals or communities.

Top Innovations in 30 years

admin — Tue, 07 Jul 2009 12:37:55 +0000

In our last article on Technology Curve & Health ,we wrote about the impact of technology on our lives.. Today,we look at the innovations which have shaped our world in the last 30 years.

The top innovations in the last 30 years

Fiber optics	Open source software
Biofuels	Mobile phones
Microfinance	Photovoltaic cells
Anti-retroviral AIDS treatment	LCDs
Bar codes	E-mail
Media file compression	GUI
Microprocessor	Digital photgraphy
Internet	RFID
Office software	E-commerce
Non-invasive surgery	PC/Laptops
MRI	DNA sequencing
SRAM/Flash memory	ATMs
Wind turbines	Stents
GPS	LEDs
Genetically modified plants	Social networks on Internet

Watch this show on PBS about the top 30 innovations in the last 30 years that has changed our lives.

Preventive Health Care better!

admin — Mon, 06 Jul 2009 12:26:37 +0000

In a recent article- One Way to Lower Health Costs: Pay People to Be Healthy by Wharton Business School,empasis was on preventive health to reduce the cost of healthcare in the long term.

One Way to Lower Health Costs: Pay People to Be Healthy

Published : June 24, 2009 in Knowledge@Wharton

Good news: Health costs as little as $3 a day. At least, that’s all it took in

one recent study for several patients to forgo bad behaviors that put their

health at risk.

Each year, more than 40% of premature deaths in the United States result

from unhealthy behaviors such as smoking, over-eating or failing to take

medications as prescribed. Physicians routinely struggle to get patients to

give up their bad habits for the sake of their long-term health, yet 20% of

Americans still smoke, and 71% are either overweight or obese.

“We know that people in the short term have a lot of trouble changing

their behavior in ways that is in their long-term best interest,” says Kevin Volpp, Wharton professor of

medicine and health care management, and a professor at the University of Pennsylvania School of

Medicine. “People aren’t very good at making these tradeoffs between immediate gratification and

delayed and often intangible benefits, such as good health 10 years from now.”

Kevin Volpp, Wharton professor of medicine and health care management, and a professor at the

University of Pennsylvania School of Medicine, discusses various methods being researched to

encourage positive behavior modification.

Volpp — with collaborators Mark V. Pauly, Wharton professor of health care management; George

Loewenstein, professor of economics and psychology at Carnegie Mellon University; and others — may

have found an answer to this problem: cash.

As director of Penn’s Center for Health Incentives, part of the Leonard Davis Institute of Health

Economics, Volpp is in perpetual pursuit of carrots that will lure patients away from lethal behaviors. In a

series of ongoing studies, Volpp has found evidence that money can motivate some patients to stop

smoking, lose weight or keep up with their daily medication.

A smoking-cessation study led by Volpp, “Financial Incentives for Smoking Cessation,” published in the

New England Journal of Medicine and conducted among employees at General Electric, found that 9.4%

of smokers who were offered $750 in incentives to quit smoking were able to remain smoke free for 18

months, compared with just 3.6% of smokers who tried to quit without financial incentive. Another

Volpp-led study, ” Financial Incentives for Weight Loss,” published in the Journal of the American

Medical Association, found that dieters who could earn money by loosing weight lost more pounds more

quickly than those who weren’t offered a monetary reward. And a small preliminary study of patients who

regularly forgot to take their medication, titled “A Test of Financial Incentives to Improve Warfarin

Adherence,” found that the chance to win an average of $3 per day in a daily lottery pushed many of them

to remember to take the daily dose.

‘P4P4P’

“Businesses and insurers should be paying attention [to these findings] and incorporating them into their

policies,” said Pauly, who has worked with Volpp to study the effectiveness of monetary incentives for

patients. Volpp and Pauly call the innovative approach “P4P4P” — pay for performance for patients.

“The good news is that there’s stuff that actually … causes employees to change their behavior,” Pauly

said. For an employer, implementing a successful incentive program has the potential to create healthier,

more productive employees. It also reduces health care costs down the road, Pauly explained. “There’s

This is a single/personal use copy of

Knowledge@Wharton. For multiple copies, custom

reprints, e-prints, posters or plaques, please

contact PARS International: reprints@parsintl.com

P. (212) 221-9595 x407.

All materials copyright of the Wharton School of the University of Pennsylvania. Page 1 of 4

One Way to Lower Health Costs: Pay People to Be Healthy: Knowledge@Wharton

(http://knowledge.wharton.upenn.edu/article.cfm?articleid=2266)

two for the price of one here. It’s a win-win.”

Some employers have tried to implement P4P4P approaches, but they often design programs that miss the

mark, according to Volpp. For example, an incentive program that offers employees $250 off their health

insurance premium at the end of the year if they go to the gym once a week will probably fall flat. In the

first place, a $250 discount off an insurance premium doesn’t feel the same as a $250 check in hand.

Second, people tend to focus on the present, so a small pay-off at the end of a calendar year won’t be

enough to inspire a couch potato to go to the gym in the dark of winter. “Those types of incentives are

very poorly designed,” Volpp said. “How the incentive is actually delivered is really important.”

Volpp’s studies draw heavily on lessons from behavioral economics: First, research shows that small

rewards and punishments have greater impact if they occur immediately. Second, people are often

motivated by experience of rewards in the past, the prospect of rewards in the future, and the possibility

of receiving a large reward. Third, when making decisions, most people try to avoid regret, so they will

be motivated to take action if it helps prevent a loss.

The studies on smoking, weight loss and medicine adherence were all designed with these lessons in

mind. One similarity among them, for example, is the use of frequent, small rewards to encourage

positive behavior.

The study on smoking cessation followed 878 employees of General Electric through an 18-month

program to quit smoking. Half of the employees (436 people) were offered $100 to complete a

community-based smoking-cessation program in their area, $250 if they had quit smoking at some point

within six months after taking the course, and $400 if they remained smoke-free for another six months

after that. (Researchers verified that participants had kicked the habit by testing their saliva or urine.) The

rest of the employees (442 people) were asked to enroll in a smoking-cessation program, and their

progress was tracked in the same period to see if they quit. They were given no financial incentives.

The incentive group outperformed the information-only group at every step. More than one out of every

seven participants in the incentive group enrolled in a smoking-cession program, compared with less than

one out of 18 in the information-only group; 10.8% of the incentive group finished a smoking cessation

program, compared with just 2.5% of the control group. After the first six months, 20.9% of the incentive

group reported that they had quit smoking, compared with 11.8% of the control group. After nine to 12

months, the gap between the incentive and control groups had grown, with quit rates of 14.7% and 5% in

the incentive and control groups, respectively. The final follow-up at 15 to 18 months found 9.4% of

smokers in the incentive group remained smoke-free, while just 3.6% of those in the information-only

group had managed to quit.

The results for the incentive group far exceed average quit rates: more than 40% of smokers in the United

States try to quit each year, but only 3% make it for more than 12 months. “This study showed that these

approaches can be quite effective in employer settings,” said Volpp. “GE has announced plans to

implement an approach similar to those for all 152,000 employees next year, which is pretty exciting.”

Despite the groundbreaking results, Volpp isn’t satisfied. Smoking is considered the leading cause of

preventable death in the United States, killing roughly 438,000 Americans each year. According to the

Centers for Disease Control, each adult smoker costs employers $1,760 in lost productivity and $1,623 in

excess medical spending annually. “We still have 85% that didn’t quit,” Volpp said, referring to the

study’s 12-month mark. “There’s still a lot of room for improvement.”

Volpp and his colleagues may find some support in legislation signed by President Obama on Monday

that gives the U.S. Food and Drug Administration unprecedented control over tobacco products. The new

law, for example, includes measures that will prevent tobacco companies from marketing their products to

teenagers, lower the amount of nicotine in tobacco products, and define what labels are allowed and where

they are placed.

Trust, but Verify

One of the barriers to offering more frequent, smaller rewards in the smoking study was the cost of

verifying that smokers were nicotine-free, Volpp said. “We felt that we couldn’t design a smoking study

where we could do frequent tests.” Studies better suited to frequent tests provided evidence that small

All materials copyright of the Wharton School of the University of Pennsylvania. Page 2 of 4

One Way to Lower Health Costs: Pay People to Be Healthy: Knowledge@Wharton

(http://knowledge.wharton.upenn.edu/article.cfm?articleid=2266)

recurring rewards keep people motivated.

One example is the weight loss study of 57 dieters at the Philadelphia Veterans Affairs Medical Center,

which created two types of incentive plans built on small, frequent rewards. The 16-week study divided

participants into three groups: one enrolled in a “deposit contract,” another in a lottery, and a third in a

weight loss program with no financial rewards.

Participants in the deposit contract were able to contribute between $.01 and $3 each day into an account.

In addition to matching the deposit, researchers would add $3 for each day participants called in and

reported a weight at or below their goal. Participants would receive a text message daily, telling them

how much money they had accumulated. The catch: They would only receive the accumulated amount at

the end of each month only if they reached their weight loss goal. So depending upon how much they

invested and how much weight they lost, participants in the deposit contract group could accumulate as

much as $252 per month, or lose up to $93.

The second incentive group got to play a daily lottery that offered a one in 100 chance of a $100 reward,

or a one in five chance of a $10 reward. (Each patient was assigned a two-digit number, such as 27. Every

day, the lottery would generate a random number. Participants would win $10 if the first or last digits of

their number matched; if both digits matched, the participant would win $100.) Participants would only

be eligible to win if they had met their weight loss goal for the day and had called in to report it before the

lottery took place. Like the deposit group, participants were given daily text messages that told them how

much they had accumulated and would only receive the payoff at the end of the month if they met their

weight loss goal.

In addition to small, immediate rewards and the anticipation of a larger payoff, the study also tried to

maximize the “threat of regret” as a motivating force. In both incentive groups, participants who failed to

lose weight were given daily text messages reminding them how much they could have earned had they

met their target. For those in the deposit contract group, forfeited money went to a pool that was

distributed equally among successful participants who lost more than 20 pounds after 16 weeks. To top it

off, participants in both incentive groups who lost more than 20 pounds by the end of the four-month

study got a final bonus of $50.

Both incentive groups outperformed the control group. After 16 weeks, the deposit contract group lost a

mean of 14 pounds, the lottery group a mean of 13.1 pounds and the control group a mean of 3.9 pounds.

About half of the participants in the incentive groups met the 16-pound weight loss goal by the end of the

study, while only 10.5% in the control group did.

A follow-up seven months later, however, showed that participants in all three groups gained much of the

weight back, although the incentive groups remained at a lower weight than when they began the study,

while the control group did not. “Substantial amounts of weight were regained between the end of the

weight loss phase and the follow-up,” Volpp wrote in a paper about the study. “Further testing of

longer-term use of these incentives is needed to determine whether longer use would lead to sustained

weight loss.”

Volpp said he is excited about a follow up weight loss study that puts specially-equipped scales directly

in the workplace, allowing study participants to log verifiable weights daily instead of once a month. The

scale will recognize the employee’s ID and will take a photo each time the participant weighs in. “So we

can run a daily incentive program with verifiable results, rather than using self-reported weight-loss

during the month and relying on in-person weights only at the end of the month,” Volpp said.

The ‘Peanuts’ Effect

Volpp sees promise in the lottery-based programs because they incorporate so many of the insights

gained from behavioral economics, including the importance of frequent feedback and incentives and the

threat of regret. Lotteries are likely more effective than direct payments if the expected value of the

reward is small because most people tend to discount rewards if they are too small — a phenomenon

known as the “peanuts” effect — and because most people overestimate their chances of winning big in a

lottery.

Two small pilot studies of 20 patients taking the drug Warfarin found that a daily lottery significantly

All materials copyright of the Wharton School of the University of Pennsylvania. Page 3 of 4

One Way to Lower Health Costs: Pay People to Be Healthy: Knowledge@Wharton

(http://knowledge.wharton.upenn.edu/article.cfm?articleid=2266)

increased the proportion of patients who took their daily medication. But like the weight loss study, the

patients returned to their bad habits once the financial incentive was removed.

With every study, Volpp finds new questions to consider about how programs are designed, how much of

a financial reward is optimal and how incentive-based programs could be combined with other approaches

to improving patient behavior. “The challenging or dissatisfying part is that each study just opens up a

new chapter in terms of how we think about defining further progress,” said Volpp. “There are all these

questions that come up; for example in the smoking study, what would happen if we gave out $1,000 or

$1,500? We really don’t know.”

Pauly pointed out that there are other issues that incentive programs must overcome, such as regulatory

and legal barriers, employer reluctance to invest in programs that might not pay off until years later when

many workers will be at different companies, and the resistance from employees themselves, who may

see such incentive-based programs as overly paternalistic. It will also be tricky for employers to establish

incentive-based programs without creating resentment among workers who don’t have any bad health

habits to kick.

Despite the stumbling blocks, incentive-based approaches still hold promise, in part because “nothing else

has worked,” Pauly said. “You could fill up a basement with failed documents on how to curb health care

spending.”

Volpp agreed. As a physician himself, he has been frustrated in his own clinical practice with patients

who were unable to follow through in changing their health behaviors, even in situations where they were

clearly at high risk of suffering significant impairments in quality of life or life expectancy. “You see the

consequences of unhealthy behaviors all the time,” he said. “A lot of the existing approaches just don’t

work. It’s clear that we need new approaches to help people.”

This is a single/personal use copy of Knowledge@Wharton. For multiple copies, custom reprints, e-prints, posters or plaques, please contact

PARS International: reprints@parsintl.com P. (212) 221-9595 x407.

All materials copyright of the Wharton School of the University of Pennsylvania. Page 4 of 4

Each year, more than 40% of premature deaths in the United States result Americans still smoke, and 71% are either overweight or obese. from unhealthy behaviors such as smoking, over-eating or failing to take medications as prescribed. Physicians routinely struggle to get patients to give up their bad habits for the sake of their long-term health, yet 20% of Americans still smoke, and 71% are either overweight or obese.

The U.S. spent $2.4 trillion on health care in 2008, according to the World Health Organization, or about $6,714 per citizen.

Despite this high cost of delivery of healthcare to the people,yet many of the unisured population are still not able to get access to adequate health care,Preventive medicine will offer tools to the people,which will enable them to lead a healthy life and therby reduce the burden on health care system.

Technology Curve & Health

admin — Fri, 03 Jul 2009 01:55:31 +0000

Technology Curve

Every year there are new technologies which enter into our world,some of them are very exciting and some confusing.Application of these new technologies in our every day life,makes them useful,although some could be harmful in long term.

When a new tech enters into our life,it follows a typical growth curve-the initial euphoria around it may last for a while,so called buzz around it,followed by a period of high expectation,wherein everybody who talks about it will think it will change the world and the way we look at thinks etc etc.This period is followed by a phase of disillusionment,wherein many will assume that it is just a fad and like season of the year will pass on with change of time,and people will ignore it.This is then followed by the final phase of acceptation of the technology-its benefits and also limitations and many of us will then live with them.
There are many thousands of such technologies ranging from Personal computers to Internet to Internet search engines to email.

Will Health 2.0 follow the same trend,that will have to be watched keenly,while many of the ventures in Health 2.0 are me too..yet,quite a few of them are innovative,in that the benefits of these may be realized many years from today.