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TitleArtificial Intelligence in Dermatology: A Primer.
AuthorsYoung, AT; Xiong, M; Pfau, J; Keiser, MJ; Wei, ML
JournalThe Journal of investigative dermatology
Publication Date1 Aug 2020
Date Added to PubMed2 Apr 2020
AbstractArtificial intelligence is becoming increasingly important in dermatology, with studies reporting accuracy matching or exceeding dermatologists for the diagnosis of skin lesions from clinical and dermoscopic images. However, real-world clinical validation is currently lacking. We review dermatological applications of deep learning, the leading artificial intelligence technology for image analysis, and discuss its current capabilities, potential failure modes, and challenges surrounding performance assessment and interpretability. We address the following three primary applications: (i) teledermatology, including triage for referral to dermatologists; (ii) augmenting clinical assessment during face-to-face visits; and (iii) dermatopathology. We discuss equity and ethical issues related to future clinical adoption and recommend specific standardization of metrics for reporting model performance.
Linkhttp://doi.org/10.1016/j.jid.2020.02.026
TitleTelehealth in Primary Health Care: A Scoping Review of the Literature.
AuthorsBeheshti, L; Kalankesh, LR; Doshmangir, L; Farahbakhsh, M
JournalPerspectives in health information management
Publication Date1 Dec 2022
Date Added to PubMed21 Apr 2022
AbstractThe use of telehealth as a viable mobility to deliver quality services steadily increases in various levels of the health system. Despite the increasing use of telemedicine in secondary and tertiary health care services, there is a long way to go in the use of this technology in public health and primary health care (PHC). This study aimed to explore the features, approaches, and various dimensions of telehealth in PHC. A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in three bibliographic databases including PubMed, Web of Sciences, and Scopus and in Google Scholar to collect papers published in November 2018 to 2000. Data were extracted according to a predefined form and check for completeness and accuracy by a second reviewer. Through reviewing papers, the authors extracted information on the general characteristics and features of telehealth services, kinds of PHC services delivered via telehealth, hardware and software facilities used for providing health care through telehealth services packages, as well as their benefits, outcomes and obstacles. Telehealth can be used for different purposes of PHC through deploying a full range of communication channels available to the public. Due to the opportunistic use of existing devices and platforms, telehealth can provide scalable PHC services nationwide and worldwide. However, implementing telehealth in PHC faces challenges from technical, organizational, and human perspectives. Digital equity (in terms of technology access and e-health literacy) is required to expand telehealth services to the populations in underserved areas.
Link
TitlePublic health digitalization in Europe.
AuthorsOdone, A; Buttigieg, S; Ricciardi, W; Azzopardi-Muscat, N; Staines, A
JournalEuropean journal of public health
Publication Date1 Oct 2019
Date Added to PubMed19 Nov 2019
AbstractAs digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges. We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction. A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level.
Linkhttp://doi.org/10.1093/eurpub/ckz161
TitleEthical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic.
AuthorsSolimini, R; Busardò, FP; Gibelli, F; Sirignano, A; Ricci, G
JournalMedicina (Kaunas, Lithuania)
Publication Date30 Nov 2021
Date Added to PubMed25 Dec 2021
AbstractBackground and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional-patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.
Linkhttp://doi.org/10.3390/medicina57121314
TitleDigital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review.
AuthorsWongvibulsin, S; Habeos, EE; Huynh, PP; Xun, H; Shan, R; Porosnicu Rodriguez, KA; Wang, J; Gandapur, YK; Osuji, N; Shah, LM; Spaulding, EM; Hung, G; Knowles, K; Yang, WE; Marvel, FA; Levin, E; Maron, DJ; Gordon, NF; Martin, SS
JournalJournal of medical Internet research
Publication Date8 Feb 2021
Date Added to PubMed9 Feb 2021
AbstractCardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.
Linkhttp://doi.org/10.2196/18773
TitleDigital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems.
AuthorsKoehle, H; Kronk, C; Lee, YJ
JournalYearbook of medical informatics
Publication Date1 Aug 2022
Date Added to PubMed5 Dec 2022
AbstractWithout specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar. We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies.
Linkhttp://doi.org/10.1055/s-0042-1742512
TitleDigital health, gender and health equity: invisible imperatives.
AuthorsSinha, C; Schryer-Roy, AM
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed18 Oct 2018
AbstractA growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind. SinhaChaitaliCInternational Development Research Centre (IDRC), Ottawa, Canada.Schryer-RoyAnne-MarieAMNairobi, Kenya.engIntroductory Journal ArticleEnglandJ Public Health (Oxf)1011886381741-3842IMDeveloping CountriesFemaleHealth EquityHumansMaleSex FactorsSexismTelemedicineUna cantidad creciente de evidencia muestra que el uso de las tecnologías digitales en la salud, ya sea eSalud (eHealth), mSalud (mHealth) o "salud digital", está mejorando y salvando vidas en países de ingresos bajos y medios. A pesar de esta descripción frecuente y persistente, muy pocos estudios analizan sus efectos en la igualdad en materia de salud y las dinámicas de género y de poder. Este suplemento informativo aborda estos imperativos invisibles al ir más allá de las medidas de cobertura tradicionales, la eficiencia y la eficacia en función de los costos asociadas con las intervenciones de salud digital, para desentrañar las diferentes experiencias de los beneficiarios y trabajadores de la salud. Este conjunto de trabajos presenta resultados de una cohorte de aplicación de proyectos de investigación en África, Asia, América Latina y el Medio Oriente; y dos comentarios ofrecen observaciones de actividades de evaluación orientadas en el aprendizaje en toda la cohorte. La historia que surge de esta cohorte comprende tres temas: (i) la salud digital puede influenciar positivamente la igualdad en materia de salud; (ii) los análisis de género y de poder son esenciales; y (iii) la salud digital puede usarse para fortalecer la rendición de cuentas ascendente y descendente. Estos resultados, a nivel de proyecto individual y al nivel de la cohorte, brindan recomendaciones alentadoras acerca de cómo abordar el diseño, la aplicación y la evaluación de las intervenciones de salud digital para examinar la agenda de los Objetivos de Desarrollo Sostenible de no dejar a nadie atrás. Palabras clave: m-Salud, mSalud, eSalud, salud digital, género, igualdad en materia de salud, mujeres, ODS, rendición de cuentas, sistemas de salud De plus en plus d’études révèlent que le recours aux technologies numériques en santé – désignées par les termes cybersanté, santé mobile ou santé numérique – permet de sauver des vies dans les pays à revenu faible ou moyen et d’en améliorer la qualité. Malgré la prévalence et la constance des données, très peu d’études traitent de ses répercussions sur l’équité en santé, la sexospécificité et la dynamique de pouvoir. Le présent supplément se penche sur ces impératifs invisibles et va au-delà des mesures traditionnelles de couverture, d’efficacité et de rentabilité associées aux interventions numériques en santé, afin de lever le voile sur les différentes expériences que vivent les travailleurs de la santé et les bénéficiaires de soins de santé. Ce recueil de textes présente les résultats d’une cohorte de projets de recherche sur la mise en oeuvre menés en Afrique, en Asie, en Amérique latine et au Moyen-Orient, et deux commentaires font part d’observations tirées d’activités d’évaluation axées sur l’apprentissage réalisées dans toute la cohorte. L’analyse des résultats de la cohorte aboutit à trois constats : (i) la santé numérique peut exercer une influence positive sur l’équité en santé; (ii) l’analyse comparative entre les sexospécificités et l’analyse de la dynamique de pouvoir sont essentielles; (iii) la santé numérique peut être utilisée pour renforcer la responsabilisation vers le haut et vers le bas. Ces constats, qu’ils soient liés à chacun des projets ou à l’ensemble de la cohorte, donnent lieu à des recommandations encourageantes quant à la manière d’aborder la conception, la mise en oeuvre et l’évaluation d’interventions numériques en santé, de sorte à réaliser le programme et les objectifs de développement durable consistant à ne laisser personne de côté. Mots clés: santé mobile, cybersanté, santé numérique, sexospécificité, équité en santé, femmes, ODD, responsabilisation, systèmes de santé
Linkhttp://doi.org/10.1093/pubmed/fdy171
TitleRapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era.
AuthorsChang, JE; Lai, AY; Gupta, A; Nguyen, AM; Berry, CA; Shelley, DR
JournalThe Milbank quarterly
Publication Date1 Jun 2021
Date Added to PubMed3 Jun 2021
AbstractPolicy Points Telehealth has many potential advantages during an infectious disease outbreak such as the COVID-19 pandemic, and the COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. The COVID-19 pandemic has catalyzed fundamental shifts across the US health care delivery system, including a rapid transition to telehealth. Telehealth has many potential advantages, including maintaining critical access to care while keeping both patients and providers safe from unnecessary exposure to the coronavirus. However, not all health care providers and patients are equally ready to take part in this digital revolution, which raises concerns for health equity during and after the COVID-19 pandemic. The study analyzed data about small primary care practices' telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene's Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city's efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State's stay-at-home order on March 22. We focused on small primary care practices because they represent 40% of primary care providers and are disproportionately located in low-income, minority or immigrant areas that were more severely impacted by COVID-19. To examine whether telehealth use and barriers differed based on the socioeconomic characteristics of the communities served by these practices, we used the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) to stratify respondents as being in high-SVI or low-SVI areas. We then characterized respondents' telehealth use and barriers to adoption by using means and proportions with 95% confidence intervals. In addition to a primary analysis using pooled data across the five waves of the survey, we performed sensitivity analyses using data from respondents who only took one survey, first wave only, and the last two waves only. While all providers rapidly shifted to telehealth, there were differences based on community characteristics in both the primary mode of telehealth used and the types of barriers experienced by providers. Providers in high-SVI areas were almost twice as likely as providers in low-SVI areas to use telephones as their primary telehealth modality (41.7% vs 23.8%; P <.001). The opposite was true for video, which was used as the primary telehealth modality by 18.7% of providers in high-SVI areas and 33.7% of providers in low-SVI areas (P <0.001). Providers in high-SVI areas also faced more patient-related barriers and fewer provider-related barriers than those in low-SVI areas. Between April and June 2020, telehealth became a prominent mode of primary care delivery in New York City. However, the transition to telehealth did not unfold in the same manner across communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
Linkhttp://doi.org/10.1111/1468-0009.12509
TitleeHealth and mHealth Development in Spain: Promise or Reality?
AuthorsMahou, X; Barral, B; Fernández, Á; Bouzas-Lorenzo, R; Cernadas, A
JournalInternational journal of environmental research and public health
Publication Date10 Dec 2021
Date Added to PubMed25 Dec 2021
AbstractIn the last decades, the use of Information and Communication Technologies (ICTs) has progressively spread to society and public administration. Health is one of the areas in which the use of ICTs has more intensively developed through what is now known as eHealth. That area has recently included mHealth. Spanish health system has stood out as one of the benchmarks of this technological revolution. The development of ICTs applied to health, especially since the outbreak of the pandemic caused by SARS Cov-2, has increased the range of health services delivered through smartphones and the development of subsequent specialized apps. Based on the data of a Survey on Use and Attitudes regarding eHealth in Spain, the aim of this research was to conduct a comparative analysis of the different eHealth and mHealth user profiles. The results show that the user profile of eHealth an mHealth services in Spain is not in a majority. Weaknesses are detected both in the knowledge and use of eHealth services among the general population and in the usability or development of their mobile version. Smartphones can be a democratizing vector, as for now, access to eHealth services is only available to wealthy people, widening inequality.
Linkhttp://doi.org/10.3390/ijerph182413055
TitleRoutine Prenatal Care.
AuthorsPeahl, AF; Turrentine, M; Srinivas, S; King, T; Zahn, CM
JournalObstetrics and gynecology clinics of North America
Publication Date1 Sep 2023
Date Added to PubMed28 Jul 2023
AbstractThe one-size-fits-all model of prenatal care has remained largely unchanged since 1930. New models of prenatal care delivery can improve its efficacy, equity, and experience through tailoring prenatal care to meet pregnant people's medical and social needs. Key aspects of recently developed prenatal care models include visit schedules based on needed services, telemedicine, home measurement of routine pregnancy parameters, and interventions that address social and structural drivers of health. Several barriers that affect the individual, provider, health system, and policy levels must be addressed to facilitate implementation of new prenatal care delivery models.
Linkhttp://doi.org/10.1016/j.ogc.2023.03.002
MNCHFPRHHIV/AIDSMalariaNoncommunicable diseaseCOVID-19Decision-makingEducation & trainingBehavior changeGovernancePrivacy & securityEquityCHWsYouth & adolescentsSystematic reviewsProtocols & research designMedical RecordsLaboratoryPharmacyHuman ResourcesmHealthSMSChatbotsAI