E-Health环境下患者电子参与框架构建与策略研究

患者参与被认为是新阶段医疗改革的重要支柱和医疗保健质量改善的新活力。近年来E-Health技术发展迅速,为患者参与医疗保健提供了更广泛的途径以及更丰富的手段。归纳梳理出患者电子参与的基本内涵,结合国外推动患者电子参与的举措和相关文献研究构建患者电子参与框架,阐述患者电子参与的类型、媒介与方法,最后从项目支撑、患者教育和信息权限等方面提出我国在E-Health环境下推进患者电子参与具体举措。

e-Health的评估

信息通讯技术迅速发展,e-Health也随之迅速发展起来。e-Health能促进医疗卫生领域的发展,但是也可能会带来灾难,因此对e-Health进行评估很有必要。e-Health的评估框架与方法目前还处于发展初期。

Ranking of E-Health Barriers Faced by Saudi Arabian Citizens, Healthcare Professionals and IT Specialists in Saudi Arabia

Many boundaries are hindering successful utilisation of e-health in the Kingdom of Saudi Arabia (KSA). We have previously proposed an integrated framework of knowledge management and knowledge discovery to overcome barriers of e-health in KSA. Our proposed framework facilitates diabetes self-management for diabetic citizens in the Kingdom. In this paper, we will investigate and rank the barriers of e-health in KSA from the prospective of three stakeholders. We designed a questionnaire which constituted of items related to eight different e-health barriers and its associated sub-barriers. Citizens participated in 51 items related to six barriers. Healthcare professionals answered 83 items related to eight barriers. IT specialists participated in 74 items related to six barriers. Within each group of respondents, we compared the mean scores for each factor and sub-factor. The highest possible score for the mean was 5.00 and the lowest was 0.00 where the higher the mean score was the more the barrier constituted an obstacle for e-health in KSA. Citizens ranked the connectivity of information system as the top barrier with the mean of 4.0 whereas the least barrier was the cultural barriers with the mean score of 3.1. Healthcare professionals ranked the connectivity of information systems as the top barriers with the mean score of 3.5 whereas the least barrier was the technical expertise and computer skills with the mean score of 2.2. The top ranked barrier from the perspective of IT specialists was the medication safety with the mean score of 3.5 and the least ranked barrier was security and privacy with the mean score of 2.2. The results showed consistency with the literature review. Our proposed framework will contribute to the successful implementation of e-health initiatives and assist citizens in KSA to self- manage diabetes.

E-Health and Telemedicine: Current State and Future Steps

The article reviews the questions related to building the e-health systems. The key element of the system is electronic healthcare record to be formed according to the modular approach in the form of primary and satellite electronic medical records. Person-centred healthcare is proposed as a foundation for e-health. Such an approach provides a potential opportunity for all the medical doctors to obtain necessary information about their patients at any time via the teleconsultations in particular. Transition to e-health is associated with the creation of new opportunities for making diagnostic and therapeutic decisions based on the use of build-in decision support modules. The computer-assisted software design or hybrid systems are considered as the fourth generation medical information systems. It is reasonable to implement the entire information space of e-health, including the information systems of medical institutions and regional data repositories, based on cloud-optimized storage and computing solutions. This approach is expected to be implemented in Russia as a part of the unified state health information system. The authorized access to integrated databases for medical doctors of various specialties is required. In the framework of e-health, telemedicine is considered as an important component. Main elements comprise the real-time access of medical consultants to personified medical databases and remote follow-up of patients by the means of personal or home-based telemedicine. The use of personal portable devices for the control of vital signs of the organism is especially promising. Electronic stethoscopes and specialized video cameras for acquiring objective information should be increasingly used by remote consultants. Unfortunately, this trend is still underdeveloped in Russia. In perspective, e-health as unified medical space will provide a transition to the integrated analysis of population health by medical doctors of various specialties from different countries and will open new prospects for studying health based on the intelligent analysis of integrated data of patients.

E-Coach健康教育管理模式在护理领域的应用进展

从E-Coach健康教育管理模式的概述、常见干预形式与干预周期、在疾病护理管理中的应用效果以及未来发展趋势与建议方面进行综述,以期为E-Coach健康教育管理模式在我国的应用、发展提供借鉴。

A Review of e-Health Research in Information System

e-Health—a new form of health care service using information technology—has received a great deal of academic attention in the past. What can we learn from these prior studies? This article analyses the development of prior work using the scientific literature related to e-Health from the Web of Science core database. Our systematic review suggest that: 1) IT adoption is the most important research topic in this field, 2) Research methods are growing in diversity, 3) Research topics are reasonably differentiated.

Physicochemical Properties and Health Risks of Informal E-Waste Processing at Alaba International Market in Lagos, Nigeria

This study investigated the groundwater quality and health risks associated with informal e-waste processing in the Alaba International Market in Lagos, Nigeria. Twenty-two groundwater samples were collected from hand-dug wells in the market area and analyzed for physicochemical properties and heavy metal concentrations. The results showed that the groundwater quality was poor, with high levels of heavy metals, including cadmium, lead, and chromium. The health index (HI) for children and adults was above the tolerable threshold levels, indicating a potential health risk to the population. Principal component analysis and hierarchical cluster analysis were used to identify the sources of metals in groundwater, and the results showed that informal e-waste processing was a significant source of contamination. The study highlights the need for effective management strategies to mitigate the potential health risks associated with informal e-waste processing and ensure public health and environmental safety.

Evaluation of the Living Conditions and Health Perceptions of Waste Electrical and Electronic Equipment Handlers in the Informal Sector in Dakar

Electrical and electronic devices are becoming an increasingly important part of our society. In Africa, and in Senegal in particular, the handling and management of electronic and electrical equipment (EEE) that has reached the end of its life is mainly informal. This professional environment is characterized by the disintegration of the sector and the social heterogeneity that can be found there. The objective of this study is to assess the standard of living of electrical and electronic equipment waste handlers in the Dakar region, as well as their perception of their health. A survey was used to obtain information on sociodemographic background, living arrangements, perception of health status, and good practices to be implemented in case of work-related health problems. Life style, perception of general health and health problems were ranged as excellent, very good, good, average and poor. Informal recyclers in the Dakar region lived mainly in rooms and buildings as tenants (49.1%), or in family homes (48.4%) before starting this activity, and 51.2% continue to live in rooms and buildings as tenants compared to 41.4% who still live in a family home. The perception of health status ranged from poor to excellent, and 4.9% believe that they are limited in work due to a disability or health problem. Informal work is a heterogeneous phenomenon that makes research and policymaking particularly complex. There are several external factors within informal WEEE re-cyclers that can cause health problems or functional disability. However, the living conditions and the perception they have of their state of health are contradictory to the working conditions and the social environment to which they belong. A biomedical approach would consolidate these achievements by confirming or invalidating them.

基于E-Science的医院科研管理及其建设

结合广西中医学院附属瑞康医院科研管理情况,提出一种E-Science环境下的医院科研管理系统架构。认为医院科研管理应与计算机网格技术相结合,构建E-Science环境下虚拟实验室,同时加强建设开放的E-Science科研活动组织体系,支持高效、共享的学术交流。

基于E-Prime的煤矿噪声对矿工反应时与出错数的影响效应研究

基于人的S-O-R行为模式,利用心理学试验软件E-Prime的行为试验模块,研究煤矿噪声对矿工行为的影响。辅以调查问卷,在实验室对20名矿工分7 d在7种不同噪声等级下的行为进行了研究,以反应时和操作可靠度作为评价标准。利用E-Prime、E-Studio、E-Merge、Excel和SPSS等软件对所得的行为数据进行整理与分析。结果表明:噪声级在35~75 dB之间反应时变化不显著,超过75 dB反应时的变化显著;噪声级在35~65 dB之间出错次数和可靠度变化不显著,超过65 dB出错次数和可靠度的变化非常显著;建议有条件的矿可以将噪声安全临界值设定为75 dB,以减少不安全行为的发生。

呼吸系统功能状态与sICAM-1、sVCAM-1、E-selectin的相关性

目的探讨呼吸系统功能状态与E-选择素(E-selectin)、可溶性细胞间黏附分子1(soluble inte FAellular adhesion molecule-1,sICAM-1)、可溶性血管细胞黏附分子1(souble vascular cell adhesion molecule 1,sVCAM-1)的相关性。方法选取体检中心健康体检者216名,根据HRA系统检测的呼吸系统功能状态的结果,将研究对象分为呼吸功能正常组,呼吸功能轻度改变组,支气管、呼吸道炎性反应状态组三组,分别编号为A、B、C组。清晨空腹采血,留取血清,测定sICAM-1、sVCAM-1、Eselectin的含量。结果与A组相比,吸烟使B、C组呼吸系统功能状态改变的危险性增大(OR=1.216,95%CI:0.6~2.466;OR=3.2,95%CI:1.502~6.819)。随着呼吸系统功能状态炎性程度的增加,E-selectin、sICAM-1、sVCAM-1的浓度明显增高,且差异有统计学意义(P均<0.01)。A组中E-selectin、sICAM-1、sVCAM-1的浓度在吸烟组和非吸烟组的差异均无统计学意义;B组中,与非吸烟组相比,吸烟组sICAM-1、sVCAM-1明显增高(P均<0.01);在C组中,吸烟组中E-selectin、sICAM-1、sVCAM-1明显高于非吸烟组,且差异均有统计学意义(P均<0.01)。结论随着呼吸系统功能状态严重程度的增高,E-selectin、sICAM-1、sVCAM-1的浓度明显增高。吸烟者血清E-selectin、sICAM-1、sVCAM-1的水平增加。

E-Coach慢病管理模式在高血压控制中的应用研究

目的探讨E-Coach慢病管理模式在高血压患者中的应用效果。方法将232例原发性高血压患者随机分为研究组(116例)和对照组(116例)。对照组采取常规门诊管理,研究组在常规门诊管理的基础上接受由专科护士为主导的E-Coach慢病管理模式管理。干预6个月后评价效果。结果对照组98例、研究组102例患者完成全程干预。研究组血压控制率、平均每周有氧锻炼时间、认知症状管理及与医生沟通评分显著高于对照组,收缩压显著低于对照组(P<0.05,P<0.01)。结论 E-Coach慢病管理模式有利于改善高血压患者的自我管理行为,提高血压控制率。

基于e-患者视角探究个人健康档案建设

为建设满足e-患者在互联网医疗、移动医疗中信息需求的个人电子健康档案,分析个人电子健康档案在e-患者健康管理、就医模式和医疗决策的必要性,提高个人健康档案的实际可用性和适用性。理论研究表明:建立整合统一数据存储平台、规范数据记录标准、关联医药报销系统个人健康档案能够在较大程度上提高e-患者对自身医疗的参与度、决策度和准确度。

Epidemiology of hepatitis E in South-East Europe in the "One Health" concept

The significance of hepatitis E virus(HEV)as an important public health problem is rising.Until a decade ago,cases of HEV infection in Eur-ope were mainly confined to returning travelers,but nowadays,hepatitis E represents an emerging zoonotic infection in many European countries.The aim of this manuscript is to perform a systematic review of the published literature on hepatitis E distribution in humans,animals and environmental samples("One Health"concept)in the South-Eastern European countries.Comparison of the available data showed that the anti-HEV seroprevalence in the South-Eastern Europe varies greatly,depending on the population studied,geographical area and methods used.The IgG seroprevalence rates in different population groups were found to be 1.1%-24.5%in Croatia,up to 20.9%in Bulgaria,5.9-%17.1%in Romania,15%in Serbia,up to 9.7%in Greece and 2%-9.7%in Albania.Among possible risk factors,older age was the most significant predictor for HEV seropositivity in most studies.Higher seroprevalence rates were found in animals.HEV IgG antibodies in domestic pigs were detected in 20%-54.5%,29.2%-50%,38.94%-50%and 31.1%-91.7%in Serbia,Bulgaria,Romania and Croatia,respectively.In wild boars seroprevalence rates were up to 10.3%,30.3%and 31.1%in Romania,Slovenia and Croatia,respectively.A high HEV RNA prevalence in wild boars in some countries(Croatia and Romania)indicated that wild boars may have a key role in the HEV epidemiology.There are very few data on HEV prevalence in environmental samples.HEV RNA was detected in 3.3%and 16.7%surface waters in Slovenia and Serbia,respectively.There is no evidence of HEV RNA in sewage systems in this region.The available data on genetic characterization show that human,animal and environmental HEV strains mainly belong to the genotype 3.

Knowledge, Practices, and Environmental and Occupational Health Risks Associated with Electronic Waste Recycling in Cotonou, Benin

Objective: The e-waste recycling is increasing worldwide, yet there remain outstanding environmental and occupational health concerns. Most research conducted on e-waste recycling has focused on only few countries (e.g., China, Ghana), thus there is a need to increase understanding of e-waste workers’ (recyclers’) knowledge and practices in other locations, that is purpose of this study. Methods: In a cross-sectional study conducted in Cotonou, Benin, 45 e-waste recyclers were interviewed from September to November 2018. Survey data was collected concerning their demographics, professional practices, and knowledge of occupational and environmental risks associated with e-waste recycling. Results: Most participants reported the following methods of material recovery of electronic items in declining orders: dismantling (97.8%) > sorting (91.1%) > incinerating (88.9%). Only 44.2% of the recyclers reported wearing ≥ 1 piece of personal protective equipment (PPE). More than 90% of e-waste workers noted that they disposed the e-waste in natural sites. About half, 46.7% believed that e-waste can pollute water and 71.1% considered that it can pollute air and soil. Recyclers reported several diseases including respiratory (67.4%), heart (62.8%), eye (65.1%), kidney (41.9%) and cancers (30.2%) could be linked to their work, respectively. Interestingly, we also found associations between the number of electronic items dismantled per month and self-report symptoms from the e-waste recyclers such as finding blood in urine and stool, wounds, dizziness, and itchy skin. Our results also indicated associations between the number of hours worked per day and blood in urine, dizziness, itchy skin and airway obstruction. Conclusion: To our knowledge this is the first study to interview e-waste workers in Benin. Doing this increase understanding of their work practices and knowledge to help inform intervention and prevention activities.

Telehealth interventions to reduce management complications in type 1 diabetes:A review

Type 1 diabetes is a chronic illness with a high burden of care.While effective interventions and recommendations for diabetes care exist,the intensive nature of diabetes management makes compliance difficult.This isespecially true in children and adolescents as they have unique psychosocial and diabetes needs.Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions,namely time,cost,and access.Telehealth interventions allow for the dissemination of these interventions to a broader audience.Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use.While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over inperson interventions,many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered.These and other challenges are discussed with recommendations for researchers and telehealth providers provided.

Electronic Health Records Implementation Readiness: An Integrative Review

Purpose: The purpose of this review was to discuss the status of evidence related to the assessment of readiness of healthcare facilities for e-health initiatives implementation, specifically the common Electronic Health Record (EHR) systems. Methods: An integrative review approach was utilized. The databases of Google Scholar, Scopus, Science Direct, PubMed, Medline, CINAHL, Ovid, ProQuest, and EBSCO host were searched for related evidence published between 2000 and 2018. Results: Seventeen studies were included in the current review. In terms of methodological approach, the included studies were 7 correlational studies, 5 review papers, 4 qualitative papers, and one mixed methods study. At the current integrative review, the themes of complex healthcare change, and the main theme of e-health readiness assessment were identified. Conclusion: Assessing and reporting the levels of readiness for EHRs implementation are highly recommended as it has a high impact on the critically-needed adoption and usage of the implemented system. Selecting the right tool for the right audience to address readiness is essential in the assessment process which is recommended to be conducted early at the road map of the project implementation. Future research is recommended to address readiness for e-health initiatives at the different settings and different target populations including communities where the healthcare facilities functions and service receivers’ readiness.

Impact of Using m-Health App on Improving Undergraduate Students’ Sports and Health Habits and Their Attitudes toward Its Use

This study aims to explore the Sultan Qaboos University undergraduate students’ perceptions and attitudes towards using m-Health app and its impact on improving their sports and health habits. Triangulation was used by applying a questionnaire and focus groups interviews to answer the research questions. The survey sample was (20) male and female students from four science and humanities colleges. Both quantitative and qualitative findings unequivocally reveal the students’ positive perceptions and attitudes toward the use of the mobile health app. No statistically significant differences were found between the responses of either males or females, or the science and humanitarian colleges of the sample students. In light of these findings, the study set forth its conclusions and recommendations.