Empower Health Research Articles

“What if the patient has a severe reaction, and it is my fault?” A qualitative study exploring factors for sustainable implementation of penicillin allergy delabelling

BackgroundPenicillin allergy delabelling (PAD), the process of evaluating penicillin allergy labels, is a key target in antibiotic stewardship, but uptake of the procedure outside clinical studies is limited. We aimed to explore factors that need to be addressed to sustainably implement a clinical pathway for PAD.MethodsWe conducted a qualitative study based on semi-structured interviews with focus groups consisting of a purposive sample of twenty-five nurses and physicians working in four different hospitals in Western Norway. Systematic text condensation was applied for analysis.ResultsPsychological safety was reported as crucial for clinicians to perform PAD. A narrative of uncertainty and anticipated negative outcomes were negatively associated with PAD performance. Education, guidelines, and colleague- and leadership support could together create psychological safety and empower health personnel to perform PAD. Key factors for sustainable implementation of PAD were facilitating the informant’s profound motivation for providing optimal health care and for reducing antimicrobial resistance. Informants were motivated by the prospect of a simplified PAD procedure. We identified three main needs for implementation of PAD: (1) creating psychological safety; (2) utilising clinicians’ inherent motivation and (3) optimal organisational structures.ConclusionA planned implementation of PAD must acknowledge clinicians’ need for psychological safety and aid reassurance through training, leadership, and guidelines. To implement PAD as an everyday practice it must be minimally disruptive and provide a contextually adaptive logistic chain. Also, the clinician’s motivation for providing the best possible healthcare should be utilised to aid implementation. The results of this study will aid sustainable implementation of PAD in Norway.EthicsThe study was approved by the Western Norway Regional Committee for Medical Research Ethics (Study No:199210).

Description of the Level of Knowledge and Behavior of Type Two Diabetes Mellitus Patients Regarding Diabetic Foot at Koja Regional Hospital in June 2023

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. In the Southeast Asia region, Indonesia is ranked 3rd with a prevalence of 11.3%. Previous studies have shown that the level of knowledge and behavior of type 2 diabetes mellitus patients regarding diabetic foot is still inadequate. This study aims to describe the level of knowledge and behavior of patients with type 2 diabetes mellitus regarding diabetic foot. The research design is descriptive with a cross-sectional approach. The reachable population for this study were all type two diabetes mellitus patients at Koja Hospital who the researchers could meet when conducting the study in June 2023. The sampling technique used was purposive sampling with a sample size of 40 patients. The research subjects were 40 people with type 2 Diabetes Mellitus. The results showed that in terms of knowledge, 50% of sufferers had a high level of knowledge. However, negative behavior is more dominant with a percentage of 57.5%. Although the level of knowledge and type two diabetes mellitus patients about diabetic feet at Koja Hospital in June 2023 is still high, patient behavior is still low, so it is necessary to train and empower health service providers to deliver adequate health messages regarding the prevention of diabetic feet

Empowering community health professionals for effective air pollution information communication

BackgroundAir pollution remains a significant public health risk, particularly in urban areas. Effective communication strategies remain integral to overall protection by encouraging the adoption of personal air pollution exposure reduction behaviours. This study aims to explore how community health professionals can be empowered to communicate air pollution information and advice to the wider community, to encourage the uptake of desired behaviours in the population.MethodsThe study adopted a qualitative methodology, where four homogenous Focus Group Discussions (FGDs) were held with a range of community health professionals, including Health Care Professionals, Community Health and Wellbeing Workers (CHWWs) and Social Prescribing Link Workers (SPLW). A classical content analysis was conducted with the Structural Empowerment Theory (SET) and Psychological Empowerment Theory (PET) as guiding concepts.ResultsFive key themes were identified: from a structural empowerment perspective: [1] resources and support, [2] knowledge. From a psychological empowerment perspective: [3] confidence as advisor, [4] responsibility as advisor, and [5] residents’ receptiveness to advice. It was concluded that advice should be risk stratified, clear, easy to follow and provide alternatives.ConclusionThis study identified ways for community health professionals to be empowered by local councils or other organisations in providing advice on air pollution, through the provision of essential structural support and opportunities to enhance their knowledge and confidence in the subject. Implementing recommendations from this study would not only empower community health professionals to advise on air pollution to the wider community but also increase adherence to health advice.

PAEDIATRIC-16 ADVANCING IN PAEDEATRIC BRAIN CANCER CARE

Abstract OBJECTIVE To empower health workers in the cancer care continuum to nationally reduce the disease burden from brain cancer through active engagement, advocacy , collaboration and education -to introduce theories and concepts including current trends, issues , challenges and debates in brain cancer. METHOD The talk cancer zim trust organised a hybrid national webinar on paedeatric brain cancer on 26 May 2023 under the mantra "advancing in brain cancer care , where are we? The objectives were to be met through presantations from the neurosurgeon , oncologist, psychiatrist, palliative care specialist , Kidzcan and the GICC focal person for the country.Thematic areas covered were palliative care,radiation oncology, neurosurgery, advocacy and psychooncology. RESULTS a total of 193 health proffessionals attended the meeting online while 24 health proffessionals attended the meeting in.person.The targeted audience consisted of radiographers, oncology nurses, pharmacists, rehabilitation specialists, medical physicists and specialist doctors such as oncologists, neurosurgeons and psychiatriasts. CONCLUSION There is need for a holistic approach to paedatric brain cancers throughout the cancer trajectory from awareness, diagnosis, screening through treatment and palliative care and research

Development of a post discharge telecare program for premature infants in Covid 19 era: Protocol for a mixed methods study.

Post-discharge care of premature infants is an important goal that can provide a safe transition for these infants from the hospital to the home setting, especially who has undergone significant changes during Covid19. Most premature infants experience complications because of routine hospital care termination after discharge because of limitations and barriers that Covid can create for the infant and the parents. It is necessary to develop a program that provides ongoing care for these infants. Telecare is one feasible option that can be used to implement this program. The study aims to develop a post-discharge telecare program for premature infants in the Covid era in Iran. This is an exploratory mixed-methods study that will be conducted by Qualitative-quantitative methods in three consecutive phases at Isfahan University of Medical Sciences in January 2022. In the first phase, a qualitative study will be conducted to identify and determine the needs and strategies in the Covid 19 era to promote premature infant care after discharge. The data will be collected through deep semi-structured interviews. Participants (parents, physicians, and nurses) will be selected by purposive sampling methods, and the conventional content analysis method will be used for data analysis. In the second phase, the identified infants' and parents' needs as an initial draft of the program will be prioritized and confirmed by the modified Delphi method and a panel of experts. The final program will be developed in this phase. In the quantitative third phase, the confirmed program will be implemented as a semi-experimental study that uses a telecare strategy. Finally, we will evaluate the effectiveness of this telecare program. A program that uses qualitative and quantitative methods can provide evidence for promoting premature infant health after hospital discharge in Covid 19 era. We anticipate that this program will promote knowledge and empower health team members, especially nurses, to provide ongoing telecare for premature infants.

Integrating Human-Centered Design and Social Science Research to Improve Service-Delivery and Empower Community Health Workers: Lessons from Project RISE

This article aims to communicate insights from a collaboration between human-centered designers and social science researchers. We report the insights from Project RISE (Rituals to Improve Service-delivery and Empower health workers), which employed a complex systems approach to understanding Accredited Social Health Activists’ motivations and performance in Bihar, India. We describe the process of interdisciplinary integration between human-centered design and mixed-method social science research. We describe insights from each phase of Project RISE. In the Discover phase, we engaged in an expansive and inclusive ideation process informing the formulation of research questions and mixed methodology. Design-led synthesis transformed research findings into actionable, context-specific insights. In the Define phase, we integrated mixed methods rigor with the design process to identify opportunities instrumental in shaping the development of design drivers and solution concepts. We engaged in inclusive prototyping and open-source collaboration to prototype productive solutions in the Create phase. We detail the challenges encountered and the strategies to address them in each phase. Integrating human-centered design and social science research can tackle community health workers’ complex challenges and create more productive public health solutions.

Addressing Hypertension Care in Africa (ADHINCRA): Study protocol for a cluster-randomized controlled pilot trial

BackgroundUncontrolled hypertension is a major risk factor for cardiovascular disease. Evidence-based interventions to improve hypertension control in high-income countries have not been translated equally in sub-Saharan Africa (SSA). The objective of the Addressing Hypertension Care in Africa (ADHINCRA) Study was to test the feasibility and signal of efficacy of a multilevel, nurse-led, mobile health enhanced intervention in improving hypertension control in Ghana. MethodsUsing a cluster randomized controlled pilot trial design, four hospitals in Kumasi, Ghana, were randomized to the intervention arm (2 hospitals) and enhanced usual care arm (2 hospitals). A total of 240 patients with uncontrolled hypertension defined as systolic blood pressure (BP) ≥140 mmHg on their most recent visit were included (60 patients per hospital). Patients in the intervention arm received an intervention that consisted of nurse-led task-shifting and a mobile health application (Medtronic® Labs' Empower Health), and home BP monitoring. The enhanced usual care arm received usual care as determined by their providers, plus short text messages on health. The intervention was administered for six months, after which it was withdrawn, and patients were followed for six more months to assess outcomes. Feasibility measures included recruitment and dropout rates of study participants, protocol adherence in both arms. Clinical outcomes included changes in BP control status and systolic BP levels from baseline. Secondary outcomes included change in glycemic control, rates of hypertensive urgencies/emergencies, cardiovascular disease events, and medication adherence. DiscussionFindings from this study will provide critical pilot data to inform the conduct of a larger scale trial and the development of scalable health system and policy interventions to improve hypertension control in low-resource settings.Trial registrationNCT04010344. Registered on July 8, 2019 at ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT04010344

Towards remote leadership in health care: Lessons learned from an integrative review.

To gather and synthesize current empirical evidence on remote leadership and to provide knowledge that can be used to develop successful remote leadership in health care. A integrative literature review with an integrated mixed methods design. The literature search was carried out between February and March 2019 in the CINAHL, Medline (Ovid), PsycInfo, Scopus, SocIndex, Web of Science and Business Source Elite (EBSCO) databases. An integrative review was conducted to identify relevant studies published from 2010 to 2019. Of the 88 eligible studies, 21 studies met the inclusion criteria and were selected for the final review. The included studies were analysed using mixed methods synthesis, more specifically, data-based convergent synthesis. The performed analysis identified three main themes: characteristics of successful remote leadership; enhancing the leader-member relationship; and challenges in remote leadership. The first theme included the following sub-themes: remote leader characteristics; trust; communication; and leading the team culture. The second theme covered the importance of organizing regular face-to-face meetings, clear communication policies and the connection between positive team spirit and good remote leader-member relationship, while the third theme emphasized leader- and member-related challenges for remote work. As none of the identified studies had been conducted in a health care setting, future remote leadership research must also specifically consider the health care context. This will be pivotal to exploring how remote work can foster a safe workplace culture, empower health care workers, increase job satisfaction and improve patient outcomes. Remote leadership has rarely been studied in the health care context. Trust, communication, team spirit and a leader's characteristics are central to remote leadership, a finding which is useful for re-evaluating and improving the current culture at health care organizations.

Using a Personal Health Library-Enabled mHealth Recommender System for Self-Management of Diabetes Among Underserved Populations: Use Case for Knowledge Graphs and Linked Data.

BackgroundTraditionally, digital health data management has been based on electronic health record (EHR) systems and has been handled primarily by centralized health providers. New mechanisms are needed to give patients more control over their digital health data. Personal health libraries (PHLs) provide a single point of secure access to patients' digital health data and enable the integration of knowledge stored in their digital health profiles with other sources of global knowledge. PHLs can help empower caregivers and health care providers to make informed decisions about patients’ health by understanding medical events in the context of their lives.ObjectiveThis paper reports the implementation of a mobile health digital intervention that incorporates both digital health data stored in patients’ PHLs and other sources of contextual knowledge to deliver tailored recommendations for improving self-care behaviors in diabetic adults.MethodsWe conducted a thematic assessment of patient functional and nonfunctional requirements that are missing from current EHRs based on evidence from the literature. We used the results to identify the technologies needed to address those requirements. We describe the technological infrastructures used to construct, manage, and integrate the types of knowledge stored in the PHL. We leverage the Social Linked Data (Solid) platform to design a fully decentralized and privacy-aware platform that supports interoperability and care integration. We provided an initial prototype design of a PHL and drafted a use case scenario that involves four actors to demonstrate how the proposed prototype can be used to address user requirements, including the construction and management of the PHL and its utilization for developing a mobile app that queries the knowledge stored and integrated into the PHL in a private and fully decentralized manner to provide better recommendations.ResultsTo showcase the main features of the mobile health app and the PHL, we mapped those features onto a framework comprising the user requirements identified in a use case scenario that features a preventive intervention from the diabetes self-management domain. Ongoing development of the app requires a formative evaluation study and a clinical trial to assess the impact of the digital intervention on patient-users. We provide synopses of both study protocols.ConclusionsThe proposed PHL helps patients and their caregivers take a central role in making decisions regarding their health and equips their health care providers with informatics tools that support the collection and interpretation of the collected knowledge. By exposing the PHL functionality as an open service, we foster the development of third-party applications or services and provide motivational technological support in several projects crossing different domains of interest.

Addressing Preterm Birth History With Clinical Practice Recommendations Across the Life Course.

Preterm birthrates, coupled with excellent preterm birth survival rates, guarantee that every health care provider, regardless of specialty, is caring for patients who were born preterm. Patients and families may not share a preterm birth history however, eliciting this information is important for mitigating potential risk. Long-term health outcomes research supports health implications associated with preterm birth throughout the life course. Through an in-depth review of literature and validation from health care experts in pediatric and adult care, recommendations for primary care providers were developed. The aim was to enhance the identification of those born prematurely, empower health care providers to employ familiar screening strategies, and advocate for mitigations strategies with anticipatory guidance and health promotion. These recommendations advocate a paradigm shift toward proactive intervention, rather than the reactive practice of waiting for children to fail to meet specific milestones or begin to show comorbid tendencies.

Improved blood pressure control via a novel chronic disease management model of care in sub-Saharan Africa: Real-world program implementation results.

A chronic disease management model of care (Empower Health) was launched in rural and urban areas of Ghana and Kenya in 2018. The goal was to improve disease awareness, reduce the burden of disease, and improve the clinical effectiveness and efficiency of managing hypertension. Leveraging the model, clinicians provide patients with tailored management plans. Patients accessed regular blood pressure checks at home, at the clinic, or at community‐partner locations where they received real‐time feedback. On the mobile application, clinicians viewed patient data, provided direct patient feedback, and wrote electronic prescriptions accessible through participating pharmacies. To date, 1266 patients had been enrolled in the “real‐world” implementation cohort and followed for an average of 351 ± 133 days across 5 facilities. Average baseline systolic blood pressure (SBP) was 145 ± 21 mmHg in the overall cohort and 159 ± 16 mmHg in the subgroup with uncontrolled hypertension (n = 743) as defined by baseline SBP ≥ 140 mmHg. SBP decreased significantly through 12 months in both the overall cohort (−9.4 mmHg, p < .001) and in the uncontrolled subgroup (−17.6 mmHg, p < .001). The proportion patients with controlled pressure increased from 46% at baseline to 77% at 12 months (p < .001). In summary, a new chronic disease management model of care improved and sustained blood pressure control to 12 months, especially in those with elevated blood pressure at enrollment.

Water, Sanitation and Hygiene (WASH) Efforts and Sustainable Development Goal 6 (SDG6)

Water, sanitation and hygiene (WASH) can be characterized by accessibility, availability and safety among others. These characteristics are unique to the Eastern Mediterranean Region (EMR) given its context and volatile situation. In this session, WASH services and progress towards the Sustainable Development Goal 6 (SDG 6) related to availability and sustainable management of water and sanitation will be examined. This examination will consider the different challenges faced by EMR countries and the key capacities needed to reach the SDG targets and empower health systems and communities. Focus will be given to some of the SDG6 indicators pertaining to water services, population use, treatment, quality, efficiency, resources, management, cooperation, ecosystem changes, development assistance, procedures and policies.The session will also highlight some of the regional and national approaches for water management and their relation with environmental health issues and some diseases. The discussion will shed light on water scarcity, sanitation and hygiene issues, impact on health, food and waterborne diseases in EMR. Additionally, examples of health stakeholders’ initiatives and WASH involvement in the region will be provided, especially from countries in emergencies, vulnerable communities and remote areas.The session will indicate some of the areas where other health stakeholder can collaborate to further assess the WASH situation in the region in relation to health, promote better WASH practices, and generate evidence for policy makers to take needed actions.

The Beirut blast 2020: Lessons learned from the Swiss Emergency Medical Team specialized "Mother & Child".

On August 4, 2020, Beirut was hit by a devastating explosion leading to mass casualties: thousands were injured and there were significant damages to residences, offices, and health structures. The Emergency Medical Team (EMT) specialized "Mother and Child" was deployed by the Swiss Humanitarian Aid in order to support local health facilities, empower local health professionals to resume clinical activities and ensure access, and continuity of patient care in particular in the fields of gynecology-obstetrics and pediatrics. This communication presents the particularities of an EMT deployment in an urban area of an upper middle-income country with some recommendations for such settings.

Asthma and anaphylaxis.

Both asthma and anaphylaxis are recognized noncommunicable hypersensitivity conditions, which should be correctly diagnosed and treated/controlled in order to decrease avoidable deaths. Nevertheless, their association is not completely clear. We here propose to review the current and new evidence-based data of asthma and anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals in treating symptoms and preventing death. Hypersensitivity life-threatening conditions, such as anaphylaxis and asthma can coexist, mimic or worse each other. Asthma itself is not a strong predictor of more severe anaphylaxis. However, poor asthma control associated with more severe anaphylaxis reactions in all ages. In children, asthma is associated with the severity and recurrences of anaphylactic reactions. Although recent data point for the association between asthma and anaphylaxis, we still do not have harmonized evidence to confirm if we are dealing with two independent comorbidities one worsening each other. However, as far as this review is covering two relevant public health problems in the field of allergy, it is mandatory put in place decisions supporting recommendations to better manage the affected patients and reduce the risk.General strategies should include regular notification of this association, optimization of the classification and coding for anaphylaxis and asthma (new ICD 11 allergy codes) in order to harmonize epidemiological stratified data, early diagnosis of asthma in childhood, regular investigation of asthma in cases of anaphylaxis and optimization of the asthma control and lung function for all patients with indication to provocation tests, desensitization or allergen immunotherapy regardless to the trigger. Implementation of these strategies will involve national and international support for ongoing efforts in relationship with networks of centres of excellence to provide personalized management for the most at-risk patients and prevent death.

Therapeutic approach of anaphylaxis

Anaphylaxis is a recognized cause of death in all ages, which requires prompt recognition and treatment. We here propose to review the current and new pharmacological treatment of anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals with new tools that can be used to treat symptoms and prevent anaphylaxis. The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and application of precision medicine. Several biologic therapies and new devices are emerging as potential preventive treatment for anaphylaxis. Adrenaline (epinephrine) is still the first-line treatment for any type of anaphylaxis and is recognized as the only medication documented to prevent hospitalizations, hypoxic sequelae and fatalities. β2-adrenergic agonists and glucagon remains as the second-line treatment of anaphylaxis, meanwhile glucocorticoids and antihistamines should be used only as third-line treatment. Their administration should never delay adrenaline injection in anaphylaxis. More intuitive adrenaline autoinjectors design and features are required as well as a worldwide availability of adrenaline autoinjectors. Biological drugs, such as omalizumab, have been used as therapeutic adjuvants as a preventive treatment of anaphylaxis, but cost-effectiveness should be considered individually. Understanding the specifications of underlying mechanisms can potentially support improvements in the patients' allergological work-up and open the opportunity of developments of potential new drugs, such as biological agents. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among healthcare providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.

Civilian pharmacy involvement in Department of Defense Innovative Readiness Training

ObjectivesInnovative Readiness Training (IRT) is a United States military exercise that provides training for military personnel while providing services for communities. The objective of this paper was to describe civilian pharmacy services provided during an IRT, Operation Empower Health. SettingOperation Empower Health took place on May 10 to 18, 2018, in Savannah and Garden City, Georgia. Pharmacy operations included a limited formulary of medications. Civilian pharmacy volunteers were paired with military persons at 2 of 4 locations. Practice descriptionStudent pharmacists, residents, preceptors, and faculty provided disease state education to patients during triage. After receiving medical or dental services, patients were provided prescription and over-the-counter medications at the dispensing and counseling station. Civilian pharmacy personnel worked with military personnel to dispense and counsel on medications. Many patients required additional health services or postclinic care. University of Georgia College of Pharmacy faculty members were able to meet with patients for follow-up. An in-service to military personnel was provided by the pharmacists regarding common medication errors. EvaluationWithin Operation Empower Health, 7942 patients were provided health care services at no cost. A total of 11 students, 5 residents, 2 University of Georgia College of Pharmacy faculty, and 1 preceptor provided pharmacy services during the event. Civilian pharmacy personnel were able to educate 566 patients for a total of 2700 minutes. In addition to medications, patients were counseled on lifestyle interventions. ConclusionOverall, IRT builds mutually beneficial civilian–military partnerships between communities and the Department of Defense. Civilian pharmacy personnel were able to offer medication and lifestyle counseling in addition to managing medication dispensing. Student pharmacists, in particular, were given a unique interprofessional learning opportunity in addition to having a culturally competent experience.

Novel Research Initiatives for Early Recognition and Comprehensive Management of Autism Spectrum Disorder to Empower Health Professionals and Health Care Providers: Two Decade Experience from a Tertiary Care Centre in India (P5.6-046)

Novel Research Initiatives for Early Recognition and Comprehensive Management of Autism Spectrum Disorder to Empower Health Professionals and Health Care Providers: Two Decade Experience from a Tertiary Care Centre in India (P5.6-046)

Subnational estimation of modern contraceptive prevalence in five sub-Saharan African countries: a Bayesian hierarchical approach

BackgroundGlobal monitoring efforts have relied on national estimates of modern contraceptive prevalence rate (mCPR) for many low-income countries. However, most contraceptive delivery programs are implemented by health departments at lower administrative levels, reflecting a persisting gap between the availability of and need for subnational mCPR estimates.MethodsUsing woman-level data from multiple semi-annual national survey rounds conducted between 2013 and 2016 in five sub-Saharan African countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) by the Performance, Monitoring and Accountability 2020 project, we propose a Bayesian Hierarchical Model with a standard set of covariates and temporally correlated random effects to estimate the level and trend of mCPR for first level administrative divisions in each country.ResultsThere is considerable narrowing of the uncertainty interval (UI) around the model-based estimates, compared to the estimates directly based on the survey data. We find substantial variations in the estimated subnational mCPRs. Uganda, for example, shows a gain in mCPR of 6.4% (95% UI: 4.5–8.3) based on model estimates of 20.9% (19.6–22.2) in mid-2014 and 27.3% (26.0–28.8) in mid-2016, with change across 10 regions ranging from − 0.6 points in Karamoja to 9.4 points in Central 2 region. The lower bound of the UIs of the change over four rounds was above 0 in 6 regions. Similar upward trends are observed for most regions in the other four countries, and there is noticeable within-country geographic variation.ConclusionsReliable subnational estimates of mCPR empower health departments in evidence-based policy making. Despite nationally increasing mCPRs, regional disparities exist within countries suggesting uneven contraceptive access. Raising investments in disadvantaged areas may be warranted to increase equity in access to modern contraceptive methods.

Perfil epidemiológico da Hanseníase em Rondonópolis / MT: 2001 a 2010

O objetivo deste estudo foi caracterizar os casos novos de Hanseníase notificados e confirmados no Município de Rondonópolis/MT. Trata-se de pesquisa de caráter quantitativo, com delineamento transversal, não experimental, retrospectiva, por meio de avaliação exploratória e descritiva utilizando dados do Sistema de Informação de Agravos de Notificação (SINAN) do Ministério da Saúde no período de 2001 a 2010. Durante o período do estudo foram diagnosticados 1.919 novos casos, o grupo etário mais frequente foi de 20 a 39 anos, sexo masculino, pardos, ensino fundamental incompleto e residente em zona urbana. Constatou-se ainda que a classificação operacional mais frequente foi a multibacilar, sendo a dimorfa predominante e a maioria dos casos não apresentaram nenhuma incapacidade física. Os resultados evidenciam elevado índice de casos de Hanseníase, sendo necessário descentralizar as ações de controle desta doença, capacitar os profissionais de saúde para realizarem o diagnostico precoce e prevenção.

Tamper-Resistant Mobile Health Using Blockchain Technology.

BackgroundDigital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials.ObjectiveThe aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network.MethodsWe developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults.ResultsElectronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network.ConclusionsBlockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization.