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mHealth 3.0
AI assited lifestyle modificationin
Prevention and Management of Chronic Disease(Asthma model)
Mark Lazarovich MDTimberlane Allergy and Asthma
South Burlington VTUSA
Clinical Vignette
55 y.o., overweight woman with cat allergy, asthma, diabetes and HTN. Asthma and allergy managed and stable for 15 years. Lives alone with dog.
Yearly follow-up visit: Increasing dyspnea, cough, wheeze, loss of glycemic control elevated BP.
What happened?1. Developed Sinusitis2. Developed Dog Allergy3. Got a cat4. Dog died5. Non-compliance
Chronic disease in America
$2.3 of $2.7 trillion spent. 2011.45% of Americans133 million. 2000
15%
85%
Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF - 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.
USA Asthma Numbers
CDC. National Health Interview Survey (NHIS) data: 2011 lifetime and current asthma. Atlanta, GA: US Department of Health and Human Services, CDC: 2012
$53 B$56 B
World Asthma Numbers1
Note: Shanghai asthma prevalence in 1997 was 0.41% in 2015 it was 1.8%. A 340% increase2
World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, 2007. The changing epidemiology of asthma in Shanghai, China J Asthma 2015 Jun:52(5):465-70
Cost of asthma therapy
$$-$$$$$$$$$$$
a-PGD2
? a-IL4/IL13
$-$$
SABAPDE-I SS
a-IL5a-IgE$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
a-IL4
ICS
IT
LABALTRA
LTRsi
Actionable Co-factors and Asthma
Obesity
Inactivity
Air Quality
Mental Health Problems
Lack of sleep
Food Quality
USA Trends in Obesity
Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among adults: United States, Overweight and Obesity Statistics | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 10/16/16, 12:13 PMhttps://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx Page 10 of 11 trends 1960–1962 through 2007–2008. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics; 2010.
Reducing obesity makes asthma better
n Surg/Lifestyle QL Asthma
Control FEV-1 Inflam.Markers Eos AHR
Macgregor and Greenberg, 1993
(USA)40 S NA NA NA NA
Dixon JB et al1999
(Aus)32 S NA NA NA NA
Stenius-Aarniala et al, 2000
2000 (Fin)38 L NA NA NA
Dixon AE et al2011
(USA)46 S
Dias-Junior2014(Bra)
33 L
USA Trends in (in)Activity
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise. 2008;40(1):181–188.
Brownson RC et al. Declining Rates of Physical Activity in The United States: What Are the Contributors? Annual Review of Public Health. First published online as a Review in Advance on December 8, 2004
Decrease in recommneded activity levels in children after age 11. 42% to 7.6% overall.
34.7% to 5.4% of girls.
Activity makes asthma better
n Duration QL AsthmaControl FEV-1 Inflam.
Markers Eos AHR
Fanelli et al2007
(Bra)38p 16 week NA NA NA
Mendes et al2010
(Bra)101 3 mo NA NA NA
Eichenberger2013 (meta)
(Swiss)599 NA NA NA
Franca-Pinto2015(Bra)
43 12 week NA
Dagstuhl Perspetives Workshop
Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and
Wellbeing,Jun. 29–Jul. 2, 2014
http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf
Companion agenda to technologically managed Healthcare
http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf
Technologically supported, proactive well-being
Technologically supported well-being in management of
chronic and acute illness
mHealth + Proactive Well-Being = Wellth
Elizabeth F. Churchill and m.c. schraefel mHealth+Proactive WEll-Being = Wellth Creation . Forum: Health Matters ACM 2015 Gillian R. Hayes Editor
“Wellth Creation”
Developing sustained strategies for increasing the experience of well-being. (emotional and visceral.) (translating into micro, meso and macro socio-economic gain).
Well-being has an N=1
Wellth creation will involve rethinking:
1. notions of health 2. interactive technology design 3. the form and role of health-related data 4. engagement with stakeholder groups (micro, meso, macro)
Elizabeth F. Churchill and m.c. schraefel mHealth+Proactive Well-Being = Wellth Creation . Forum: Health Matters ACM 2015 Gillian R. Hayes Editor
Barriers to successful mHealth application
- Tyrannical- App fatigue- Data fatigue- Lack of contextual integration- No long term studies- Poor UX- Quantitative Tedium- How to choose?- Poor integration- Not fun- Inflexible- Impersonal- Too personal- Other………
Emotion
Logic
Subconscious Conscious
Clustering of current
health apps
Modified from: Report from Dagstuhl Perspectives Workshop 14272 Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and WellbeingEdited by m. c. schraefel1 and Elizabeth F. Churchill 21 University of Southampton, UK, [email protected] 2 formerly of eBay Research Labs, San Jose, CA, US, [email protected]
Current Motivational Models
Is health the primary motivator?
No
Dara Torres 41, Swimming5th Olympic Games.2008 Silver Medal
No
ObeseDe-conditionedUnmotivated
Emotion
Logic
Subconscious Conscious
Area to explore?
Modified from: Report from Dagstuhl Perspectives Workshop 14272 Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and WellbeingEdited by m. c. schraefel1 and Elizabeth F. Churchill 2. 1 University of Southampton, UK, [email protected] 2 formerly of eBay Research Labs, San Jose, CA, US, [email protected]
Needed Motivational Models
Emotional motivation
I use Facebook, Instagram, Twitter, Google because:
“I want to:”-know-be included-be validated-be recognized-be praised-be special-matter-have-be aware-be current
Moving beyond e-Health and the Quantified Self ACM CSCW Vancouver March 2015
1. “Me”, “Us”, “Them”2. Social3. Non-tyrannical4. Assistive, Aspirational (not Prescriptive)5. Playfull (explorable, interrogable)6. Contextual
Qualities of Wellth promoting Systems
Moving beyond e-Health and the Quantified Self. Workshop at 2015 ACM Conference on Computer-Supported Cooperative Work and Social Computing. March 14-18 Vancouver, BC, Canada
in5 (Dr. m.c. Schraefel)
MoveEat
CogitateEngageSleep
All of the above are done daily.All require skills.All are essential.
All need to be actively engaged.
MoreLessQualityCalories
Tune rather then change
Modified from; in5 working brain body connection for creative excellence. m.c. Schraefel 2014 @mcphoo
Acknowledgements
Director of UX, Google
Distinguished Visiting Scholar, Media X, Stanford University
Vice President ACM SigCHI
Prof. Computer Science and Human PerformanceUniversity of Southampton UK
Research Associate, CSAIL MIT
NSCA Strength and Conditioning CoachMaster Trainer, Z-healthNutrition CoachFunctions Movement Trainer
dr. m.c schraefel Dr. Elizabeth Churchill Stephen Yanow
Chairman 3CE Technologies