The development of a mobile u-Health program and evaluation for self-diet management for diabetic patients

BACKGROUND/OBJECTIVES: This study aims to develop a mobile nutritional management program for integration into the already developed web-based program, Diabetes Mellitus Dietary Management Guide (DMDMG) for diabetic patients. Further, we aim to evaluate the amended DMDMG program. SUBJECTS/METHODS: The mobile application based on an Android operating system includes three parts: 1) record of diet intake, which allows users to take pictures of the meal and save to later add diet records into DMDMG; 2) an alarm system that rings at each meal time, which reminds users to input the data; 3) displays the diet record and the results of nutrient intake, which can be also viewed through the web program. All three parts are linked to the web-based program. A survey was conducted to evaluate the program in terms of nutrition knowledge, dietary attitude, eating behavior and diet intake by non-equivalent control group design among diabetic patients with 14 DMDMG users and 12 non-user controls after a one-month trial of DMDMG. RESULTS: Non-users did not use the program, but participated in the weekly off-line nutrition classes for one month. The program users showed increased healthful dietary behavior (P < 0.01) and dietary attitude scores (P < 0.05). More DMDMG users had higher nutrition knowledge scores after one-month trial than non-users. However, dietary intake significantly increased in non-user group for calcium and sodium (P < 0.05) while the user group did not show significant changes. CONCLUSIONS: The program has created positive changes in patients' dietary life. All the users were satisfied with the program, although some expressed minor difficulties with an unfamiliar mobile app.

The development of a mobile u-Health program and evaluation for self-diet management for diabetic patients

BACKGROUND/OBJECTIVES: This study aims to develop a mobile nutritional management program for integration into the already developed web-based program, Diabetes Mellitus Dietary Management Guide (DMDMG) for diabetic patients. Further, we aim to evaluate the amended DMDMG program. SUBJECTS/METHODS: The mobile application based on an Android operating system includes three parts: 1) record of diet intake, which allows users to take pictures of the meal and save to later add diet records into DMDMG; 2) an alarm system that rings at each meal time, which reminds users to input the data; 3) displays the diet record and the results of nutrient intake, which can be also viewed through the web program. All three parts are linked to the web-based program. A survey was conducted to evaluate the program in terms of nutrition knowledge, dietary attitude, eating behavior and diet intake by non-equivalent control group design among diabetic patients with 14 DMDMG users and 12 non-user controls after a one-month trial of DMDMG. RESULTS: Non-users did not use the program, but participated in the weekly off-line nutrition classes for one month. The program users showed increased healthful dietary behavior (P < 0.01) and dietary attitude scores (P < 0.05). More DMDMG users had higher nutrition knowledge scores after one-month trial than non-users. However, dietary intake significantly increased in non-user group for calcium and sodium (P < 0.05) while the user group did not show significant changes. CONCLUSIONS: The program has created positive changes in patients' dietary life. All the users were satisfied with the program, although some expressed minor difficulties with an unfamiliar mobile app.

The Effects of U-Health Program on Metabolic Syndrome of Workers / 한국직업건강간호학회지

PURPOSE: This study was to investigate the effects of U-Health program on metabolic syndrome of workers. METHODS: This study was conducted with a pretest-posttest control group study for 6 month from May to October 2010. Subjects in the experimental group participated in the U-Health program (n=315), whereas the control group did not (n=157). RESULTS: In the U-Health group, statistically significant reductions in BMI(body mass index), waist circumference, cholesterol, and triglyceride were observed. The results of this study showed that 6 months of U-Health program influenced on the metabolic syndrome of workers in a positive way. CONCLUSION: It is, therefore, suggested to actively utilize the U-Health program to manage the workers' health.

The Effects of U-Health Program on Metabolic Syndrome of Workers / 한국직업건강간호학회지

PURPOSE: This study was to investigate the effects of U-Health program on metabolic syndrome of workers. METHODS: This study was conducted with a pretest-posttest control group study for 6 month from May to October 2010. Subjects in the experimental group participated in the U-Health program (n=315), whereas the control group did not (n=157). RESULTS: In the U-Health group, statistically significant reductions in BMI(body mass index), waist circumference, cholesterol, and triglyceride were observed. The results of this study showed that 6 months of U-Health program influenced on the metabolic syndrome of workers in a positive way. CONCLUSION: It is, therefore, suggested to actively utilize the U-Health program to manage the workers' health.

Development of Web-based u-Health Self-nutrition Management Program for Diabetic Patients / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to develop web-based self-nutrition management u-Health program for diabetic patients (DMDMG: Diabetes Mellitus Dietary Management Guide) for achieving systematic self-management of diet. METHODS: The program consisted of five parts with different contents according to the results of needs assessment. Five major parts were 1) meal management part which contains calorie prescription, meals recording and dietary assessment, 2) prevention of disease part with information of diabetes and assessment of dietary behavior, 3) dietary behavior modification part with an education on dietary behavior modification plan and dietary behavior plan, 4) meal plan containing a training section for meal plan and self constructing part for meal planning by making tables, and 5) information about myself which composed with general and physical information. The system proposed in this study provides nutrients intake results right after input of diet intake, which is possible with simultaneous calculation of input data in the server with 3,495 food and 1,821 meal data base. The nutrients analysis program was evaluated with 26 diabetic patients with two-day 24 hr recall. RESULTS: The differences of nutrients intakes between DMDMG and CANPRO 3.0 ranged from 13.5-16.5%, which was caused by the differences of databases of the two programs. The characteristics of DMDMG were; 1) it can provide an interactive tailored nutrition management, 2) it is a practical tool of diabetes nutritional management, 3) the program gives motivation for the dietary behavior modification. CONCLUSIONS: The effectiveness of whole program needs to be conducted, but the program was an innovative tool for self-management of nutrient intakes, diet behaviors, meal management and tailored nutrition education.

U-Health Service for Managing Chronic Disease: A Case Study on Managing Metabolic Syndrome in a Health Center in South Korea / 대한의료정보학회지

OBJECTIVES: We were to analyze the effect of managing metabolic syndrome using a u-health service in a health center. METHODS: We collected biometric data from 316 subjects living in a county (gun) in South Korea before and after the introduction of uhealth services in 2010. Analysis was done by contingency table using SPSS and latent growth model using AMOS. RESULTS: We found that regional u-health services affected instance of metabolic syndrome. Further, biometrics and health behavior improved. After six months of u-health services, the number of subjects with three or more factors for metabolic syndrome decreased by 62.5%; 63.3% of regular drinkers stopped drinking; 83.3% of subjects who rarely exercised began to exercise twice a week or more; and 60.9% of smokers stopped smoking. CONCLUSIONS: U-health services can change health behavior and biometrics to manage metabolic syndrome in rural areas. The usefulness of u-health services is discussed.

The Consumers' Perceptions and Requirements for Personal Health Records in Korea / 대한의료정보학회지

OBJECTIVE: The aim of the study was to identify factors influencing the willingness of healthcare consumers to use personal health records (PHR) and to investigate the requirements for PHR services. METHODS: A face-to-face interview was conducted with 400 healthcare consumers from the 3rd-18th of July 2008 using a structured questionnaire. To identity factors affecting the willingness to use PHR and to pay for PHR services, logistic regression analysis was performed. To investigate the requirements for PHR services according to the willingness of the consumers to use PHR and to pay for PHR services, t-test analysis was conducted. RESULTS: Of the 400 healthcare consumers, 239 (59.8%) were willing to use PHR and 111 (27.8%) were willing to pay for PHR services. The willingness to use PHR was higher in the elderly, those with a disease, and those with experience to use health information on the Internet, and the willingness to pay for PHR services was higher in those with a relatively high income (p6,000,000 won and 4,500,000-6,000,000 won, respectively, than in those earning <1,500,000 won, and approximately 1.96 times (95% CI=1.18-3.27) higher in those with experience using health information on the Internet than in those without experience. The willingness to pay for PHR services was approximately 5.9 times (95% CI=1.84-19.06) higher in those with an income of 4,500,000-6,000,000 won than in those with an income <1,500,000 won (p<0.05). Demands for test results, medication history, family history, problem list, genetic information, clinical trial information, and social history were significantly higher in those with a willingness to use PHR and those with a willingness to pay for PHR services than in those without willingness to use PHR and those without a willingness to pay for PHR services (p<0.05). Compared to those without a willingness to pay for PHR services, those with a willingness to pay for PHR services showed a significantly higher demand for all the functions (p<0.01). CONCLUSION: The results of this study suggest that healthcare consumers potentially have a considerable demand for PHR services, and although it is not recognized and used widely yet, PHR is an essential service. In order to enhance people's awareness of PHR and to promote people to use PHR services, we need efforts and initiatives to execute campaigns and education for people to ease access to the service, and to reduce the gap in service utilization skills.

Current State of u-Health and Its Developmental Strategies in Korea

u-Health based on ubiquitous information and communication network is being considered as an alternative to the mainstream face-to-face healthcare services in addition to its supportive functions. Traditional healthcare system has inherent problems such as limited accessibility and inadequate fulfillment of service needs to the underserved populations. Proponents of u-Health suggest that it will provide solutions to those problems. There have been many trials and pilot projects for telemedicine since 1988 in Korea, and the system is now called "u-Health". After legislation of clause regarding telehealth in the Korean medical law in 2002, local governments have made several attempts to utilize u-Health system to the patients with chronic disease living in rural under-served area. Recently, Korean government has implemented u-Health trial projects about tehemedicine, monitoring chronic disease, and providing homecare in the three underserved rural and many-islands area. Patients' perceived level of satisfaction, preference, attitude, and usability of u-Health was significantly high. Patient's compliance to u-Health has improved over time. A strategic approach based on the innovative and proactive mindset to the u-Health is strongly needed. At the time of u-Health implementation in the medically underserved area, utilization of both u-Health center and mobile clinic is recommended to achieve operational efficiency, and ensure high quality of service. Although u-Health is effective and supportive method to the mainstream face-to-face healthcare, we should be cautious, since u-Health model needs more development and more rigorous experiments.

Application of u-Health to Emergency Medical Service System

Recent advances in information and telecommunication technology make u-health strategies possible in Emergency Medical Services (EMS) system. The u-Health can offer advanced life support, medical oversight to the emergency medical technician, quality improvement in EMS, and hazard management. The aim of this study is to provide comprehensive review, and to discuss the role and problems of the u-Health used in EMS system. The efficient operation of EMS system is contingent upon the quality management of both the working systems and underlying communication infrastructures of u-health. The u-Health services for EMS requires assessment skill, IT technology and organization of all systems. The u-Health raises the level of a medical control and treatment to a much higher degree in pre-hospital setting and also tends to decrease mortality. By utilizing u-Health system, the patient's data collected from ambulances transfer simultaneously to a central emergency medical information center (EMIC) and hospitals. Medical director delivers medical oversight to the paramedics in the ambulance, and also transmits the information to a doctor at ER before arriving to the hospital. The transmitted data contains the patient's information, vital signs (blood pressure, pulse rate, respiration rate, and temperature), ECG, pulse oxymetry, a moving picture and information at the point of care administration. For a successful integration of u-Health to EMS system, information technologies, assessment technologies, telecommunications, and legal remedy are needed. Especially, advance in assessment technologies offer the possibility of small size, but also of intelligent, active devices that are wireless and non-invasive or minimally-invasive. u-Health will benefit the patients by advanced life support in pre-hospital and emergency department settings. It will help decrease the cost associated with the hospital, mortality, and morbidity.

u-Health for Management of Chronic Diseases: Physical Activity and Therapeutic Exercise

Recently, the aging society is facing with the rapid increase of chronic diseases. Despite the advanced medical technology, chronic diseases have not comprehensively managed yet. In the modern society, many people have to spend their extended life span suffering from chronic diseases and disabilities, and also a huge medical cost has emerged as a serious social problem. With IT improvement, u-health system has been developed to link home and medical service systems by arranging medical data, decision making and medical guidelines for various situations. It can promote the therapeutic compliance for the patients with chronic diseases. And also for the medical service providers, it can provide useful data to make an accurate medical decision. As we know, the chronic disease is caused by inactivity and the management of chronic disease requires the modification of inactive life style. U-health medical fitness system can not only prescribe proper activity to control the chronic disease but also it can monitor the patients' physical activity in everyday life. By the successful management of chronic diseases based on u-health system, we want to achieve the expansion of disease-free and disability-free life expectancy and a solution to reduce the burden of medical expenses in modern society eventually.

Application of u-Health Under Special Situations

u-Health is a good alternative in providing health care service under special situations where access to health care is limited. With the expansion of life space and the increase of travel, people are being put in danger across various situations on the sea, in the sky, disasters, and so on. It is not easy to provide health care in those situations, while people may still have high expectation to heath care. This gap can be narrowed by using u-Health, which is based on advanced information and communication technologies. The special situation for u-Health is where normal health care cannot be performed because of physical limitation and danger, which can be further broken down to five situations. The first is a situation on means of transportation such as ship and airplane. The second situation is when medical facilities are far away from life space, in places like backwoods. The third situation occurs on the place where it is difficult for patients to receive treatment due to restrained freedom, for example, a prison. The forth is the situation where the medical team is unable to approach easily, such as war zone and disaster area. The last special situation is the extreme environments like polar region. In order to make the u-health system more helpful for patients under special situations, there is a need for a research development and investment on sensors to measure accurate bio-signals, the network to transmit the data, and the technologies to analyze the data and to provide feedback. Therefore, institutional supports for technology development are required for further development of u-Health for people in great needs.

A Developmental Process of Telemedicine, e-Health & u-Health

As Information Technology has developed, there has been a birth of new medical fields including telemedicine, e-Health, and u-Health. The differences between the new terms resulted from renewed definitions with the development of technology. However, aside from the simple change in terminology medical services that use the terms has expanded along with the change in terminology. Currently most countries use telemedicine as a part of their healthcare system. As such, related devices and services have been slated to become a totally new industry. In Korea, due to the advances in IT, Increase in medically vulnerable and aging population, and increase in the number of patients with chronic disease, telemedicine has been widely used in public healthcare system. Several developmental attempts by public and private sectors have had limited success due to legal and institutional limitations but recent changes in medical law and movement to allow tele-diagnosis and treatment in the public sector has brought in a new era. Although development of telemedicine technology may be the key, it is even more important that the development in medical services models as well as their application be on the same track. Furthermore, from the clinical and academic standpoint, the aspects of safety, efficiency, and economic viability must be thoroughly tested and applied. Most importantly, active involvement from the medical community in development of new medical technology as well as new service models for diagnosis and treatment is required. The most advanced technology would be useless if it is not being actively utilized by the medical community in the treatment and management of patients.

Study of u-Health Definition using Q method's Subjectivity Analysis / 대한의료정보학회지

OBJECTIVE: This study attempted to analyze and to give a concrete form of u-Health concept which has very broad and diverse definitions until now, because of the newness of the concept. METHOD: Q method was adopted to unravel the concept, and 50 Q-statements were selected and rated by 48 P-samples, and the resulting data were analyzed by factor analysis of SPSS. RESULT: Six factors were drawn as to Potentiality, Functionality, Technology, Integrity, Futuristic and Consumer-centered. The concept u-Health was defined as "Futuristic functional healthcare service which is consumer-centered and has enormous potentiality utilizing technology". CONCLUSION: Based on the definition, u-Health should be expanded and extended crossover the boundaries of disciplines and professionals to make it the real fruition of "Consilience".

Megatrends and Perspectives of Emerging Medical Services

In the era of u-health, the megatrends of new medical services are the use of information and communication technologies to provide health care information and services to stakeholders including medisumers. They pursue improved quality of health care, increased access to information and process, cost-saving, industry development related to u-Health, and enforcement of competitiveness. The goals of activating u-Health are to improve laws and regulations, to provide incentives, to increase government support and establish a monitoring system, and to encourage financial investment for institutes related to health service market for an effective health system. Characteristics of megatrends in the era of u-health are represented as 5 c's: content, community, commerce, connectivity, and care. It contains the development of 'contents' for u-health, share and exchange information in the 'u-community', promote 'commercial u-health care models', 'connectivity' for standardization, activating 'care for network governance' by developing services, and build a value- and IT-based and patient-centered purchasing system, which will bring a paradigm shift in medical services.

The Remote Health System utilizing Wireless Communication of Personal Health Information / 대한의료정보학회지

OBJECTIVE: The current personal health devices are used as stand.alone machines or transmit the personal health information only to local PCs. The objective of this research is to build a system which can transmit personal health information from personal health devices to the healthcare server systems. METHODS: In this research, we used infrared (IrDA) and Bluetooth for wireless communication from the personal health devices to a PDA. And, we utilized SMS (Simple Message Service) and world wide web systems to deliver the data from the PDA to other mobile phones or to the board in the web server. RESULTS: We developed the system that wirelessly communicates personal health information from the personal health devices to a PDA. The system also delivers both glucose and blood pressure data from the PDA to other mobile phones by SMS (Simple Message Service) or automatically register to the board in the web server. CONCLUSION: We showed convenient and easy way of collecting personal health information. Our system will contribute improving personal healthcare environment and personal health device business.