Public Health Framework for Smart Cities within the Comprehensive Approach to Sustainability in Europe: Case Study of Diabetes

European cities should address the climate change challenges, improving quality of life and reducing costs. They need potential smart and digital approaches. Public health (PH) has recognized climate change as a major challenge. The development of urban policies should be guided by evidence-based PH practices. The environmental health determinants and the climate crisis now represent a clear PH threat. The core of the Smart City is sustainability, and its basic condition is active PH. The inclusion of public health into the pillars of the Smart City concept to contribute toward mitigating PH crises, such as the COVID-19 pandemic, is a framework for action. Design Science Research Methodology (DSRM) is used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and smart city experts participated in the DSRM process, using diabetes as a case study. The European Green Deal served as a blueprint for this transformational change toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating clearly the several dimensions of the PH functions within a digital city, via the identification of a set of digital PH services that are required to support the SPHEC framework. This allows for an assessment of the actual benefits that are obtained with the digital health services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the SPHEC framework, through the development of proper digital health services within the smart city, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to take this challenge more seriously. © 2023 by the authors.

Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery.

BACKGROUND: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. METHODS: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. RESULTS: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. CONCLUSIONS: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

The Global use of Telemedicine in Tropical Medicine: Where we are after COVID-19?

Issue The use of Telemedicine (TM) to provide remote care is an important strategic resource for reducing inequalities in access to Public Health globally. Many countries with a high prevalence of Tropical Diseases (TD) have an insufficient number of physicians, but this potential for remote assistance is still largely untapped. Description of the problem A Scoping Review was combined with the SWOT technique (Strengths, Weaknesses, Opportunities, and Threats), which is a strategic analysis tool that enables action planning based on the evaluation of the interaction between the internal capacities of a process and external influencing factors. The SWOT analysis matrix of this study was based on a bibliographic research on the topic of TM applied to the clinical management of TD. It sought to obtain a characterization of the current global scenario, identifying (I) the contexts in which initiatives are being implemented and (II) the main gaps in the evidence. The objective is to subsidize action planning by healthcare systems, taking advantage of the expansion pandemic trend. Results A Scoping Review selected 41 studies. As strengths, the advances in the development of m-health tools for clinical and epidemiological monitoring of TD stood out, as well as some successful local experiences in implementing targeted TM systems. Among the weaknesses are infrastructure limitations and a lack of international cooperation initiatives. As for the opportunities, the context of the COVID-19 pandemic increased the importance of the topic on the health systems agenda and boosted investments in the sector. Regarding the threats, the scarcity of specific clinical guidelines and protocols and robust evidence on cost-effectiveness may be highlighted. Lessons The incorporation of TM in the qualification of clinical care for TD can have a relevant impact on the improvement of global public health indicators. The experience in such services is still scarce but represents an opportunity. Key messages There is a relevant potential in using Telemedicine to improve global access to Public Health in TD endemic areas. To support telemedicine there is the need to raise the awareness of managers, health workers and researchers about innovation in Tropical Diseases.