Effect of telehealth-based versus in-person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity

Aims: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post-COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. Method(s): A total of 150 patients with obesity and diabetes who were followed every 4-6 weeks either in-person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight-based daily protein intake from protein supplements and food, an activity/sleep schedule-based meal times, and an aerobic exercise goal of a 2000-calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth-based follow-up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no-show rates, number of visits, program duration, and drop-out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). Result(s): Mean age was 47.2 +/- 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 +/- 7.7-39.7 +/- 6.7 kg/m2 (p < 0.0001). Mean program duration was 189.4 +/- 169.3 days. An HbA1c% unit decline of 1.3 +/- 1.5 was achieved with a 10.1 +/- 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in-person appointments (10.6% +/- 5.1 vs. 9.6% +/- 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in-person follow-up (213.8 +/- 194 vs. 159.3 +/- 127, p = 0.019). The mean annual telehealth and in-person no-show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 +/- 3.0 vs. 8.6 +/- 5.1) and drop-out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 +/- 267.5 min vs. 200.6 +/- 110.8 min), PLT (28.9 +/- 17.5 min vs. 3.1 +/- 1.6 min), and PST (1033 +/- 628 min vs. 113.7 +/- 61.4 min) were significantly longer (p < 0.0001) for the in-person group. Conclusion(s): Telehealth offered comparable %TBWL and HbA1c decline as in-person follow-up, but with a shorter follow-up, fewer appointments, and no-shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes.Copyright © 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

A Low-Cost Portable Ventilator Using IoT

The demand of ventilators has been increasing dramatically from the past few years due to the spike in the COVID-19 cases globally. Around the World, the abscence of availability of ventilators have taken a lot of lives in just the past couple of years. The use of ventilators has been proven to be helpful from preventing the danger of lung harm through low- quantity airflow and helps us to get the adequate amount of influx of pure air. The ventilators available are expensive and scarce in supply. They are heavy and would normally weigh around 7 to 8 kgs, which makes it inconvenient to carry from place to place due to its enormous size. Our project aims at developing a smart ventilator system using a microcontroller board and sensors based on Internet of Things (IOT). The smart ventilator will be portable and very light in weight, which makes it handy to use and requires no additional expertise to handle it. The usage of the high torque motor enables us to change the pressure as per the requirement. The sensors used collects the temperature and the Pulse oximetry levels and the same is updated on the LCD display.

Health-related outcomes in patients enrolled on surgical and non-surgical routes in a weight management service.

BACKGROUND AND AIMS: This study evaluates a specialist weight management service and compares outcomes in participants referred to the service undergoing either surgery or non-surgical routes to support weight loss. METHODS: Four hundred and forty eight participants were assessed on various weight-related outcomes (body mass index [BMI], psychological distress, quality of life, nutrition, weight-related symptoms, physical activity) on referral to the service and on discharge. The effect of group (surgery or non-surgery) and time in the service were facilitated by doubly multivariate analyses of variance models. RESULTS: Between referral and discharge, participants improved significantly on a combination of outcomes (P < .001) and on each outcome assessed individually. The magnitude of overall improvement was moderate (partial-η2 = 0.141). Individual improvement components varied; including a moderate reduction of 3.2% in the BMI outcome measure and a substantive gain of 64.6% in quality of life. Participants on non-surgical routes performed significantly better than participants on surgical routes on a linear combination of outcomes (P < .001) and on all outcomes except nutrition; with an effect of route small-to-moderate in magnitude (partial-η2 = 0.090). CONCLUSIONS: Weight management services are successful in achieving weight management-related outcomes in the short- and long-term, with large overall improvements between referral and discharge averaged over all participants observed. Non-surgical routes appear to confer benefits between referral and discharge compared to surgical routes.

Patients With Super Obesity Do Not Perceive Themselves as Being at Higher Risk for a More Severe Course of COVID-19 Infection.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to major health-related concerns in the population. Several risk factors for a severe course of COVID-19 disease have been identified, with obesity taking an important role. However, it is unclear whether this association is only known in the expert world or whether individuals also experience themselves as risk patients due to their obesity and whether the desire for weight reduction may also be associated with a hoped-for risk reduction. These questions were addressed in a cross-sectional study of patients who have presented to an obesity center in order to lose body weight. Methods: Patients (n = 155) of the obesity center were asked to complete an ad hoc questionnaire to assess whether the desire to lose weight is also associated with a hoped-for risk reduction with respect to COVID-19 disease during the middle of the pandemic in the period between October 2020 and April 2021. We additionally assessed their perceived general stress using the Perceived Stress Questionnaire (PSQ). Results: In our explorative study, overall worries correlated significantly with worries about contracting COVID-19 (r = 0.483, p < 0.001). There has been an association with concerns about severe COVID-19 progression and psychological distress from the COVID-19 pandemic (r = 0.543, p < 0.001). In addition, a correlation was found between persons who worry about contracting COVID-19 and feeling like an at-risk patient (r = 0.530, p < 0.001). Interestingly, the higher the BMI (>50 kg/m2), the lower were the worries in PSQ (ANOVA p = 0.046). However, COVID-19-related worry was nonetheless present in the higher BMI subgroups. The most intense worries were experienced by individuals with a BMI between 35 and 39 (PSQ worries 50.44), immediately followed by individuals with a BMI between 40 and 49 (PSQ worries 49.36). Discussion and Conclusion: An increased risk for a more severe course of COVID-19 infection is not generally perceived by obese individuals. In particular, individuals with very high BMI (>50)-although being at very high risk for a severe course of the COVID-19 disease-do not display increased worries, which might point toward heightened denial.

Health risks and benefits of international travel for adult patients with asthma

Asthma is a very prevalent condition. A significant proportion of patients with asthma will engage in travel for work or leisure purposes. Patients may be fearful of travel, especially during the current COVID-19 global pandemic. However, there are health benefits to be obtained, including leaving an area of high air pollution and travelling to an area of lower air pollution, travelling to high altitude, the beneficial effects of a low trigger environment and the psychological benefits associated with travel. Travel can be associated with improved diet and increased vitamin D exposure. Caution should be taken with alcohol consumption as it may worsen asthma. Whilst bariatric surgery has been shown to improve asthma symptoms and control, there are dangers associated with bariatric surgery tourism that the traveller should be made aware of. Travellers with asthma may experience jet lag and a worsening in their symptoms. Caution is required around exogenous melatonin use. Optimal asthma control pre-travel is essential. The destination should be carefully considered, in terms of air pollution, altitude and possible environmental triggers. Pre-travel, written asthma management plans should be reviewed and updated if necessary. Patients should carry more asthma medications than they think is necessary, including oral corticosteroids and a pressurised metered dose inhaler via spacer. Travellers with asthma should have a self-management plan in the event of exacerbations occurring during travel.

Wearable Non-invasive Health Monitoring Device for Elderly using IOT

Patients and old age people suffering from Chronic, systemic diseases like heart diseases, asthma diseases, Alzheimer and dementia, Kidney diseases etc. needs regular health monitoring and extra care during any emergency. During the world of pandemic, those people suffered a lot and needed more attention from expert/specialists. Due to the difficulty in consulting the expert specialists in person, wearable technology plays an important role, which evolved for ease of use and advancements for monitoring patient’s health status. So, a wearable health monitoring system using IOT is proposed to monitor the regular health parameters periodically. The proposed system is a single integrated device consists of sensors for measuring vital physical parameters like pulse rate, respiratory rate, and temperature. Those data and initial predictions are sent via IOT cloud platform and expert opinions are received for further action as remote monitoring. If any critical changes are found, the same has been transmitted to doctor end and closest people of contact. If temperature changes are found below or above the standard value about 97 to 99 F, along with any respiratory difficulties with abnormal values are brought immediately to the notice of the specialist, due to the recent treats in covid. The sensor values are monitored time to time and connected to Arduino with GSM module for alert message. The proposed patient health monitoring system based on IOT helps the doctors and family members to keep track of the patient’s health. The covid pandemic period also made us realize to monitor even normal healthy person, which is the need of the hour. Also, the unit is wearable, small in the form of belt/collar, light weight and cheap. The aim of the study is fulfilled, to prognosticate the possibility of unidentified or untreated health effects and monitor the patient health.

Homeostasis Disrupted and Restored-A Fresh Look at the Mechanism and Treatment of Obesity During COVID-19.

The prevalence of obesity in the United States approaches half of the adult population. The COVID-19 pandemic endangers the health of obese individuals. In addition, the metabolic syndrome poses a challenge to the health of obese adults. Bariatric surgery and diet restore metabolic homeostasis in obese individuals; however, it is still unclear which strategy is most effective. For example, intermittent fasting improves insulin sensitivity and diet alone decreases visceral adipose tissue at a disproportionately high rate compared to weight loss. Bariatric surgery causes rapid remission of type 2 diabetes and increases incretins for long-term remission of insulin resistance before meaningful weight loss has occurred. Malabsorptive surgeries have provided insight into the mechanism of altering metabolic parameters, but strong evidence to determine the duration of their effects is yet to be established. When determining the best method of weight loss, metabolic parameters, target weight loss, and risk-benefit analysis must be considered carefully. In this review, we address the pros and cons for the optimal way to restore metabolic homeostasis.