Impact of digital transformation on tropical health / Impacto de la transformación digital en la salud tropical

La Transformación Digital (TD) es todo un proceso que busca optimizar la relación usuario­organización, mejorando así los procesos y el desempeño. Con la llegada de la pandemia COVID-19 a principios del año 2020, cuando fue necesario acelerar la inclusión de las Tecnologías de Información y Comunicación (TIC) para continuar ofreciendo los servicios sanitarios, se constituye el sistema peruano de TD como un sistema funcional; con normas, principios y procedimientos; y con técnicas e instrumentos para ordenar las actividades del sector público y con miras a su optimización. Se planteó una investigación de carácter descriptivo para conocer el impacto de la transformación digital en la salud tropical del Perú. Para ello se determinaron el impacto en la gestión de datos, gobernanza, e intercambio de conocimiento e innovación digital de 4 enfermedades metaxénicas y 3 zoonóticas seleccionadas a partir del análisis de los distintos componentes de la sala virtual de situación de salud del Centro Nacional de Epidemiología, Prevención y Control de Enfermedades del Perú. Los datos fueron analizados bajo el Sistema de Información para la Salud (IS4H) de la OPS que permitió valorar la interoperabilidad de los procesos relacionados con la categorización de estas nosologías. Para todos los factores evaluados: gestión de datos, innovación, gestión y gobernanza y gestión e intercambio de conocimiento, los resultados, en general, estuvieron alrededor de la media (3 puntos, en una escala del 1 al 5), siendo el valor más alto (3,3 puntos) para la gestión y gobernanza, y el valor más bajo (2,7 puntos) para la innovación. Se necesita un enfoque más holístico en la salud pública para asegurarse de que se proporcione una respuesta eficaz frente a las enfermedades tropicales. Si los sistemas de salud se colocan en el medio de la acción, esto permitiría tener mayores posibilidades de hacer frente a estas enfermedades mediante el uso adecuado de las herramientas modernas que logren complementar el enfoque tradiciona(AU)

Digital Transformation (TD) is a whole process that seeks to optimize the user-organization relationship, thus improving processes and performance. With the arrival of the COVID-19 pandemic at the beginning of 2020, when it was necessary to accelerate the inclusion of Information and Communication Technologies (ICT) to continue offering health services, the Peruvian DT system was established as a functional system; with norms, principles and procedures; and with techniques and instruments to order the activities of the public sector and with a view to their optimization. A descriptive investigation was proposed to know the impact of digital transformation on tropical health in Peru. For this, the impact on data management, governance, and exchange of knowledge and digital innovation of 4 metaxenic and 3 zoonotic diseases selected from the analysis of the different components of the virtual health situation room of Centro Nacional de Epidemiología, Prevención y Control de Enfermedades of Peru. The data were analyzed under PAHO's Information System for Health (IS4H), which made it possible to assess the interoperability of the processes related to the categorization of these nosologies. For all the factors evaluated: data management, innovation, management and governance, and knowledge management and exchange, the results, in general, were around the average (3 points, on a scale from 1 to 5), with the highest value being highest (3.3 points) for management and governance, and the lowest value (2.7 points) for innovation. A more holistic approach to public health is needed to ensure that an effective response to tropical diseases is provided. If health systems are placed in the middle of the action, this would allow them to have greater possibilities of dealing with these diseases through the appropriate use of modern tools that manage to complement the traditional approach(AU)

Rompiendo la infodemia: descubriendo el SARS-CoV-2 / Breaking infodemic: discovering SARS-CoV-2

By December 2019, multiple cases of unexplained pneumonia were reported in some hospitals in the city of Wuhan, China. Since then, it had been confirmed that it corresponded to an acute respiratory infection caused by a new coronavirus that spread quickly, becoming pandemic in a very short time. On the other hand, this pandemic forced confinement for months, something unprecedented. In that time, millions of people went online for entertainment, education, etc. Consequently, the use of the Internet increased, bringing, on the one hand, online education, and entertainment on the Internet, ensuring social distancing; and on the other hand, it brought new new risks to human life, among them rumors. In this way and given the large number of publications that could denote the level of misinformation about COVID-19 and the impact it could have on global public health, various scientific publications were analyzed and identified from a bibliometric point of view. Potential relationships between the descriptors obtained from the bibliometric search were identified. The results were conglomerated into 5 clusters: Cluster 1, related to studies on access to information provided on COVID-19; cluster 2 shows the list of studies that have been carried out on the information on the COVID-19 vaccine, cluster 3 analyzes the different responses given by conspiracy theories, rumors and misinformation about COVID-19, the Group 4 shows cross-sectional and longitudinal research on COVID-19 and the information it provides to the health sector, and cluster 5 represents studies on scientific production and communication that have contributed to global health during the pandemic(AU)

Para diciembre de 2019, se registraron múltiples casos de una neumonía inexplicables en algunos hospitales de la ciudad de Wuhan, China. Desde ese momento se había confirmado correspondía a una infección respiratoria aguda causada por un nuevo coronavirus que se propagó rápidamente haciéndose pandémico en muy poco tiempo. Por otra parte, esta pademia obligó a un confinamiento por meses, algo sin precedente. En ese tiempo, millones de personas se conectaron en línea para entretenimiento, educación, etc. En consecuencia, el uso de Internet aumentó trayendo, por una parte, educación online y entretenimiento en Internet asegurando el distanciamiento social; y por otra parte, trajo nuevos nuevos riesgos a la vida humana, entre ellos los rumores. En ese sentido, y ante la gran cantidad de publicaciones que podrían denotar el nivel de desinformación sobre el COVID-19 y el impacto que podría tener en la salud pública mundial, se analizaron e identificaron diversas publicaciones científicas desde el punto de vista bibliométrico. Se identificaron las relaciones potenciales entre los descriptores arrojados de la búsqueda bibliométrica. Los resultados se conglomeraron en 5 clúster: El clúster 1, relacionado con los estudios sobre el acceso a la información proporcionada sobre COVID-19; el clúster 2, muestra la relación de los estudios que se han realizado sobre la información de la vacuna COVID-19, el clúster 3, analiza las distintas respuestas que dan las teorías conspirativas, los rumores y la desinformación sobre el COVID-19, el grupo 4 muestra investigaciones transversales y longitudinales sobre el COVID-19 y la información que brinda al sector salud, y el clúster 5 representa los estudios sobre producción y comunicación científicas que han contribuido a la salud mundial durante la pandemia(AU)

Digital Inclusion for Farmworkers in a Pandemic: The North Carolina Farmworker Health Program Internet Connectivity Project, 2020‒2021.

The North Carolina Farmworker Health Program (NCFHP) implemented an emergency program in response to North Carolina migrant and seasonal farmworkers' urgent need for Internet access for health information, family connections, and telehealth services during COVID-19 isolation and quarantine. This article describes the NCFHP Internet Connectivity Project implementation and evaluation from June 2020 to December 2021. The project placed 448 devices across the state and provided Internet access to more than 3184 farmworkers during the 2021 peak farming season. (Am J Public Health. 2022;112(11):1551-1555. https://doi.org/10.2105/AJPH.2022.307017).

Does providing free internet access to low-income households affect COVID-19 spread?

This paper evaluates whether a policy of providing free, in-home Internet for lower-income households can reduce COVID-19 case rates among those households. Using data from a pilot program in Toronto, we find that deploying free public WiFi in large apartment blocks within a low-income neighborhood leads to a 14.4% reduction in weekly cases in that neighborhood. Having in-home WiFi reduces the propensity of residents to visit businesses in the arts, entertainment, and recreation category, suggesting that WiFi benefits residents by providing in-home substitutes for leisure activities.

Factors Associated with Emotion Regulation in Men with Internet Access Living in Brazil during the COVID-19 Pandemic.

Objective: to evaluate the factors associated with emotion regulation in men with internet access living in Brazil during the COVID-19 pandemic. Method: an epidemiological survey, conducted with 1015 men. An electronic form was applied containing sociodemographic and occupational characteristics, support and coping strategies, as well as emotional and behavioral aspects. Emotion regulation was assessed using the Emotion Regulation Questionnaire. Results: The prevalence values observed were 44.6% for Low Cognitive Reappraisal and of 47.1% for High Emotional Suppression. The following factors were identified as associated: (a) with Low Cognitive Reappraisal: being aged 30 years old or more, practicing physical activity, worrying about social distancing and having positive emotions and feelings; and (b) with High Emotional Suppression: being heterosexual, non-white race/skin color, having security support or public administration, not sanitizing food, worrying about lack of physical activity and not having negative emotions. Conclusion: the adoption of emotion regulation strategies was associated with individual, contextual and emotional/behavioral characteristics. Masculinity ideals seem to exert an influence on these relationships.

The Association of Broadband Internet Access and Telemedicine Utilization in rural Western Tennessee: an observational study.

BACKGROUND: Broadband access has been highlighted as a national policy priority to improve access to care in rural communities. OBJECTIVE: To determine whether broadband internet availability was associated with telemedicine adoption among a rural patient population in western Tennessee. METHODS: Observational study using electronic medical record data from March 13th, 2019 to March 13th, 2021. Multivariable logistic regression incorporating individual-level characteristics with broadband availability, income, educational attainment, and primary care physician supply at the zip code level, and rural status as determined at the county level. SETTING: Single health system in western Tennessee. PARTICIPANTS: Adult patients with one or more in-person or remote encounter in a health system in western Tennessee and residing in western Tennessee between March 13th, 2019 and March 13th, 2021 (N = 54,688). OUTCOME MEASURES: Completion of one or more video encounters in the year following March 13th, 2020 (N = 3199; 7%). Our primary characteristic of interest was the proportion of residents in each zip code with access to the internet meeting the Federal Communications Commission definition of broadband access, adjusting for age, gender, race, income, educational attainment, insurance type, rural status, and primary care provider supply. RESULTS: Patients in a rural western Tennessee health system were predominantly white (79%), residing in rural zip codes (73%) with median household incomes ($52,085) less than state and national averages. Patients residing in a zip code where there is 80 to 100% broadband access compared to 0 to 20% were more likely in the year following March 13th, 2020 to have completed both telemedicine and in-person visits ([OR; 95% CI] 1.57; 1.29, 1.94), completed only telemedicine visits (2.26; 1.71, 2.97), less likely to have only completed in-person visits (0.81; 0.74, 0.89), but no more or less likely to have accessed no care (1.07; 0.97, 1.18). DISCUSSION: The availability of broadband internet was shown to be one of many factors associated with the utilization of telemedicine for a rural, working-class community after March 13th, 2020. CONCLUSIONS: Access to broadband internet is a determinant of access to telemedicine for patients in rural communities and should be a priority for policymakers interested in improving health and access to care for rural patients.

Internet access is a necessity: a latent class analysis of COVID-19 related challenges and the role of technology use among rural community residents.

BACKGROUND: Rural and remote communities faced unique access challenges to essential services such as healthcare and highspeed infrastructure pre-COVID, which have been amplified by the pandemic. This study examined patterns of COVID-related challenges and the use of technology among rural-living individuals during the first wave of the COVID-19 pandemic. METHODS: A sample of 279 rural residents completed an online survey about the impact of COVID-related challenges and the role of technology use. Latent class analysis was used to generate subgroups reflecting the patterns of COVID-related challenges. Differences in group membership were examined based on age, gender, education, race/ethnicity, and living situation. Finally, thematic analysis of open-ended qualitative responses was conducted to further contextualize the challenges experienced by rural-living residents. RESULTS: Four distinct COVID challenge impact subgroups were identified: 1) Social challenges (35%), 2) Social and Health challenges (31%), 3) Social and Financial challenges (14%), and 4) Social, Health, Financial, and Daily Living challenges (19%). Older adults were more likely to be in the Social challenges or Social and Health challenges groups as compared to young adults who were more likely to be in the Social, Health, Financial, and Daily Living challenges group. Additionally, although participants were using technology more frequently during the COVID-19 pandemic to address challenges, they were also reporting issues with quality and connectivity as a significant barrier. CONCLUSIONS: These analyses found four different patterns of impact related to social, health, financial, and daily living challenges in the context of COVID. Social needs were evident across the four groups; however, we also found nearly 1 in 5 rural-living individuals were impacted by an array of challenges. Access to reliable internet and devices has the potential to support individuals to manage these challenges.

Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programs.

BACKGROUND: Cystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models. METHODS: Adult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth. RESULTS: Ninety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion. CONCLUSION: During the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.

Perceived Diet Quality, Eating Behaviour, and Lifestyle Changes in a Mexican Population with Internet Access during Confinement for the COVID-19 Pandemic: ESCAN-COVID19Mx Survey.

Perceived changes in diet quality, emotional eating, physical activity, and lifestyle were evaluated in a group of Mexican adults before and during COVID-19 confinement. In this study, 8289 adults answered an online questionnaire between April and May 2020. Data about sociodemographic characteristics, self-reported weight and height, diet quality, emotional eating, physical activity, and lifestyle changes were collected. Before and after confinement, differences by sociodemographic characteristics were assessed with Wilcoxon, Anova, and linear regression analyses. Most participants were women (80%) between 18 and 38 years old (70%), with a low degree of marginalisation (82.8%) and a high educational level (84.2%); 53.1% had a normal weight and 31.4% were overweight. Half (46.8%) of the participants perceived a change in the quality of their diet. The Diet Quality Index (DQI) was higher during confinement (it improved by 3 points) in all groups, regardless of education level, marginalisation level, or place of residence (p < 0.001). Lifestyle changes were present among some of the participants, 6.1% stopped smoking, 12.1% stopped consuming alcohol, 53.3% sleep later, 9% became more sedentary, and increased their screen (43%) as well as sitting and lying down time (81.6%). Mexicans with Internet access staying at home during COVID-19 confinement perceived positive changes in the quality of their diet, smoking, and alcohol consumption, but negative changes in the level of physical activity and sleep quality. These results emphasise the relevance of encouraging healthy lifestyle behaviours during and after times of crisis to prevent the risk of complications due to infectious and chronic diseases.

National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey.

BACKGROUND: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. OBJECTIVE: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. METHODS: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). RESULTS: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. CONCLUSIONS: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities.

Disparities in Technology and Broadband Internet Access Across Rurality: Implications for Health and Education.

Amidst the COVID-19 pandemic, interest in using telehealth to increase access to health and mental health care has grown, and school transitions to remote learning have heightened awareness of broadband inequities. The purpose of this study was to examine access and barriers to technology and broadband Internet service ("broadband") among rural and urban youth. Washington State public school districts were surveyed about youth's access to technology (ie, a device adequate for online learning) and broadband availability in spring 2020. Availability of and barriers to broadband (ie, geography, affordability, and smartphone-only connectivity) were assessed across rurality. Among responding districts, 64.2% (n = 172) were rural and 35.8% (n = 96) were urban. Rural districts reported significantly fewer students with access to an Internet-enabled device adequate for online learning (80.0% vs 90.1%, P < .01). Access to reliable broadband varied significantly across geography (P < .01). Compared with their urban peers, rural youth face more challenges in accessing the technology and connectivity needed for remote learning and telehealth. Given that inadequate broadband infrastructure is a critical barrier to the provision of telehealth services and remote learning in rural areas, efforts to improve policies and advance technology must consider geographical disparities to ensure health and education equity.

The Moral Requirement for Digital Connectivity.

Crises illustrate the value of digital connectedness. When our physical routines are disrupted, having alternative options to connect with others is important. Yet there are clear divisions in access to the internet, and in the distribution of the skills required to take advantage of the internet. I argue that the COVID-19 pandemic is but one example of a more general idea; that everyone has a moral claim to internet access. We ought to use this opportunity to address the continued inequities in internet access and use amongst our population.

Disparities in Audio-only Telemedicine Use Among Medicare Beneficiaries During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Under emergency coronavirus disease 2019 pandemic regulations, Medicare granted temporary payment parity with in-person visits for audio-only (telephone) telemedicine visits. This policy was designed to expand telemedicine to patients without camera-equipped devices and broadband internet. However, audio-only telemedicine use has been substantial. OBJECTIVE: The aim of this study was to explore whether the rate of audio-only telemedicine during the pandemic is related to patient access to technology or provider behavior. DESIGN: Cross-sectional analysis of the Summer and Fall 2020 Medicare Current Beneficiary Survey coronavirus disease 2019 supplements, using multivariable logistic models and accounting for complex survey design. SUBJECTS: A total of 3375 participants in the summer survey and 2633 participants in the fall 2020 were offered a telemedicine visit to replace a scheduled in-person visit by their usual care provider. MEASURES: We compared beneficiaries who were exclusively offered audio-only telemedicine to beneficiaries who were offered video telemedicine or both audio and video. RESULTS: We found that among Medicare beneficiaries who were offered telemedicine to replace a scheduled in-person appointment, ~35% were exclusively offered audio-only. 65.8% of beneficiaries exclusively offered audio-only reported having a smartphone/tablet and home internet. After controlling for personal access to technology, Hispanic [adjusted odds ratio (AOR)=2.09, P<0.001], dually eligible (AOR=1.63, P=0.002), nonprimary English speaking (AOR=1.64, P<0.001), and nonmetro beneficiaries (AOR=1.71, P=0.003) were more likely to be offered audio-only during July-November 2020. CONCLUSIONS: These findings suggest audio-only telemedicine use during the pandemic is only partially related to patient access to technology. Policymakers must work to both expand programs that provide smartphones and broadband internet to disparity communities and telemedicine infrastructure to providers.

Accessibility of Telehealth Services During the COVID-19 Pandemic: A Cross-Sectional Survey of Medicare Beneficiaries.

INTRODUCTION: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults. METHODS: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy. RESULTS: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment. CONCLUSION: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.

Telemedicine in Peru as a Result of the COVID-19 Pandemic: Perspective from a Country with Limited Internet Access.

The COVID-19 pandemic contributed to the worldwide implementation of telemedicine because of the need for medical care for patients, especially those with chronic diseases. This perspective paper presents the current situation of telemedicine in Peru, showing advances in regulation, cases of successful implementation, and the current challenges. Access to health should be available to all, and more efforts need to be implemented to offer access to the internet to achieve high-quality telemedicine to all the vulnerable groups in Peru.