Perceptions and Experiences of Healthcare Providers and Patients Towards Digital Health Services in Primary Health Care: A Cross-Sectional Study.

BACKGROUND: Digital health has the potential to help achieve the Sustainable Development Goals (SDGs) by supporting health systems and enhancing health promotion and disease prevention. However, obstacles such as restricted internet access, inadequate technical assistance, clinical resource disparity, and insufficient user training can impede the utilization and growth of digital health. Researchers should examine healthcare providers' and patients' perspectives to identify challenges and enhance usability. METHODOLOGY: The study was conducted among women health volunteers, staff nurses, and patients who used the VinCense mobile application (MedIoTek Health Systems Private Limited, Chennai, India) to record vital signs. A semi-structured questionnaire was used to evaluate participants' sociodemographic characteristics, perception of digital health monitoring, and patients' attitudes toward digital health monitoring devices. The data were analyzed using R programming, Version 4.3.3 (www.r-project.org). A multinomial logistic regression analysis was used to examine the association between sociodemographic characteristics and attitudes of patients toward digital health monitoring. RESULTS: The study involved 27 healthcare providers and 406 patients. The majority (66.6%) of healthcare providers found the device convenient and efficient. Around 74.1% faced technical difficulties like internet connectivity and device battery issues. Among patients, 79.8% were satisfied with their digital health monitoring experience, 86.2% found device usage comfortable and 78.1% expressed satisfaction with health education and feedback. Around 354 (87.2%) patients stated that technology has improved healthcare, and 326 (80.3%) said that health technologies have improved ease. The results indicate that female gender (p=0.00), age above 50 years (p=0.04), and occupation status as a semiskilled worker (p=0.03), skilled worker (p=0.00), and clerical/shop/farmer (p=0.01) were statistically significant and associated with the positive attitude for digital health monitoring. CONCLUSIONS: The digital health monitoring experience was found satisfactory by both patients and healthcare providers. The mobile health (mHealth) has tremendous potential for enhancing patient health. Therefore, it is advisable to contemplate an expansion of the VinCense mHealth Platform and other digital solutions to improve service delivery in primary healthcare setups.

The enigma of life: confronting marvels at the edges of science.

Einstein famously claimed that "the most incomprehensible thing about the universe is that it is comprehensible." This statement suggests that no amount of scientific explanation will suffice to make sense of the bizarre situation of the human mind within the universe. So what are the actual roles of awe and wonder within the framework of contemporary science? How, for instance, do awe and wonder inform scientists' understanding of the phenomena they are researching? What aspects of contemporary science are more likely to elicit wonder, and why? Is science rechanneling our innate thirst for knowledge and understanding toward more concrete and palpable realities, or is it aggravating the tension between truth and meaning by revealing the scope of our ignorance when it comes to probing the ultimate nature of reality? Physicist Marcelo Gleiser, experimental psychologist Tania Lombrozo, and physician Gavin Francis analyze the impact of awe and wonder on their own work and on the mindsets of their colleagues carrying out leading-edge scientific research.

Indicators and correlates of low energy availability in male and female dancers.

OBJECTIVES: To investigate indicators and correlates of low energy availability (LEA) in male and female dancers. METHODS: A Dance-Specific Energy Availability Questionnaire (DEAQ) was developed and administered online internationally to dancers training at preprofessional, professional or advanced amateur level. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Questions addressed recognised physiological indicators and consequences of LEA in the context of dance, together with potential correlates. LEA was quantified using a scoring system to include these characteristics. RESULTS: 247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with 85% practising ballet. Psychological, physiological and physical characteristics consistent with LEA were reported by 57% of the female dancers and 29% of male dancers, indicating a risk of RED-S. The unique nature of dance training, in terms of demands and environment, was found to be potentially influential in development of this situation. Less than one-third (29%) of dancers were aware of RED-S. CONCLUSION: This study found dancers to be a specific group of high-level artistic performers displaying indicators of LEA and consequently at risk of developing the adverse clinical health and performance consequences of RED-S. Awareness of RED-S was low. The DEAQ has the potential to raise awareness and be a practical, objective screening tool to identify dancers in LEA, at risk of developing RED-S.

Clinical evaluation of education relating to nutrition and skeletal loading in competitive male road cyclists at risk of relative energy deficiency in sports (RED-S): 6-month randomised controlled trial.

OBJECTIVE: To clinically evaluate education to improve eating behaviour and skeletal loading exercise in male cyclists at risk of poor bone health and impaired performance due to relative energy deficiency in sports. METHODS: Early race season, 50 competitive male road cyclists were matched, in pairs, based on Z-scores for lumbar spine bone mineral density (BMD). One member of each pair was randomly allocated to receive educational interventions. After the season, 45 cyclists returned for dual-energy X-ray absorptiometry scans and blood tests. Least significant change was applied to identify clinically meaningful BMD changes. Cyclists completed a follow-up sport-specific questionnaire and clinical interview to ascertain adherence to the interventions. RESULTS: The questionnaire and clinical interview categorised behaviour changes as positive, negative or unchanged. Positive changes in nutrition and skeletal loading were associated with a statistically significant increase of 2.0% in lumbar spine BMD; 7 of 11 cyclists' increases were clinically meaningful. Negative changes in both behaviours were associated with a significant decrease of 2.7% in lumbar BMD; all nine cyclists' BMD decreases were clinically meaningful. Regarding performance, taking account of functional threshold power, changes in nutritional behaviour accounted for gains or losses of 95 British Cycling racing points. Cyclists reported psychological barriers to change in behaviours, specifically fear of negatively impacting performance. CONCLUSIONS: Educational nutritional and skeletal loading interventions can improve bone health, well-being and race performance in male cyclists over a 6-month race season. Psychological support may be required to help some athletes change behaviour.

Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists.

OBJECTIVES: To evaluate the efficacy of a sport-specific energy availability (EA) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S). METHODS: Fifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed by a newly developed sport-specific questionnaire and clinical interview (SEAQ-I) and received dual energy X-ray absorptiometry (DXA) bone mineral density (BMD) and body composition scans and blood tests for endocrine markers. RESULTS: Low EA as assessed using the SEAQ-I, was observed in 28% of cyclists. Low lumbar spine BMD (Z-score<-1.0) was found in 44% of cyclists. EA was the most significant determinant of lumbar spine BMD Z-score (p<0.001). Among low EA cyclists, lack of previous load-bearing sport was associated with the lowest BMD (p=0.013). Low EA was associated with reduced total percentage fat (p<0.019). The 10 cyclists with chronic low EA had lower levels of testosterone compared with those having adequate EA (p=0.024). Mean vitamin D concentration was below the level recommended for athletes (90 nmol/L). Training loads were positively associated with power-to-weight ratios, assessed as 60 min functional threshold power (FTP) per kg (p<0.001). Percentage body fat was not significantly linked to cycling performance. CONCLUSIONS: This study demonstrates that a SEAQ-I is effective for identifying male road cyclists with acute intermittent and chronic sustained low EA. Cyclists with low EA, particularly in the long-term, displayed adverse quantifiable measures of bone, endocrinology and performance consequences of RED-S.

Effect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults.

INTRODUCTION: Bacterial meningitis is a medical emergency, the outcome of which is improved by prompt antibiotic treatment. For patients with suspected meningitis and no features of severe disease, the British Infection Society recommends immediate lumbar puncture (LP) before antibiotics, to maximise the chance of a positive cerebrospinal (CSF) culture. In such patients, CT scanning before LP is not needed. METHODS: The case notes of adults with meningitis admitted to a large district general hospital over 3 years were reviewed. Patients were classified as Likely Bacterial Meningitis or Likely Viral Meningitis based on their CSF and peripheral blood results using the Meningitest Criteria, with microbiological and virological confirmation. RESULTS: Of 92 patients studied, 24 had Likely Bacterial Meningitis, including 16 with microbiologically confirmed disease (none had PCR tests for bacteria). Sixty-eight had Likely Viral Meningitis, four of whom had viral PCR, including one with herpes simplex virus. No patient had an LP before antibiotics. CSF culture was positive for eight (73%) of the 11 patients who had an LP up to 4 h after starting antibiotics, compared with eight (11%) of 71 patients with a later LP (p<0.001). None of the 34 LPs performed more than 8 h after antibiotics was culture-positive. For 62 (67%) of the 92 patients, the delay was due to a CT scan, although only 20 of these patients had a contraindication to an immediate LP. CONCLUSIONS: Too many patients with acute bacterial meningitis are being sent for unnecessary CT scans, causing delays in the LP, and reducing the chances of a positive CSF culture after starting antibiotics. However, even if antibiotics have been started, an LP within 4 h is still likely to be positive. Molecular tests for diagnosis should also be requested.

Sleep during the Antarctic winter: preliminary observations on changing the spectral composition of artificial light.

Antarctic Base personnel live for 3 months in winter with no natural sunlight. This project compared sleep, by actigraphy, during periods of increased exposure to white light or blue enriched light in 2003. The primary aim was to help define the optimum spectral composition and intensity of artificial environmental light. Nine men and one woman (33 +/- 7 years, mean +/- SD), wore activity and light monitors continuously from 28.2 to 9.10, and kept sleep diaries. Extra light was provided by light boxes (standard white, 5300 K, or prototype blue enriched, 10,000 K, Philips Lighting), which were turned on in bedrooms and in communal/work areas approximately 08.00-18.00 hours. After a no-treatment control period, 28.2-20.3, sequential 4-5 week periods of first white, then blue light, were imposed with a further control period 19.9-9.10. A limited baseline study in 2002 (no interventions) similarly measured light and activity in seven men and one woman (30 +/- 7 years). Daily light exposure in winter (lux, mean +/- SD) was doubled in 2003 (maximum 1039 +/- 281, average 64 +/- 21), compared to 2002 (572 +/- 276 and 30 +/- 11), P < 0.05 and P < 0.01, with no differences between white and blue light. There were no major differences in sleep between light conditions in 2003. A delay in sleep timing was found in midwinter compared to control (2003, bedtime, P < 0.05, sleep start, P < 0.05, sleep end, P < 0.01) and sleep fragmentation increased (P < 0.05). Sleep efficiency was slightly higher during all blue light periods compared to all white periods (P < 0.05). The use of higher intensity light of suitable spectral composition is proposed.

Sleep and circadian phase in a ship's crew.

Numerous factors influence the increased health risks of seamen. This study investigated sleep (by actigraphy) and the adaptation of the internal clock in watch-keeping crew compared to day workers, as possible contributory factors. Fourteen watch keepers, 4 h on, 8 h off (0800-1200/2000-2400 h, 1200-1600/2400-0400 h, 1600-2000/0400-0800 h) (fixed schedule, n = 6; rotating by delay weekly, n = 8), and 12 day workers participated during a voyage from the United Kingdom to Antarctica. They kept daily sleep diaries and wore wrist monitors for continuous recording of activity. Sleep parameters were derived from activity using the manufacturer's software and analyzed by repeated-measures ANOVA using SAS 8.2. Sequential urine samples were collected for 48 h weekly for 6-sulphatoxymelatonin measurement as an index of circadian rhythm timing. Individuals working watches of 1200-1600/2400-0400 h and 1600-2000/0400-0800 h had 2 sleeps daily, analyzed separately as main sleep (longest) and 2nd sleep. Main sleep duration was shorter in watch keepers than in day workers (p < 0.0001). Objective sleep quality was significantly compromised in rotaters compared to both day workers and fixed watch keepers, the most striking comparisons being sleep efficiency (percentage desired sleep time spent sleeping) main sleep (p < 0.0001) and sleep fragmentation (an index of restlessness) main sleep (p < 0.0001). The 2nd sleep was substantially less efficient than was the main sleep (p < 0.0001) for all watch keepers. There were few significant differences in sleep between the different watches in rotating watch keepers. Circadian timing remained constant in day workers. Timing of the 6-sulphatoxymelatonin rhythm was later for the watch of 1200-1600/2400-0400 h than for all others (1200-1600/2400-0400 h, 5.90 +/- 0.85 h; 1600-2000/0400-0800 h, 1.5 +/- 0.64 h; 0800-1200/ 2000-2400 h, 2.72 +/- 0.76 h; days, 2.09 +/- 0.68 h [decimal hours, mean +/- SEM]: ANOVA, p < 0.01). This study identifies weekly changes in watch time as a cause of poor sleep in watch keepers. The most likely mechanism is the inability of the internal clock to adapt rapidly to abrupt changes in schedule.