Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries.

BACKGROUND: Benefits of cardiopulmonary rehabilitation (CPR) in patients with chronic obstructive pulmonary disease (COPD) are well established, but long-term sustainability of training-induced effects and its translation into healthy lifestyles are unsolved issues. It is hypothesized that Integrated Care Services supported by Information and Communication Technologies (ICS-ICT) can overcome such limitations. In the current study, we explored 3 ICS-ICT deployment experiences conducted in Barcelona, Trondheim and Athens. METHODS: In the 3 sites, a total of 154 patients completed an 8-week supervised CPR program. Thereafter, they were allocated either to an ICS-ICT group or to usual care (CPR + UC) during a follow-up period of at least 12 months with assessment of 6-min walking test (6MWT) as main outcome variable at all time points in the 3 sites. Because real deployment was prioritized, the interventions were adapted to site heterogeneities. RESULTS: In the ICS-ICT group from Barcelona (n = 77), the use of the personal health folder (PHF) was the cornerstone technological tool to empower COPD patients for self-management showing high applicability and user-acceptance. Long-term sustainability of training-induced increase in exercise capacity was observed in ICS-ICT compared to the control group (p = 0.01). Likewise, ICS-ICT enhanced the activities domain of the SGRQ (p < 0.01) and daily physical activity (p = 0.03), not seen in controls. No effects of ICS-ICT were observed in Trondheim (n = 37), nor in Athens (n = 40), due to technological and/or organizational limitations. CONCLUSIONS: The study results suggest the potential of the ICS-ICT Barcelona's approach to enhance COPD management. Moreover, it allowed identification of the factors limiting transferability to the other sites. The research prompts the need for large multicenter trials specifically designed to assess effectiveness, efficiencies and transferability of this type of intervention.

[Drug treatment of school children with attention deficit and hyperactivity disorder]. / Medikamentell behandling av skolebarn med oppmerksomhetssvikt og hyperaktivitet.

BACKGROUND: The use of stimulants in the treatment of AD/HD has increased dramatically over the last twenty years. We wanted to assess the prevalence of students treated with stimulants in the elementary schools in the city of Trondheim, Norway. MATERIAL AND METHODS: Fifty of 53 schools (94%), representing 16,141 students, answered two questionnaires. Mentally retarded, autistic and otherwise severely handicapped students attending special groups or schools, were excluded. RESULTS: In all, 57 students (3.5 per 1,000) were treated with either methylphenidate or racemic amphetamine. Multivariate analysis suggested that the structure of the classroom was an essential risk factor for being treated with stimulants. The risk was higher in so-called "open schools" (no fixed walls between groups of students) than in schools with traditional classrooms (< 30 students in rooms separated by fixed walls). (Odds ratio: 5.5; 95% confidence interval: 1.1-26.4.) More detailed information was obtained from 47 of the 57 students; only one of whom was female. Teaching resources required for optimal pedagogical treatment were available for about one out of two of these 47 students. INTERPRETATION: Our results do not suggest that an inappropriately high proportion of students in the region are taking stimulants for AD/HD. On the contrary, AD/HD may be underdiagnosed and inadequately treated in girls. It seems likely that students with AD/HD are less likely to be treated with stimulants in schools with traditional classrooms, and our results also suggest a lack of teaching resources for these students.