Text messaging, email, digital photography, GPS, web surfing… and health.
When smart phones or tablets are used to make personal health decisions, manage medical care or transmit health information, they become part of a rapidly expanding field know as mHealth.
Doctors, patients, healthcare administrators and even students in UGA’s New Media Institute are paying attention and getting involved with wireless innovations related to health. If you operate on Gizmodo time, then mHealth is not a new concept. Experts have been excited about its benefits – and concerned about pitfalls — for years.
Dr. Joseph Kim is one of them.
Originally trained as a physician, he has founded three websites focused on medicine and technology and become an mHealth pundit who speaks often to professional groups. Last month he cautioned an audience of journalists that the world of health-related mobile apps is a wild frontier where anything can happen.
Anyone with the technical know-how can develop an mHealth app, they aren’t regulated by any government agency or medical association, erroneous information may be built into them and an app might violate individual privacy, Kim told the Association of Health Care Journalists.
No special credentials are needed to develop an app and classify it as “health” or “medical,” said Kim, and distribution through iTunes and similar services for other platforms is near universal.
At the University of Georgia’s New Media Institute (NMI), students who develop health-related apps for smart phones are not required to have any training in health or medicine.
“We think it [the cell phone] is a really potentially useful tool for communicating important personal information about health to people,” said Dr. Scott Shamp, director of the institute.
The NMI has been operating in the mHealth space since 2004, when students spent one day producing mobile PSA’s encouraging individuals to be checked for HIV status.Now, students devote entire semesters to develop “promo”-types – designed to show the range of technical possibilities – of applications showing how technology could be used to advance personal health, said Shamp.
Although student projects at the NMI are never intended for distribution to the public, the fact that students can make them indicates how simple it is for a tech-savvy group to produce these apps. Students earn a New Media Certificate by successfully completing four courses, including the one where they have the opportunity to design health apps.
“Our focus is on idea generation,” said Shamp, whose students build apps that encourage people to exercise more, or eat less, but do not venture into wireless manipulation of diagnosis, disease management, or medical treatment.
Like Kim, Shamp knows this is no place for amateurs.
“You get into a whole lot more dangerous realm when you start talking about collecting healthcare information,” Shamp said, “that’s one thing that people consider to be very private.” People see health information as highly personal, because lives can be upended by stigma and discrimination related to health status.
That said, phones are also highly personal “When was the last time you let someone see your phone?” Shamp asked.
Since people are less likely to share their cell phone with others, they may assume that the information uploaded into mHealth apps is secure as well. But, we are quickly finding out about the grave potential of privacy breaches from cell phone makers and service providers: consider the recent tracking revelation with Apple.
Because there are no regulations or legal protections associated with mHealth apps, naïve patients may place their own health, or health information, at risk by using them, said Kim.
Felicia Harris is a graduate student at the University of Georgia. With a concentration in Mass Media, she is interested in the media’s effects on people’s well-being and livelihood.
MONROE, Ga. – A recent study suggests that doctors can learn a great deal simply by timing how long it takes an older person to walk a set distance at a normal pace. In fact, they can gain some idea of how long that person will live.
Researchers who analyzed walking speed and survival for nearly 35,000 seniors concluded that gait speed could become a new “vital sign” that can be used to predict how long people will live.
“Walking is the result of proper functioning of a complex network of organs, systems and apparati,” said Dr. Matteo Cesari, a geriatric specialist in Rome whose editorial accompanied the study in the January 5th issue of the Journal of the American Medical Association.
“We do not know whether a person walks fast because he or she is healthy, or vice versa,” said Cesari, “this is not trivial because in medicine you need to treat the cause to have a significant effect, not the consequence.”
These observations ring true for Vicki Gasaway, who sees the correlation between walking pace and health in her clients at the Walton County Senior Citizen’s Council, Inc.
You notice people moving a little slower and those are the people who start participating less and eventually die, said Gasaway, who has worked with elderly people for 10 years and is executive director of the Center.
Researchers analyzed information about gait speed from nine large studies collected between 1986 and 2001. Although methods varied slightly from study to study, all timed walking speed over a measured distance.
This is a quick, easy and inexpensive assessment for caregivers or health providers to perform and monitor over time: all it takes is a four-meter walkway and a stopwatch.
Energy, movement control, and multiple organ systems are all involved in walking, which is why slower walking may be a warning signal in older patients – especially those who say they are doing fine.
Aging and diseases are primary contributors to a slowing gait speed, said Cesari. A decreasing gait speed could provide a warning sign for caregivers, pointing to underlying health conditions before they become clinically evident.
The assessment for gait speed aids physicians in determining a patient’s biological age, in other words, moving away from birth dates to determining how old their body is.
At Walton County Senior Citizen’s Council, birth age takes a back seat to biological age for citizens who exercise weekly, do chair exercises with a nutritionist, and even line dance.
“We have a few 90-something year olds who are still very active,” said Gasaway, “they have some health issues but they keep coming and their mobility is quite good.”
The team of researchers found that remaining years of life for each sex and age increased as walking speed increased, with gait speeds of one meter per second or higher consistently signifying survival that was longer than expected by sex and age alone.
Still, Cesari stresses the importance of gait speed as only a complementary guideline to improve routine clinical assessments.
“You should not consider gait speed as a condition to treat, but only as a marker of wellbeing,” said Cesari.
Felicia Harris is a graduate student at the University of Georgia. With a concentration in Mass Media, she is interested in the media’s effects on people’s well-being and livelihood.
References to the human papillomavirus (HPV) vaccine and cervical cancer have become inescapable on television, at the doctor’s office and online. And until recently, young women have been the only ones targeted in the push for HPV vaccination.
Rhonda Dyar, nurse manager of the health department in rural Hart County, Ga., says this hype surrounding HPV immunization definitely influences patients who come to her clinic.
“People will ask about the vaccine because they’ve seen it on television,” said Dyar. “When [they] refuse it, it’s because they’ve heard false information.”
What her patients aren’t talking about – and what isn’t mentioned in ads – is that HPV is a health concern for men as well as women.
Half of all sexually active women and men will be infected with HPV at some point in their lives. Most will never know since these infections usually come and go without a sound.
However, two strains of the virus are to blame for cervical cancer, 90 percent of anal cancers and a small percentage of other genital cancers that occur in both sexes. Two others are associated with most cases of genital warts.
Despite this and the fact that the CDC’s Advisory Committee on Immunization Practices (ACIP) allows physicians the option to vaccinate males, Dyar says she’s never been asked to administer an HPV vaccine to a male.
But now a study shows that HPV immunization protects men and boys – in addition to women – against infection.
The international study found that the vaccine Gardasil – designed to thwart infection by the four strains of HPV that cause warts or cancer – prevents initial HPV infection and genital warts in males aged 16 – 26. The report was published in the February 3rd issue of the New England Journal of Medicine.
Blocking HPV infection in males could reduce HPV-related diseases in both sexes, says Dr. Joel Palefsky, an infectious disease specialist at the University of California, San Francisco, and one of the lead researchers.
So the next step is to vaccinate everyone, right?
It’s not that simple, according to Jane J. Kim, an assistant professor of health decision science at Harvard University.
The decision to universally vaccinate depends on several factors, with cost effectiveness being the ultimate influence. And right now, she says, it looks like vaccinating both sexes is not the most effective use of health dollars.
“For the prevention of cervical cancer, vaccinating young girls is where you get the most benefit,” Kim said. “Boosting their vaccination rates would be most cost effective.”
The percentage of fully vaccinated girls in the United States is low, under 30 percent, but has been rising. As long as those rates continue to increase, Kim says, vaccinating boys won’t add much benefit for the money being spent.
But if uptake in females remains static or drops, it makes more sense to vaccinate boys along with girls. Cost effectiveness could also increase if vaccine prices go down or if proof of their benefits continues to grow.
And the benefits do appear to be growing.
While ACIP currently recommends routine HPV vaccination only for females, the FDA recently approved the vaccine for prevention of anal cancer, which is most common in men who have sex with men. Since it’s hard to target that high-risk population, and since vaccination is most effective before sexual activity begins, many say the solution is routine immunization of both sexes at an early age.
“If ‘all’ you’re doing is preventing genital warts, then it’s probably not cost effective to vaccinate boys for that,” said Palefsky. He hopes the new data on vaccine effectiveness in preventing anal cancer, along with reassessment of the cost effectiveness model, will encourage ACIP to recommend the vaccine for routine use in both sexes.
Implementing routine vaccination of males, however, is easier in theory than in practice, especially for populations already experiencing barriers to HPV prevention. In Southern and rural areas HPV vaccine coverage is lower and cervical cancer rates higher due to poor access to health care, low health funding and inadequate health education.
In Hart County, the cost of vaccination and not understanding the risks of HPV can affect vaccination rates, says Dyar. HPV vaccines are among the most expensive, and the health department is one of the only places to provide affordable vaccine options.
Dyar also believes it would be challenging to persuade parents and young men to vaccinate for HPV. Males tend to avoid medical attention anyway, she says, and sexually transmitted infections carry a stigma. And that stigma might double in rural areas for the other target population – men who have sex with men.
Overall, Dyar says, patients often don’t grasp the real meaning of HPV infection and how vaccines can prevent it as well as related diseases.
The answer to such barriers, Palefsky says, is education. “People need to understand better the connection between HPV and the diseases that we’re trying to prevent.”
As autistic children grow into adolescents and young adults, the Athens area offers public and private resources to smooth the transition into life after high school.
“There’s so much here that people don’t know about,” said Cheryl Boop, a licensed occupational therapist and vice-president of the Georgia Occupational Therapy Association. “So people end up traveling to Atlanta because they are unaware of all the services here.”
Public school programs and initiatives at the University of Georgia provide many resources close at hand.
Autism spectrum disorders are developmental disabilities that can cause significant social, communication and behavioral challenges. The Centers for Disease Control and Prevention (CDC) estimates that one in every 110 children is affected, and these conditions may be somewhat more common in Georgia.
The Individuals with Disabilities Education Act requires public schools to set up individual education plans for students with developmental disabilities, including autism, and to serve these young people until they are 21.
Many people with autism take longer to graduate from high than their classmates.
For autistic students in Clarke County Schools, transition planning begins at age 14.
“We start doing vocational assessments that really start speaking to the student’s strengths and linking them to a specific vocational skill,” said Donna Elder, special education coordinator for Clarke County schools and overseer of the autism program.
The school system works with TJ-Maxx and other local employers to identify jobs that will be a good fit for students after they leave high school. Students prepare by learning job readiness skills including time management and conflict resolution.
Social relationships are a struggle for many people with autism, and a two-year old program called Building Friendship Frontiers (BFF) pairs college students with autistic teens at Clarke Central High School and Cedar Shoals High School.
“The goal is to strengthen the teens’ social skills,” said Sheena Zhang, a senior ecology and biology major at UGA. She founded the program so UGA students would have an opportunity to engage with the local community.
“It’s really easy as a UGA student for people to forget about the citizens of Athens,” said Zhang. “Everyone is just driving around in their Mercedes and SUVs and no one is thinking about how badly the people who live here are doing.”
Each BFF volunteer is paired with an autistic teen – usually a low-income youth – and commits to having lunch with the student at school on a weekly basis. If the relationship flourishes, the volunteers arrange other shared activities such as going to the park or going to a movie outside school.
In Clarke County, 39 percent of children live at or below the federal poverty level and local schools receive Title 1 funds to help narrow achievement gaps between low-income and other students. Because schools have much to offer, many families depend solely on the school system for support.
But they can also turn to programs at UGA.
One is the Clinic for Autism Spectrum Evaluation and Research, or CASPER, which provides comprehensive assessment services for children, from 18 months through 22 years, with suspected or confirmed autism spectrum disorders.
The 8-year old clinic, which serves 5 or 6 families a year, is part of the College of Education’s Autism Spectrum Disorders Research and Training Consortium.
Many young people with autism are intellectually capable of pursuing higher education, and many colleges and universities now offer support that helps them fulfill this potential.
Counselors at the Disability Resource Center at UGA provide students with advice about course selections and scheduling, meet regularly with students to track academic progress and other issues related to the disability, and organize support groups. Counselors can also refer students for tutoring or additional help on campus, as well as privately.
“The University of Georgia’s Disability Resource Center helps us out a lot with our kids who are attending college,” said Boop, the occupational therapy expert.
Another resource for families is Georgia Options, a non-profit organization located in Bogart, Georgia. The organization helps individuals with disabilities live on their own.
Because various agencies and institutions provide various services, families still struggle to find everything needed to help teens make the transition to the post-high school world.
“Progress is being made, but we really need to find a way to bring all the resources together,” said Boop. “We have some amazing people here in Athens, we just need to let people know about them.”
Gainesville, Ga.— A new US Department of Agriculture proposal calls for major nutritional overhauls in school lunches nationwide, but Hall County School officials aren’t worried about pending reforms.
The new rules, which are expected to go into effect within the next year, will require school cafeterias to incorporate more whole grains, fruits and vegetables into their menus. Recipes will need to cut sodium content by more than half, reduce the amount of saturated fat, and limit potatoes and other starchy vegetables. Lunchrooms will be required to offer only low-fat or fat free milk.
The new regulations aim to combat growing childhood obesity rates and teach children healthier eating habits. Georgia ranks second in childhood obesity prevalence in the United States.
Hall County is “way ahead of the curve” in terms of meeting new health standards, according to Jennifer Teems, the school nutrition coordinator for the county schools.
“It’s not like before [the proposal] we thought it was OK to have 1500 mg of sodium and now we think that’s way too much,” Teems said. “Hall County has two registered dieticians on staff, myself and HillarySavage and we are constantly looking for items that better suit their health needs.”
For example, Hall County schools offer students a salad entrée every day, even though this isn’t a state or federal requirement. School cafeterias offer as many as eight nutritionally sound side dishes daily, including raw and cooked vegetables and fresh fruit. Even dessert selections aren’t overly indulgent, Teems said. For example, baked apples and juice bars made from 100 percent fruit juice are listed as desserts, but nutritionally they’re fruits in disguise.
Deep-fat fryers haven’t been used in Hall County school lunchrooms for more than three years. “All of our fries are baked, so we count them as a vegetable,” Teems said. Potatoes in one form or another are offered every day in Hall County schools, but that may have to change. USDA’s proposed rules limit potatoes and other starchy vegetables to one cup per week.
The biggest challenge will be reducing sodium content of meals by half. This will be a problem for school systems everywhere until their food suppliers bring their products into line with the new sodium requirements, Teems said. This could take a few years.
Outside the lunchroom, federal law already prevents school-supported nutrition programs from selling carbonated drinks, gum, candy or other foods of “minimal nutritional value,” according to Marilyn Yon, a nutrition consultant for the state education department.
But there’s a loophole: vending machines operated by school principals or athletic departments can still dispense junk food to kids. These fund-raising vending machines will face increased scrutiny, Yon said, when the USDA begins implementing a separate law passed by Congress last December, the Healthy and Hunger-Free Kids Act. This act gives the secretary of the USDA authority to set standards for all foods available on school campuses.
In the meantime, Teems said she and her colleagues are always looking for new ways to improve the school menu. The nutritionists considered replacing the traditional white-flour biscuit with a more healthful whole grain version, but said they were wary of how this might be received.
“Of course we want to offer kids the best, but it’s not going to do any good if the kids aren’t eating what we serve them,” Teems said. “Food is a sensitive topic, and people don’t like change in general.”
Overall, she expects the majority of parents, students and teachers will approve of the healthier choices. “With 26,000 kids, there are bound to be some negative reactions,” Teems said, “but if everyone who liked the changes spoke up I’m sure the response would be overwhelming.”
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