Associated Press, Lauren Neergaard, July 13, 2010
What if my blood sugar’s too high today? Is it time for my blood pressure pill? With nagging text messages or more customized two-way interactions, researchers are trying to harness the power of cell phones to help fight chronic diseases.
“I call it medical minutes,” says Dr. Richard Katz of George Washington University Hospital in the nation’s capital.
He’s testing whether inner-city diabetics, an especially hard-to-treat population, might better control their blood sugar — and thus save Medicaid dollars — by tracking their disease using Internet-connected cell phones, provided with reduced monthly rates as long as they regularly comply.
Consider Tyrone Harvey, 43, who learned he had diabetes seven years ago only after getting so sick he was hospitalized for a week, and who has struggled to lower his blood sugar ever since. In May, through a study Katz began with nearby Howard University Hospital’s diabetes clinic, Harvey received a Web-based personal health record that he clicks onto using his cell phone, to record his daily blood sugar measurements.
If Harvey enters a reading higher or lower than preset danger thresholds, a text message automatically pings a warning, telling him what to do. And at checkups, doctors will use the personal health record, created by Indiana-based NoMoreClipboard.com, to track all his fluctuations and decide what next steps to advise.
“Hopefully you’re paying more attention to your numbers, too,” says Howard’s Dr. Gail Nunlee-Bland, whose clinic uses an electronic health record — your official medical history — that can automatically link to NoMoreClipboard’s consumer version and update it with things like medication changes.
The trend is called mobile health or, to use tech-speak, mHealth. If you’re a savvy smartphone user, you’ve probably seen lots of apps that claim to help your health or fitness goals — using your phone like a pedometer or an alarm clock to signal when it’s time to take your medicine.
Katz and other researchers are going a step further, scientifically testing whether more personalized cell phone-based programs can link patients’ own care with their doctors’ disease-management efforts in ways that might provide lasting health improvement.
“Mobile phones provide that opportunity for persons to get the feedback they need when they need it,” explains Charlene Quinn, an assistant professor at the University of Maryland medical school, who is testing a competing cell phone diabetes system from Baltimore-based Welldoc Inc.
After all, most of the population now carries a cell phone. Accessing the Internet with them is on the rise, too — nearly 40 percent of cell callers do, the Pew Internet & American Life Project reported last week — allowing more sophisticated digital health contact.
On the other hand, older adults are less likely to use smartphones. So are people who are sicker, with multiple chronic diseases, says Dr. Joseph Kvedar, director of the Center for Connected Health, a division of Boston’s Partners Healthcare.
Kvedar notes that nearly any phone can handle simpler text-messaging programs. Among the biggest offered to date is the free text4baby, where government-vetted health tips timed to pregnant women’s due dates are texted weekly to about 50,000 participants so far.
Do these kinds of technologies work? There’s some short-term evidence, although no one knows if people stick with it once the novelty wears off:
_In a study of 70 Boston residents to improve cancer-preventing use of sunscreen, Kvedar found daily texts with reminders hooked to the weather forecast for six weeks increased sunscreen use by 40 percent.
_Researchers at New York’s Mount Sinai Medical Center found episodes of rejection dropped when they texted take-your-medicine reminders to 41 pediatric liver transplant recipients or their caregivers, adding another text nag to the parent if teen patients didn’t quickly respond that they’d taken their dose.
_The University of California, San Diego, went a step further, designing a text-message program to encourage weight loss where participants texted back answers to such questions as “Did you buy fresh raw vegetables to snack on this week?” Answering allowed more customized texted diet tips. In a pilot study of 75 people, text-message recipients lost about four more pounds in four months than those given printed dieting advice.
_The Internet-based approach offers even more two-way interaction. This fall, Quinn will report results of a 260-patient study using a range of Welldoc phone features, including more real-time monitoring of the blood sugar fluctuations users enter. A small Welldoc pilot study found users’ average blood sugar dropped over three months.
“What systems work best with patients has yet to be figured out,” says George Washington’s Katz, who is testing a version of that program, too — and worries not just about affordability when his study is over but whether interest will wane. “Otherwise, they find it’s a nice toy to start with, and forget about it.”
via From texting to apps, using cell phones for health – Yahoo! News.
]]>AP, January 6
ALHAMBRA, Calif. (AP) — The fight against fat is going high-tech. To get an inside look at eating and exercise habits, scientists are developing wearable wireless sensors to monitor overweight and obese people as they go about their daily lives.
The experimental devices are designed to keep track of how many minutes they work out, how much food they consume and even whether they are at a fast-food joint when they should be in the park. The goal is to cut down on self-reported answers that often cover up what’s really happening.
In a lab in this Los Angeles suburb, two overweight teenagers help test the devices by taking turns sitting, standing, lying down, running on a treadmill and playing Wii. As music thumps in the background, wireless sensors on their chests record their heart rates, stress levels and amount of physical activity. The information is sent to a cell phone.
”I can’t feel my legs,” 15-year-old Amorette Castillo groans after her second treadmill run.
Traditional weight-loss interventions rely mainly on people’s memory of what they ate for dinner and how many minutes they worked out. But researchers have long known that method can be unreliable since people often forget details or lie.
The new devices are being designed in labs or created with off-the-shelf parts. Some similar instruments are already on the market, including a model that tracks caloriesburned by measuring motion, sweat and heat with armbands.
But the devices in development aim to be more sophisticated by featuring more precise electronics and sometimes even video cameras. Many emerging systems also strive to provide instant feedback and personalized treatment for wearers.
At the University of Southern California lab, the teens alternated between being sedentary and active as researchers resolved the technical bugs. Later this year, some will wear the body sensors at home on weekends. If they get too lazy, they will get pinged with a text message.
”We’ll be able to know real-time if they’re inactive, if they’re active,” said Donna Spruijt-Metz, a USC child obesity expert in charge of the project.
The devices are made possible by advances in technology such as accelerometers that can measure the duration and intensity of a workout. They also use Bluetooth-enabled cell phones that can take pictures of meals and send information back.
Will all this wizardry lead to a slimmer society? Scientists say there’s reason to hope. Getting an accurate picture of what people eat and how often they move around will help researchers develop personalized weight-loss advice.
Obesity is epidemic in the United States with two-thirds of adults either overweight or obese. It’s a major health concern for children and adolescents, who are at higher risk forhigh blood pressure, high cholesterol and diabetes as they grow older.
A federally funded pilot project by the Pennington Biomedical Research Center in Louisiana is exploring whether people can lose more weight when tracked by technology.
Participants carry around Blackberry Curves to snap pictures of their meals and leftovers. They also wear a quarter-sized device on their shoe that counts the number of steps they take.
Counselors pore over the incoming data and give individually tailored health advice through e-mail or telephone. Every month, the participants get their weight checked, and their progress is compared against a separate group that receives only generic health tips.
The study involves just seven people, but researchers eventually hope to have 40.
”It’s highly personalized. You get feedback very quickly,” said Corby Martin, who heads Pennington’s Ingestive Behavior Laboratory.
By using technology to capture eating and exercise details, researchers hope to bypass self-reporting that can sometimes give an incomplete picture.
But some medical experts are concerned about ethical questions. Even if people agree to be tracked, researchers worry about intruding into the rest of their lives and the lives of those around them.
”As a researcher, I’m a professional voyeur, and I like to find out whatever I can about human subjects,” said William McCarthy, a professor of public health and psychology at the University of California, Los Angeles. ”But if I were a subject, I’d be concerned about the level of detail that’s being captured about my behavior from moment to moment.”
University of Pittsburgh engineer Mingui Sun has developed a necklace equipped with a video camera that records where a person goes and what he or she eats. Before a researcher sees the data, it’s filtered by a computer that blurs out other people’s faces.
The device is not smart enough to know whether the wearer ate a Big Mac or tofu. So a researcher inputs the food, and the computer calculates the portion size, calories and nutrients.
Sun’s lab workers are wearing the prototype, and he hopes to test it on real people by the middle of the year.
Another concern is whether people, particularly youngsters, will stick with it.
Fellow Pittsburgh researcher Dana Rofey recently completed a study of 20 overweight female preteens and teens who wore armbands tracking the number of steps taken and calories burned daily.
Researchers found the armbands were worn 75 percent of the time. Though the study did not include a comparison group, researchers were pleased with the high compliance rate.
On a recent weekday, Castillo and another study volunteer, 13-year-old Eric Carles, headed straight from school to the USC lab, where they strapped the sensors on and went through a sort of circuit training. The project manager timed them as a postdoctoral student recorded the session through a one-way mirror.
Through periods of sitting, standing and exercising, they chatted about scary movies and upcoming exams. Wearing the devices felt ”weird” to Castillo initially, but she has since grown used to it.
Castillo admits she doesn’t exercise as she often as she would like and has a sweet tooth for chocolate. Carles, who plays after-school sports, confesses he eats a lot. The teens were willing to try anything to help them lose weight.
After enduring more than two hours of required physical activity, the two were allowed to do whatever they want. Researchers called it ”free living,” and it offered a glimpse into the activities teens would choose when they test the sensors at home.
The two chose to play a music video game. With Castillo on drums and Carles on the guitar, they rocked out to Duran Duran and Bon Jovi as researchers looked on.
Fight Against Fat Goes High-Tech With New Devices – NYTimes.com.
]]>University of Southern California researchers are trying to convert that voice into a series of text messages that could motivate obese teens to get active and lose weight.
The team has devised a wireless “body area network” that includes an accelerometer, a heart rate monitor, a GPS device and a sensor that measures the electrical conductivity of skin. All the data are relayed to a phone, which transmits the information to a secure server.
The device will become so attuned to its wearer that the researchers have dubbed this the KNOWME Networks study, said Donna Spruijt-Metz of USC’s Keck School of Medicine.
“We’ll train the sensors to guess pretty well what you’re doing,” she said.
And if the network concludes that you’ve been parked on the couch too long on a sunny afternoon, it won’t hesitate to let you know.
“We’d like to be able to ping you and say, ‘You’ve been inactive for six hours, and your friend Courtney is three miles away and running — there’s an activity possibility for you,’ ” said Spruijt-Metz, an associate professor in preventive medicine.
The device can tell whether the wearer is walking, running or engaging in another form of physical activity. But there are some exceptions. The current model isn’t waterproof, so swimming doesn’t count. And the accelerometer has trouble sensing when the wearer is pedaling a bicycle. Engineering experts are working out those kinks, Spruijt-Metz said.
The researchers hope to strap the belts on to about two dozen high school students by the end of the year, with the ultimate goal of tracking — and nagging — 50 obese teens for a week.
The study is being funded by a $1 million grant from the National Institutes of Health.