El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this article, a technological solution is proposed to identify and reduce the level of mental stress of a person through a wearable device. The proposal identifies a physiological variable: Heart rate, through the integration between a wearable and a mobile application through text recognition using the back camera of a smartphone. As part of the process, the technological solution shows a list of guidelines depending on the level of stress obtained in a given time. Once completed, it can be measured again in order to confirm the evolution of your stress level. This proposal allows the patient to keep his stress level under control in an effective and accessible way in real time. The proposal consists of four phases: 1. Collection of parameters through the wearable; 2. Data reception by the mobile application; 3. Data storage in a cloud environment and 4. Data collection and processing; this last phase is divided into 4 sub-phases: 4.1. Stress level analysis, 4.2. Recommendations to decrease the level obtained, 4.3. Comparison between measurements and 4.4. Measurement history per day. The proposal was validated in a workplace with people from 20 to 35 years old located in Lima, Peru. Preliminary results showed that 80% of patients managed to reduce their stress level with the proposed solution. / Revisión por pares

The Apple Watch is capable of recording single-lead electrocardiograms (ECGs). To incorporate such devices in routine medical care, the reliability of such devices to obtain precordial leads needs to be validated. The purpose of this study was to assess the feasibility and reliability of a smartwatch (SW) to obtain precordial leads compared to standard ECGs. We included 100 participants (62 male, aged 62.8 ± 13.1 years) with sinus rhythm and recorded a standard 12-lead ECG and the precordial leads with the Apple Watch. The ECGs were quantitively compared. A total of 98 patients were able to record precordial leads without assistance. A strong correlation was observed between the amplitude of the standard and SW-ECGs’ waves, in terms of P waves, QRS-complexes, and T waves (all p-values < 0.01). A significant correlation was observed between the two methods regarding the duration of the ECG waves (all p-values < 0.01). Assessment of polarity showed a significant and a strong concordance between the ECGs’ waves in all six leads (91–100%, all p-values < 0.001). In conclusion, 98% of patients were able to record precordial leads using a SW without assistance. The SW is feasible and reliable for obtaining valid precordial-lead ECG recordings as a validated alternative to a standard ECG.

Some of the recently released smartwatch products feature a single-lead electrocardiogram (ECG) recording capability. The reliability of obtaining 3-lead ECG with smartwatches is yet to be confirmed in a large study. This study aimed to assess the feasibility and reliability of smartwatch to obtain 3-lead ECG recordings, the classical Einthoven ECG leads I-III compared to standard ECG. To record lead I, the watch was worn on the left wrist and the right index finger was placed on the digital crown for 30 s. For lead II, the watch was placed on the lower abdomen and the right index finger was placed on the digital crown for 30 s. For lead III, the same process was repeated with the left index finger. Spearman correlation and Bland-Altman tests were used for data analysis. A total of 300 smartwatch ECG tracings were successfully obtained. ECG waves’ characteristics of all three leads obtained from the smartwatch had a similar duration, amplitude, and polarity compared to standard ECG. The results of this study suggested that the examined smartwatch (Apple Watch Series 4) could obtain 3-lead ECG tracings, including Einthoven leads I, II, and III by placing the smartwatch on the described positions.

Background: Maternal and child health initiatives are embracing the use of electronic or mobile technology, a branch of digital health popularly referred to as eHealth or mHealth. While digital health can offer extensive benefits, it has raised various challenges. For instance, digital health programs are not often designed with a focus on equity in distribution nor are they designed from a gender equity standpoint. Although digital health interventions for maternal healthcare focuses predominantly on women as beneficiaries, few studies explore gendered power relations and how they impact the success of maternal and child health projects in African contexts such as Nigeria. This gap in literature risks excluding women from engaging in the digital space and can worsen the negative and unintended consequences of participating in digital health. This thesis examines the impact and implications of digital health interventions for maternal health in sub-Saharan Africa. -- Method: Two secondary and three primary studies described the various implications of digital health in sub-Saharan Africa more broadly and in rural Edo State, Nigeria, specifically. The secondary studies involved a review and a systematic review of the literature, the primary studies involved focus group discussions and in-depth interviews with pregnant or postpartum women who were beneficiaries of a digital health program and their community members. -- Results: The first paper illustrated exclusionary practices of digital health programs in sub-Saharan Africa, the second paper showed how digital health programs can challenge and redress harmful and unequal gender norms, roles, and power relations that privilege men over women. Observations from the third paper indicate that while mHealth programs are helpful to women in many ways, they are not enough on their own to undo entrenched systems of power through which men control women's reproductive lives. The fourth paper affirms that a community-centered approach to implementing digital health programs enhances women's acceptance and sustained use of digital health. The fifth paper shows how women navigate patriarchal environments through negotiation, collaboration and maneuvering to yield the best possible maternal health outcomes. -- Conclusion: At the core of all the studies was the need to understand and redress overarching factors contributing to ill health and exacerbating health inequities in maternal health through gender transformative approaches. Potentially unintended consequences, side effects, and negative effects of digital health impedes its many benefits, therefore, to achieve meaningful impact, gender and digital inclusion must remain a priority in the development, implementation, and evaluation of digital health. This thesis illuminated the needs of those with the greatest barriers to health technologies for maternal health thereby contributing to the discussion on digital health social justice with overarching themes on how to achieve equitable opportunities for all women and girls to access, use and benefit from digital health for maternal health.

No description available.

Early detection and intervention are crucial for optimal outcomes in autism spectrum disorder (ASD), but access to services is often lacking in rural communities. In fact, the average age of ASD diagnosis in rural communities is later than elsewhere, increasing the risk of missed early intervention and subsequently poorer outcomes. Caregivers in Southwest Virginia report that major barriers to ASD services include few providers with expertise in ASD, unaffordability of services, and geographic isolation; limited parent training or education about ASD emerges as a particular paucity in this region. To address these barriers, the current pilot study assessed the feasibility of delivering ASD assessment through a mobile clinic (n = 15). During COVID-19, the study shifted to pilot an ASD teleassessment protocol (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. Following a diagnostic feedback session, caregivers of children who received an ASD diagnosis (n = 28) were randomized to either attend psychoeducation sessions or receive comparable materials about ASD, with the goal of improving caregiver ASD knowledge and empowerment to seek and provide care for their child. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats exhibited high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment in the domains of family and the community improved after receiving assessment and psychoeducation services, as did total ASD knowledge (η2 = .114–.235, p < .05). / M.S. / Children with autism spectrum disorder (ASD) tend to achieve better outcomes with early intervention, which requires early assessment and diagnosis. However, families in rural areas typically have greater difficulty accessing such services, due to limited providers, high cost of services, and geographic distance from provider offices. This often results in children from rural regions being diagnosed with ASD at a later age than elsewhere, thereby missing opportunities for effective and timely treatment. To overcome these barriers, the current pilot study evaluated two novel service delivery formats: (1) mobile assessment through the Mobile Autism Clinic prior to the COVID-19 pandemic (n = 15); and (2) tele-assessment via a secure video platform during the pandemic (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. After completing an assessment, caregivers attended a feedback session to review diagnoses and recommendations. If their child received an ASD diagnosis (n = 28), caregivers then either completed additional educational sessions about ASD or received similar informational materials, with the goal of improving caregiver knowledge and empowerment. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats demonstrated high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment within their family and community improved after receiving assessment and psychoeducation services, as did total ASD knowledge.

Yes / Which antecedents affect the adoption by users is still often a puzzle for policy-makers. Antecedents examined in this research include technological artefacts from the Unified Theory of Acceptance and Use of Technology (UTAUT), consumer context from UTAUT2 and psychological behaviour concepts such as citizens' channel preference and product selection criteria. This research also investigated cultural domination on citizens' behavioural perception. The data for this study was collected among citizens from three countries: USA, Canada, and Bangladesh. The findings suggest that the UTAUT model could partially shape technology artefact behaviour and the extended UTAUT must consider specific determinants relevant to cognitive, affective, and conative or behavioural aspects of citizens. The model helps policy-makers to develop mobile healthcare service system that will be better accepted. The finding also suggests that this mobile service system should reflect a country's cultural traits. These findings basically extend the theoretical concept of UTAUT model to articulate adoption behaviour of any complex and sensitive ICT related issues like mobile healthcare system.

Stroke is a leading cause of death and disability worldwide [8], underscoring the need for effective digital solutions for stroke patients, caregivers, and healthcare professionals. Given that, this thesis aims to evaluate quality aspects of usability, accessibility, and readability of stroke-related mobile health (mHealth) applications, with the primary objective of identifying strengths and weaknesses to enhance user experience and app quality. This study assessed sixteen stroke-related apps through a comprehensive methodology, including accessibility testing with the Google Accessibility Scanner, Mobile Application Rating Scale (MARS) evaluation, heuristic evaluation, and readability assessment. Key findings indicate significant issues with touch target sizes and text contrast, which are crucial for users with impaired visionand motor skills. MARS evaluations revealed that “Constant Therapy” excelled in engagement and functionality due to its interactive features and personalized schedules. At the same time, “Stroke Recovery Predictor” and “Conversation Therapy Lite” scored lower due to limited functionality and unclear interfaces. The heuristic evaluation highlighted frequent violations of the visibility of system status and insufficient error messaging. Readability assessments showed a range of reading difficulty levels, with some apps lacking privacy policies that could be found either within the application or on the developer’s website. The study provides actionable recommendations for developers, such as improving touch target sizes, improving text contrast, increasing functional variety, optimizing navigation, and ensuring privacy policy transparency. Addressing these areas can significantly improve the usability and accessibility of stroke-related mHealth apps, ultimately supporting better health outcomes and quality of life for stroke survivors. Future research should involve more evaluators, use multiple assessment tools, and focus on specific types of stroke apps to refine the evaluation process and provide more targeted insights.

Melhorar a saúde das gestantes é uma prioridade para as agências de saúde global e para os governos dos países de baixa e média renda. O desafio da erradicação e/ou redução das morbimortalidades materna e perinatal evitáveis vem colocando em destaque a necessidade de expandir as ações para prevenção de agravos para além da abordagem clínica das complicações obstétricas, a partir do fortalecimento dos sistemas de saúde e da valorização da autonomia das mulheres dentro das sociedades, implementando a abordagem de direitos humanos como um dos componentes da qualidade do cuidado à saúde reprodutiva. O objetivo desta pesquisa é determinar se um programa de educação em saúde e apoio às gestantes, adaptado à realidade do Sistema Único de Saúde brasileiro e às especificidades da telefonia celular, é um complemento útil ao acompanhamento pré-natal padrão. A pesquisa foi realizada em duas etapas, tendo início com a condução de uma pesquisa formativa, exploratória, para identificar barreiras e facilitadores da atenção ao pré-natal e parto, avaliar aceitação do uso de mensagens de texto como item complementar ao cuidado pré-natal padrão, e desenvolver e refinar a intervenção do programa PRENACEL. Esta compreende um programa de 148 mensagens de texto no celular com informações essenciais para o acompanhamento do ciclo gravídico-puerperal de mulheres saudáveis, em atendimento na rede pública de saúde. Foi desenvolvida com propósitode melhorar resultados maternos e perinatais. Sua efetividade foi avaliada por meio de um ensaio aleatorizado por conglomerados, realizado em 20 unidades de saúde que provêm assistência pré-natal em uma cidade da região sudeste do Brasil. Gestantes em acompanhamento pré-natal nas unidades de saúde sorteadas para o grupo intervenção foram convidadas a participar do PRENACEL. Em unidades de saúde alocadas ao grupo controle, as gestantes receberam a atenção pré-natal padrão. Os dados analisados foram coletados durante a internação para o parto em quatro maternidades públicas da mesma localidade. Para cada variável de interesse, foram realizadas análise por intenção de tratar e análise por protocolo, pelo cálculo dos riscos relativos, com 95% de intervalo de confiança. Ao final do seguimento da gestação, 1210 mulheres elegíveis à participação no estudo tiveram seus desfechos avaliados nas maternidades selecionadas para a pesquisa, por meio de revisão de prontuários, cartões de pré-natal e entrevista individual estruturada. Das mulheres incluídas nas análises, 770 eram provenientes das unidades de saúde do grupo intervenção e 440 das unidades controle. Receber informações do programa PRENACEL durante a gestação foi associado a um aumento na percepção das mulheres de sentirem-se melhor preparadas para o parto, e na percepção de que o pré-natal colabora para que se sintam mais preparadas. Também foram observados impactos no estabelecimento do contato pele-a-pele e aleitamento materno e no conhecimento sobre intervenções obstétricas. Não foram observadas diferenças nos demais desfechos maternos e perinatais avaliados, incluindo a satisfação das mulheres com o atendimento. Nossa conclusão é de que o PRENACEL pode contribuir para a ampliação do acesso das mulheres a informações que lhes sejam estratégicas para que se sintam melhor preparadas para a experiência do parto. / Improving maternal health is a priority for global health agencies and for governments in low- and middle-income countries. The challenge of reducing preventable maternal and perinatal morbidity and mortality has highlighted the need to expand actions to prevent injuries beyond the clinical approach to obstetric complications, through strengthening health systems and enhancing autonomy of women within societies, by implementing a human rights approach as one of the components of the quality of reproductive health care. The objective of this research is to determine if a program of health education and support to pregnant women, adapted to be used by Brazilian National Health System and delivered by short messages service (SMS) on the cell phone is a useful complement to standard prenatal follow-up. The research was carried out in two stages, starting with the conduction of a formative and exploratory research to identify barriers and facilitators of antenatal and delivery care, to evaluate the acceptance of the use of SMS as a complementary item to antenatal care and to develop and refine the PRENACEL program intervention. It comprises a program of 148 SMS with essential information from pregnancy to puerperium, for healthy pregnant women attending antenatal care. It was developed with the purpose of improving maternal and perinatal outcomes. Its effectiveness was evaluated through a cluster-randomized trial conducted in 20 health units that provide antenatal care in a city in the southeastern region of Brazil. Pregnant women from the health units drawn for the intervention group were invited to participate in PRENACEL. In health unitsallocated to the control group, pregnant women received standard antenatal care. Analyzed data were collected during admission to labor in four public maternity hospitals in the same locality. For each variable of interest, intention-to-treat analysis and analysis by protocol were carried out, as well as the relative risk, with 95% of confidence interval. At the end of the gestation follow-up, 1210 women eligible to participate in the study had their outcomes evaluated in the maternity wards, through their medical records review, antenatal cards review and individual structured interviews. Of the women included in the analyzes, 770 came from the health units of the intervention group and 440 from the control units. Receiving information from the PRENACEL program during pregnancy was associated with an increase in women\'s perception of better preparedness for delivery, and the perception that antenatal care helps them feel more prepared. Enhancement of the timing for early skin-to-skin contact and breastfeeding, and knowledge on obstetric interventions were also observed. No differences were observed in other maternal and perinatal outcomes evaluated, including women\'s satisfaction with care. We concluded that PRENACEL can contribute to increase women\'s access to information that are strategic to the improve their perception of feeling confident and better prepared for the childbirth experience.

Melhorar a saúde das gestantes é uma prioridade para as agências de saúde global e para os governos dos países de baixa e média renda. O desafio da erradicação e/ou redução das morbimortalidades materna e perinatal evitáveis vem colocando em destaque a necessidade de expandir as ações para prevenção de agravos para além da abordagem clínica das complicações obstétricas, a partir do fortalecimento dos sistemas de saúde e da valorização da autonomia das mulheres dentro das sociedades, implementando a abordagem de direitos humanos como um dos componentes da qualidade do cuidado à saúde reprodutiva. O objetivo desta pesquisa é determinar se um programa de educação em saúde e apoio às gestantes, adaptado à realidade do Sistema Único de Saúde brasileiro e às especificidades da telefonia celular, é um complemento útil ao acompanhamento pré-natal padrão. A pesquisa foi realizada em duas etapas, tendo início com a condução de uma pesquisa formativa, exploratória, para identificar barreiras e facilitadores da atenção ao pré-natal e parto, avaliar aceitação do uso de mensagens de texto como item complementar ao cuidado pré-natal padrão, e desenvolver e refinar a intervenção do programa PRENACEL. Esta compreende um programa de 148 mensagens de texto no celular com informações essenciais para o acompanhamento do ciclo gravídico-puerperal de mulheres saudáveis, em atendimento na rede pública de saúde. Foi desenvolvida com propósitode melhorar resultados maternos e perinatais. Sua efetividade foi avaliada por meio de um ensaio aleatorizado por conglomerados, realizado em 20 unidades de saúde que provêm assistência pré-natal em uma cidade da região sudeste do Brasil. Gestantes em acompanhamento pré-natal nas unidades de saúde sorteadas para o grupo intervenção foram convidadas a participar do PRENACEL. Em unidades de saúde alocadas ao grupo controle, as gestantes receberam a atenção pré-natal padrão. Os dados analisados foram coletados durante a internação para o parto em quatro maternidades públicas da mesma localidade. Para cada variável de interesse, foram realizadas análise por intenção de tratar e análise por protocolo, pelo cálculo dos riscos relativos, com 95% de intervalo de confiança. Ao final do seguimento da gestação, 1210 mulheres elegíveis à participação no estudo tiveram seus desfechos avaliados nas maternidades selecionadas para a pesquisa, por meio de revisão de prontuários, cartões de pré-natal e entrevista individual estruturada. Das mulheres incluídas nas análises, 770 eram provenientes das unidades de saúde do grupo intervenção e 440 das unidades controle. Receber informações do programa PRENACEL durante a gestação foi associado a um aumento na percepção das mulheres de sentirem-se melhor preparadas para o parto, e na percepção de que o pré-natal colabora para que se sintam mais preparadas. Também foram observados impactos no estabelecimento do contato pele-a-pele e aleitamento materno e no conhecimento sobre intervenções obstétricas. Não foram observadas diferenças nos demais desfechos maternos e perinatais avaliados, incluindo a satisfação das mulheres com o atendimento. Nossa conclusão é de que o PRENACEL pode contribuir para a ampliação do acesso das mulheres a informações que lhes sejam estratégicas para que se sintam melhor preparadas para a experiência do parto. / Improving maternal health is a priority for global health agencies and for governments in low- and middle-income countries. The challenge of reducing preventable maternal and perinatal morbidity and mortality has highlighted the need to expand actions to prevent injuries beyond the clinical approach to obstetric complications, through strengthening health systems and enhancing autonomy of women within societies, by implementing a human rights approach as one of the components of the quality of reproductive health care. The objective of this research is to determine if a program of health education and support to pregnant women, adapted to be used by Brazilian National Health System and delivered by short messages service (SMS) on the cell phone is a useful complement to standard prenatal follow-up. The research was carried out in two stages, starting with the conduction of a formative and exploratory research to identify barriers and facilitators of antenatal and delivery care, to evaluate the acceptance of the use of SMS as a complementary item to antenatal care and to develop and refine the PRENACEL program intervention. It comprises a program of 148 SMS with essential information from pregnancy to puerperium, for healthy pregnant women attending antenatal care. It was developed with the purpose of improving maternal and perinatal outcomes. Its effectiveness was evaluated through a cluster-randomized trial conducted in 20 health units that provide antenatal care in a city in the southeastern region of Brazil. Pregnant women from the health units drawn for the intervention group were invited to participate in PRENACEL. In health unitsallocated to the control group, pregnant women received standard antenatal care. Analyzed data were collected during admission to labor in four public maternity hospitals in the same locality. For each variable of interest, intention-to-treat analysis and analysis by protocol were carried out, as well as the relative risk, with 95% of confidence interval. At the end of the gestation follow-up, 1210 women eligible to participate in the study had their outcomes evaluated in the maternity wards, through their medical records review, antenatal cards review and individual structured interviews. Of the women included in the analyzes, 770 came from the health units of the intervention group and 440 from the control units. Receiving information from the PRENACEL program during pregnancy was associated with an increase in women\'s perception of better preparedness for delivery, and the perception that antenatal care helps them feel more prepared. Enhancement of the timing for early skin-to-skin contact and breastfeeding, and knowledge on obstetric interventions were also observed. No differences were observed in other maternal and perinatal outcomes evaluated, including women\'s satisfaction with care. We concluded that PRENACEL can contribute to increase women\'s access to information that are strategic to the improve their perception of feeling confident and better prepared for the childbirth experience.