mHealth 3.0

AI assited lifestyle modificationin

Prevention and Management of Chronic Disease(Asthma model)

Mark Lazarovich MDTimberlane Allergy and Asthma

South Burlington VTUSA

asthmavt@gmail.com

Clinical Vignette

55 y.o., overweight woman with cat allergy, asthma, diabetes and HTN. Asthma and allergy managed and stable for 15 years. Lives alone with dog.

Yearly follow-up visit: Increasing dyspnea, cough, wheeze, loss of glycemic control elevated BP.

What happened?1. Developed Sinusitis2. Developed Dog Allergy3. Got a cat4. Dog died5. Non-compliance

Chronic disease in America

$2.3 of $2.7 trillion spent. 2011.45% of Americans133 million. 2000

15%

85%

Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF - 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed November 18, 2014.

USA Asthma Numbers

CDC. National Health Interview Survey (NHIS) data: 2011 lifetime and current asthma. Atlanta, GA: US Department of Health and Human Services, CDC: 2012

$53 B$56 B

World Asthma Numbers1

Note: Shanghai asthma prevalence in 1997 was 0.41% in 2015 it was 1.8%. A 340% increase2

World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, 2007. The changing epidemiology of asthma in Shanghai, China J Asthma 2015 Jun:52(5):465-70

Cost of asthma therapy

$$-$$$$$$$$$$$

a-PGD2

? a-IL4/IL13

$-$$

SABAPDE-I SS

a-IL5a-IgE$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

a-IL4

ICS

IT

LABALTRA

LTRsi

Actionable Co-factors and Asthma

Obesity

Inactivity

Air Quality

Mental Health Problems

Lack of sleep

Food Quality

USA Trends in Obesity

Ogden CL, Carroll MD. Prevalence of overweight, obesity, and extreme obesity among adults: United States, Overweight and Obesity Statistics | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 10/16/16, 12:13 PMhttps://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx Page 10 of 11 trends 1960–1962 through 2007–2008. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics; 2010.

Reducing obesity makes asthma better

n Surg/Lifestyle QL Asthma

Control FEV-1 Inflam.Markers Eos AHR

Macgregor and Greenberg, 1993

(USA)40 S NA NA NA NA

Dixon JB et al1999

(Aus)32 S NA NA NA NA

Stenius-Aarniala et al, 2000

2000 (Fin)38 L NA NA NA

Dixon AE et al2011

(USA)46 S

Dias-Junior2014(Bra)

33 L

USA Trends in (in)Activity

Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise. 2008;40(1):181–188.

Brownson RC et al. Declining Rates of Physical Activity in The United States: What Are the Contributors? Annual Review of Public Health. First published online as a Review in Advance on December 8, 2004

Decrease in recommneded activity levels in children after age 11. 42% to 7.6% overall.

34.7% to 5.4% of girls.

Activity makes asthma better

n Duration QL AsthmaControl FEV-1 Inflam.

Markers Eos AHR

Fanelli et al2007

(Bra)38p 16 week NA NA NA

Mendes et al2010

(Bra)101 3 mo NA NA NA

Eichenberger2013 (meta)

(Swiss)599 NA NA NA

Franca-Pinto2015(Bra)

43 12 week NA

Dagstuhl Perspetives Workshop

Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and

Wellbeing,Jun. 29–Jul. 2, 2014

http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf

Companion agenda to technologically managed Healthcare

http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf

Technologically supported, proactive well-being

Technologically supported well-being in management of

chronic and acute illness

mHealth + Proactive Well-Being = Wellth

Elizabeth F. Churchill and m.c. schraefel mHealth+Proactive WEll-Being = Wellth Creation . Forum: Health Matters ACM 2015 Gillian R. Hayes Editor

“Wellth Creation”

Developing sustained strategies for increasing the experience of well-being. (emotional and visceral.) (translating into micro, meso and macro socio-economic gain).

Well-being has an N=1

Wellth creation will involve rethinking:

1. notions of health 2. interactive technology design 3. the form and role of health-related data 4. engagement with stakeholder groups (micro, meso, macro)

Elizabeth F. Churchill and m.c. schraefel mHealth+Proactive Well-Being = Wellth Creation . Forum: Health Matters ACM 2015 Gillian R. Hayes Editor

Barriers to successful mHealth application

- Tyrannical- App fatigue- Data fatigue- Lack of contextual integration- No long term studies- Poor UX- Quantitative Tedium- How to choose?- Poor integration- Not fun- Inflexible- Impersonal- Too personal- Other………

Emotion

Logic

Subconscious Conscious

Clustering of current

health apps

Modified from: Report from Dagstuhl Perspectives Workshop 14272 Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and WellbeingEdited by m. c. schraefel1 and Elizabeth F. Churchill 21 University of Southampton, UK, mc@ecs.soton.ac.uk 2 formerly of eBay Research Labs, San Jose, CA, US, churchill@acm.org

Current Motivational Models

Is health the primary motivator?

No

Dara Torres 41, Swimming5th Olympic Games.2008 Silver Medal

No

ObeseDe-conditionedUnmotivated

Emotion

Logic

Subconscious Conscious

Area to explore?

Modified from: Report from Dagstuhl Perspectives Workshop 14272 Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and WellbeingEdited by m. c. schraefel1 and Elizabeth F. Churchill 2. 1 University of Southampton, UK, mc@ecs.soton.ac.uk 2 formerly of eBay Research Labs, San Jose, CA, US, churchill@acm.org

Needed Motivational Models

Emotional motivation

I use Facebook, Instagram, Twitter, Google because:

“I want to:”-know-be included-be validated-be recognized-be praised-be special-matter-have-be aware-be current

Moving beyond e-Health and the Quantified Self ACM CSCW Vancouver March 2015

1. “Me”, “Us”, “Them”2. Social3. Non-tyrannical4. Assistive, Aspirational (not Prescriptive)5. Playfull (explorable, interrogable)6. Contextual

Qualities of Wellth promoting Systems

Moving beyond e-Health and the Quantified Self. Workshop at 2015 ACM Conference on Computer-Supported Cooperative Work and Social Computing. March 14-18 Vancouver, BC, Canada

in5 (Dr. m.c. Schraefel)

MoveEat

CogitateEngageSleep

All of the above are done daily.All require skills.All are essential.

All need to be actively engaged.

MoreLessQualityCalories

Tune rather then change

Modified from; in5 working brain body connection for creative excellence. m.c. Schraefel 2014 @mcphoo

Acknowledgements

Director of UX, Google

Distinguished Visiting Scholar, Media X, Stanford University

Vice President ACM SigCHI

Prof. Computer Science and Human PerformanceUniversity of Southampton UK

Research Associate, CSAIL MIT

NSCA Strength and Conditioning CoachMaster Trainer, Z-healthNutrition CoachFunctions Movement Trainer

dr. m.c schraefel Dr. Elizabeth Churchill Stephen Yanow

Chairman 3CE Technologies