Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience

Syndromic surveillance system during mass gathering of Panchkroshi Yatra festival, Ujjain, Madhya Pradesh, India

Background

The health implications surrounding a mass gathering pose significant challenges to public health officials. The use of syndromic surveillance provides an ideal method for achieving the public health goals and objectives at such events. In the absence of published reports of systematic documentation of public health preparedness in mass gatherings in the local context, we describe the public health preparedness and demonstrate the operational feasibility of a tablet-based participatory syndromic surveillance among pilgrims during the annual ritual circumambulation- Panchkroshi Yatra.

Methods

A real-time surveillance system was established from 2017-2019 to capture all the health consultations done at the designated points (medical camps) in the Panchkroshi yatra area of the city Ujjain in Madhya Pradesh. We also surveyed a subset of pilgrims in 2017 to gauge satisfaction with the public health measures such as sanitation, water, safety, food, and cleanliness.

Results

In 2019, injuries were reported in the highest proportion (16.7%; 794/4744); most numbers of fever cases (10.6%; 598/5600) were reported in 2018, while 2017 saw the highest number of patient presentations of abdominal pain (7.73%; 498/6435).

Conclusion

Public health and safety measures were satisfactory except for the need for setting up urinals along the fixed route of the circumambulation. A systematic data collection of selected symptoms among yatris and their surveillance through tablet could be established during the panchkroshi yatra, which can complement the existing surveillance for detecting early warning signals. We recommend the implementation of such tablet-based surveillance during such mass gathering events.

Digital transformation of healthcare during the COVID-19 pandemic: Patients’ teleconsultation acceptance and trusting beliefs

The COVID-19 pandemic boosted the digital transformation of many services, including healthcare, and access to medical care using teleconsultation has increased rapidly. Thus, a growing number of online platforms have been developed to accommodate patients’ needs. This paper examines the factors that predict the intention to use medical teleconsultation by extending the unified theory of acceptance and use of technology (UTAUT2) with the three dimensions of trusting beliefs and self-efficacy. A survey was administered to patients who had used a teleconsultation platform during the pandemic period. As one of the largest studies to date, a sample of 1233 respondents was collected and analyzed using a partial least squares approach, often mobilized in the information systems (IS) domain. Furthermore, a deep analysis using all recommended metrics was performed. The results highlight the significance of trusting beliefs, and self-efficacy in the adoption of digital healthcare services. These findings contribute to both theory and practice in COVID-19 research.

A Review of Infectious Diseases Associated with Religious and Nonreligious Rituals

Rituals are an integral part of human life but a wide range of rituals (both religious and non-religious), from self-flagellation to blood brotherhood to ritual sprinkling of holy water, have been associated with transmission of infections. These infections include angiostrongyliasis, anthrax, brucellosis, cholera, COVID-19, cutaneous larva migrans, Ebola, hepatitis viruses, herpes simplex virus, HIV, human T-cell leukemia virus (HTLV), kuru, Mycobacterium bovis, Naegleria fowleri meningoencephalitis, orf, rift valley fever, and sporotrichosis. Education and community engagement are important cornerstones in mitigating infectious risks associated with rituals.

Smart City and Crisis Management: Lessons for the COVID-19 Pandemic

COVID-19 shocked cities around the world and revealed the vulnerability of urban lives and functions. Most cities experienced a catastrophic disturbance that has lasted for a long time. Planning plays a critical role in responding efficiently to this crisis and enabling rapid functional recovery in the post-disaster era. Cities that have implemented digitalization initiatives and programs are likely to have more capacity to react appropriately. Specifically, digitalized cities could ensure the well-being of their residents and maintain continuity of urban functions. This research aims to analyze the role of technology in crisis management in the last two decades and provide appropriate policy recommendations for dealing with the COVID-19 pandemic. Systematic literature review and subjective content analysis are employed to investigate the effects of technology on community well-being and making cities more resilient in past crises. This study shows that different technology-driven policies and actions enable crisis management, enhance community well-being, and increase urban resilience. Technology has enhanced coping and recovery capacities by increasing participation and social connectedness, enhancing physical and mental health and maintaining the functionality of education and economic systems. These have been achieved through various solutions and technologies such as social media, telehealth, tracking and monitoring systems, sensors and locational applications, teleworking systems, etc. These solutions and technologies have also been used during the COVID-19 pandemic to enhance community well-being and sustain urban functions. However, technology deployment might have adverse effects such as social exclusion, digital divide, privacy and confidentiality violation, political bias and misinformation dissemination, and inefficient remote working and education. It is suggested that to mitigate these side effects, policymakers should liberate the process of digitalization, increase the accessibility to digital services, and enhance digital literacy.

Pediatric Otolaryngology Telehealth in Response to COVID-19 Pandemic: Lessons Learned and Impact on the Future Management of Pediatric Patients

Background:

Since the start of the COVID-19 pandemic outpatient medicine has drastically been altered how it is delivered. This time period likely represents the largest volume of telehealth visits in the United States health care history. Telehealth presents unique challenges within each subspecialty, and pediatric otolaryngology is no different. This retrospective review was designed to evaluate our division of pediatric otolaryngology’s experience with telehealth during the COVID19 pandemic.

Methods:

This study was approved by the Institutional Review Board at Vanderbilt University Medical Center. All telehealth and face-to-face visits for the month of April 2020 completed by the Pediatric Otolaryngology Division were reviewed. A survey, utilizing both open-ended questions and Likert scaled questions was distributed to the 16 pediatric otolaryngology providers in our group to reflect their experience with telehealth during the 1-month study period.

Results:

In April, 2020 our outpatient clinic performed a total of 877 clinic visits compared to 2260 clinic visits in April 2019. A total of 769 (88%) were telehealth visits. Telemedicine with video comprised 523 (68%) and telephone only comprised 246 (32%). There were 0 telehealth visits in April 2019. Interpretive services were required in 9.3% (N = 211) clinic visits in April 2019 and 7.5% (N = 66) of clinic visits in April 2020. The survey demonstrated a significant difference (P < .00002) in provider’s anticipated telehealth experience (mean 3.94, 95% CI [3.0632, 4.8118] compared to their actual experience after the study period (mean 7.5, 95% CI [7.113, 7.887].

Conclusions:

Despite low initial expectations for telehealth, the majority of our providers felt after 1 month of use that telehealth would continue to be a valuable platform post-pandemic clinical practice. Limited physical exam, particularly otoscopy, nasal endoscopy, and nasolaryngoscopy present challenges. However, with adequate information and preparation for the parents and for the physician some of the obstacles can be overcome.

Telemedicine for chronic pain management during COVID-19 pandemic

Treatment of chronic pain is an essential service. Due to lockdown, travel restrictions, social and physical distancing requirements or fear that health care facilities may be infected; patients may avoid visiting health care facilities in person. It is also imperative to decrease the risk of exposure of the health care workers (HCWs) to severe acute respiratory syndrome corona virus 2 (SARS CoV2) and to ease the overtly burdened health care system. But any disruption in pain practice will have alarming consequences for individuals, society, and whole of health care system and providers. In the current scenario of COVID-19 pandemic, telemedicine is emerging as a key technology for efficient communication and sustainable solution to provide essential health care services and should be considered for chronic pain patients (CPPs). Recently, Board of Governors in supersession of Medical Council of India along with National Institution for Transforming India (NITI Aayog) released “Telemedicine Practice Guidelines” enabling registered medical practitioners to provide healthcare using telemedicine. This article describes the challenges in CPPs during COVID-19 pandemic and the use of telemedicine as the rescue management vehicle for CPPs in current scenario.

Public health perspectives from the biggest human mass gathering on earth: Kumbh Mela, India

Mass gathering events pose critical health challenges, especially for the control of diseases. The rising population, better connectivity, and scope of travel have increased the frequency and magnitude of mass gatherings and underscore the need to shift the discourse from reacting to the public health issues they throw up to taking active steps in preventing them based on evidence through research. The Kumbh Mela is a religious event in India that constitutes the largest number of people gathered at a specific place and at a specific time. It is older than the Hajj by centuries, yet the public health aspects related to this event, which is held every 3 years, have not been fully studied. Understanding the Kumbh Mela can highlight the health challenges faced and provide crucial lessons for the management of mass gatherings. This investigation used the Kumbh Mela in the city of Allahabad as a case study to describe the health problems and the efforts taken to manage them. In-depth studies of the Kumbh Mela in the future are required to generate evidence for context-specific measures to address the complex health challenges of mass gatherings.

New digital technologies for the surveillance of infectious diseases at mass gathering events

Outbreaks of infectious diseases at mass gatherings can strain the health system of the host region and pose a threat to local and global health. In addition to strengthening existing surveillance systems, most host nations also use novel technologies to assess disease risk and augment traditional surveillance approaches. We review novel approaches to disease surveillance using the Internet, mobile phone applications, and wireless sensor networks. These novel approaches to disease surveillance can result in prompt detection.

Shared identity predicts enhanced health at a mass gathering

Identifying with a group can impact (positively) upon group members’ health. This can be explained (in part) through the social relations that a shared identity allows. We investigated the relationship between a shared identity and health in a longitudinal study of a month-long pilgrimage in north India. Questionnaire data ( N = 416) showed that self-reported health (measured before, during, and after the event) was better at the event than before, and although it reduced on returning home, it remained higher than before the event. This trajectory was predicted by data concerning pilgrims’ perceptions of a shared identity with other pilgrims at the event. We also found evidence that a shared identity amongst pilgrims had an indirect effect on changes in self-assessed health via the belief one had closer relations with one’s fellow pilgrims. We discuss the implications of these data for our understandings of the role of shared identity in social relations and health.

A comprehensive review of the Kumbh Mela: identifying risks for spread of infectious diseases

The Kumbh Mela in India is the largest mass gathering in the world which witnessed close to 100 million visitors in 2013. An event of this magnitude presents challenges. Increased population density, reduced hygienic conditions and exposure to environmental pollutants pave the way for easy transmission of pathogens. Due to the possibility of epidemics, the primary focus should be on identifying the potential risk factors and implementing appropriate preventive measures. The context of religion and psychology of the pilgrims is also closely associated with the evolution of the risk factors and so forms an important part of the discussion. We provide a brief background to the Kumbh Mela with a description of the existing and potential risk factors that require our attention.

Emergence of medicine for mass gatherings: lessons from the Hajj

Although definitions of mass gatherings (MG) vary greatly, they consist of large numbers of people attending an event at a specific site for a finite time. Examples of MGs include World Youth Day, the summer and winter Olympics, rock concerts, and political rallies. Some of the largest MGs are spiritual in nature. Among all MGs, the public health issues, associated with the Hajj (an annual pilgrimage to Mecca, Saudi Arabia) is clearly the best reported-probably because of its international or even intercontinental implications in terms of the spread of infectious disease. Hajj routinely attracts 2·5 million Muslims for worship. WHO's global health initiatives have converged with Saudi Arabia's efforts to ensure the wellbeing of pilgrims, contain infectious diseases, and reinforce global health security through the management of the Hajj. Both initiatives emphasise the importance of MG health policies guided by sound evidence and based on experience and the timeliness of calls for a new academic science-based specialty of MG medicine.

Emergence of medicine for mass gatherings: lessons from the Hajj

Although definitions of mass gatherings (MG) vary greatly, they consist of large numbers of people attending an event at a specific site for a finite time. Examples of MGs include World Youth Day, the summer and winter Olympics, rock concerts, and political rallies. Some of the largest MGs are spiritual in nature. Among all MGs, the public health issues, associated with the Hajj (an annual pilgrimage to Mecca, Saudi Arabia) is clearly the best reported-probably because of its international or even intercontinental implications in terms of the spread of infectious disease. Hajj routinely attracts 2·5 million Muslims for worship. WHO's global health initiatives have converged with Saudi Arabia's efforts to ensure the wellbeing of pilgrims, contain infectious diseases, and reinforce global health security through the management of the Hajj. Both initiatives emphasise the importance of MG health policies guided by sound evidence and based on experience and the timeliness of calls for a new academic science-based specialty of MG medicine.

In what circumstances is telemedicine appropriate in the developing world?

Objectives

To review papers reporting actual experience with telemedicine in developing countries and to summarize their findings, including the strength of the evidence.

Design

A retrospective review was conducted. Study quality was assessed.

Setting

Four commonly-used electronic databases.

Main outcome measures

Study quality scores.

Results

From a total of 202 potential articles, 38 relevant papers were identified. Thirty-four articles (89%) reported clinical experience and 14 articles (37%) reported the use of telemedicine for educational purposes. The quality of the reports was rather weak (median quality-score 3, on a scale 0–9); only one study, rated at 7, fell into the high quality score band. The fact that almost all studies reported positively in favour of telemedicine suggests a publication bias. Of the 38 articles, 15 (39%) reported the use of real-time telemedicine and 25 (66%) reported the use of asynchronous, or store-and-forward, telemedicine. Email was the most commonly reported modality (half of all studies).

Conclusion

Some of the longer established telemedicine operations have developed into substantial networks. The review suggests that great potential exists for telemedicine in the developing world. However, some caution is required in future telemedicine work if telemedicine exemplars are to be produced which can be widely copied.

A systematic review of the use of telehealth in Asian countries

We conducted a systematic review of the literature on telehealth in Asia. The Medline database was searched, together with three specialist journals, for peer-reviewed articles published in the ten years to June 2007 which were related to any telehealth application involving one or more Asian country. Out of the 1504 abstracts retrieved, 109 articles were selected by two independent reviewers for the final review. The number of published articles on telehealth in Asia increased during the review period. The largest number of studies were conducted in Japan (37%). Most telehealth applications were based on the store-and-forward modality (43%), with 35% using videoconferencing and 15% using a hybrid approach. Most of the studies were descriptive (75%) and only eight included a control group against which telehealth was compared. The most common means of telecommunication was ISDN lines, which were employed in 32% of the studies. Some 40% of the studies mentioned improved quality of health care; about 20% mentioned improved access to health care. Although most studies mentioned cost, only 13 of them assessed resource utilization and cost. The overall findings gave a generally optimistic picture of telehealth in Asia. However, there is a lack of good quality studies.

The prospect of pandemic influenza: why should the optometrist be concerned about a public health problem?

BACKGROUND

Optometrists are uniquely placed in the health care field because they provide both services as well as goods to patients. In the event of an influenza pandemic, optometrists may be challenged with a host of issues, including impediments to clinical patient care, manufacture and delivery of ophthalmic devices, and maintaining business continuity and infection control.

OVERVIEW

This report reviews pandemic influenza, the effect of a pandemic event on business survival, and response measures for the primary eye care provider. The ethical and legal issues surrounding control of a pandemic influenza and the prospect of telemedicine as a form of social distancing are also discussed.

CONCLUSIONS

Knowledge of the pharmacologic and nonpharmacologic measures to control a pandemic influenza will help prepare the eye care provider for addressing challenges to patient care and business continuity in the face of a highly contagious disease. Understanding the legal and ethical issues that arise during a pandemic event will help optometrists make informed choices as health care professionals and as citizens.

Telemedicine Diffusion in a Developing Country: The Case of India (March 2004)

Telemedicine (health-care delivery where physicians examine distant patients using telecommunications technologies) has been heralded as one of several possible solutions to some of the medical dilemmas that face many developing countries. In this study, we examine the current state of telemedicine in a developing country, India. Telemedicine has brought a plethora of benefits to the populace of India, especially those living in rural and remote areas (constituting about 70% of India's population). We discuss three Indian telemedicine implementation cases, consolidate lessons learned from the cases, and culminate with potential researchable critical success factors that account for the growth and modest successes of telemedicine in India.