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M health 3.0. ai assisted lifestyle modification in prevention and management of chronic disease

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Mark Lazarovich
Mark Lazarovich

A model for reversing the rising trajectory of health care burden associated with Chronic Diseases (overwhelmingly lifestyle related).

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mHealth 3.0 AI Assisted Lifestyle Modification in Prevention and Management of Chronic Disease (Asthma model) Mark Lazarovich MD Timberlane Allergy and Asthma South Burlington VT USA asthmavt@gmail.com
Clinical Vignette 55 y.o., overweight woman with cat allergy, asthma, diabetes and High Blood Pressure. Asthma and allergy managed and stable for 15 years. Lives alone with dog. Yearly follow-up visti: out of control asthma, diabetes and blood pressure. What happened? 1. Developed Sinusitis 2. Developed Dog Allergy 3. Got a cat 4. Dog died 5. Non-compliance
Chronic disease in America $2.3 of $2.7 trillion spent. 2011. 45% of Americans 133 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 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 $$-$$$$$$$$$$$ a-PGD2 ? a-IL4/IL13 $-$$ SABA PDE-I SS a-IL5a-IgE $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ a-IL4 ICS IT LABA LTRA 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 19601962 through 20072008. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics; 2010.
Reducing obesity makes asthma better n Surg/Life style QL Asthma Control FEV-1 Inflam. Markers Eos AHR Macgregor and Greenberg, 1993 (USA) 40 S NA NA NA NA Dixon JB et al 1999 (Aus) 32 S NA NA NA NA Stenius-Aarniala et al, 2000 2000 (Fin) 38 L NA NA NA Dixon AE et al 2011 (USA) 46 S Dias-Junior 2014 (Bra) 33 L
USA Trends in (in)Activity Troiano RP, Berrigan D, Dodd KW, M但sse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise. 2008;40(1):181188. 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 Recommended duration of activity Before age 11 = 42%, after = 7.6% Girls 34.7% to 5.4%.
Activity makes asthma better n Duration QL Asthma Control FEV-1 Inflam. Markers Eos AHR Fanelli et al 2007 (Bra) 38p 16 week NA NA NA Mendes et al 2010 (Bra) 101 3 mo NA NA NA Eichenberger 2013 (meta) (Swiss) 599 NA NA NA Franca-Pinto 2015 (Bra) 43 12 week NA
Dagstuhl Perspetives Workshop Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and Wellbeing, Jun. 29Jul. 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 Wellbeing Edited 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 Current Motivational Models
Is health the primary motivator? No Dara Torres 41, Swimming 5th Olympic Games. 2008 Silver Medal No Obese De-conditioned Unmotivated
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 Wellbeing Edited 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. Social 3. Non-tyrannical 4. 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) Move Eat Cogitate Engage Sleep All of the above are done daily. All require skills. All are essential. All need to be actively engaged. MoreLess QualityCalories Tune rather then change Modified from; in5 working brain body connection for creative excellence. m.c. Schraefel 2014 @mcphoo
M health 3.0. ai assisted lifestyle modification in prevention and management of chronic disease
M health 3.0. ai assisted lifestyle modification in prevention and management of chronic disease
Acknowledgements Director of UX, Google Distinguished Visiting Scholar, Media X, Stanford University Vice President ACM SigCHI Prof. Computer Science and Human Performance University of Southampton UK Research Associate, CSAIL MIT NSCA Strength and Conditioning Coach Master Trainer, Z-health Nutrition Coach Functions Movement Trainer dr. m.c schraefel Dr. Elizabeth Churchill Stephen Yanow Chairman 3CE Technologies

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M health 3.0. ai assisted lifestyle modification in prevention and management of chronic disease

  • 1. mHealth 3.0 AI Assisted Lifestyle Modification in Prevention and Management of Chronic Disease (Asthma model) Mark Lazarovich MD Timberlane Allergy and Asthma South Burlington VT USA asthmavt@gmail.com
  • 2. Clinical Vignette 55 y.o., overweight woman with cat allergy, asthma, diabetes and High Blood Pressure. Asthma and allergy managed and stable for 15 years. Lives alone with dog. Yearly follow-up visti: out of control asthma, diabetes and blood pressure. What happened? 1. Developed Sinusitis 2. Developed Dog Allergy 3. Got a cat 4. Dog died 5. Non-compliance
  • 3. Chronic disease in America $2.3 of $2.7 trillion spent. 2011. 45% of Americans 133 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.
  • 4. 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
  • 5. World Asthma Numbers1 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
  • 6. Cost of asthma therapy $$-$$$$$$$$$$$ a-PGD2 ? a-IL4/IL13 $-$$ SABA PDE-I SS a-IL5a-IgE $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ a-IL4 ICS IT LABA LTRA LTRsi
  • 7. Actionable Co-factors and Asthma Obesity Inactivity Air Quality Mental Health Problems Lack of sleep Food Quality
  • 8. 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 19601962 through 20072008. NCHS Health E-Stat. Hyattsville, MD: National Center for Health Statistics; 2010.
  • 9. Reducing obesity makes asthma better n Surg/Life style QL Asthma Control FEV-1 Inflam. Markers Eos AHR Macgregor and Greenberg, 1993 (USA) 40 S NA NA NA NA Dixon JB et al 1999 (Aus) 32 S NA NA NA NA Stenius-Aarniala et al, 2000 2000 (Fin) 38 L NA NA NA Dixon AE et al 2011 (USA) 46 S Dias-Junior 2014 (Bra) 33 L
  • 10. USA Trends in (in)Activity Troiano RP, Berrigan D, Dodd KW, M但sse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise. 2008;40(1):181188. 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 Recommended duration of activity Before age 11 = 42%, after = 7.6% Girls 34.7% to 5.4%.
  • 11. Activity makes asthma better n Duration QL Asthma Control FEV-1 Inflam. Markers Eos AHR Fanelli et al 2007 (Bra) 38p 16 week NA NA NA Mendes et al 2010 (Bra) 101 3 mo NA NA NA Eichenberger 2013 (meta) (Swiss) 599 NA NA NA Franca-Pinto 2015 (Bra) 43 12 week NA
  • 12. Dagstuhl Perspetives Workshop Exploring Interdisciplinary Grand Challenges in ICT Design to Support Proactive Health and Wellbeing, Jun. 29Jul. 2, 2014 http://drops.dagstuhl.de/opus/volltexte/2015/4887/pdf/dagrep_v004_i006_p108_s14272.pdf
  • 13. 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
  • 14. 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
  • 15. 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
  • 16. 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 Wellbeing Edited 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 Current Motivational Models
  • 17. Is health the primary motivator? No Dara Torres 41, Swimming 5th Olympic Games. 2008 Silver Medal No Obese De-conditioned Unmotivated
  • 18. 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 Wellbeing Edited 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
  • 19. 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
  • 20. Moving beyond e-Health and the Quantified Self ACM CSCW Vancouver March 2015 1. Me, Us, Them 2. Social 3. Non-tyrannical 4. 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
  • 21. in5 (Dr. m.c. Schraefel) Move Eat Cogitate Engage Sleep All of the above are done daily. All require skills. All are essential. All need to be actively engaged. MoreLess QualityCalories Tune rather then change Modified from; in5 working brain body connection for creative excellence. m.c. Schraefel 2014 @mcphoo
  • 24. Acknowledgements Director of UX, Google Distinguished Visiting Scholar, Media X, Stanford University Vice President ACM SigCHI Prof. Computer Science and Human Performance University of Southampton UK Research Associate, CSAIL MIT NSCA Strength and Conditioning Coach Master Trainer, Z-health Nutrition Coach Functions Movement Trainer dr. m.c schraefel Dr. Elizabeth Churchill Stephen Yanow Chairman 3CE Technologies