The main idea of the project (as this was set in March/April 2007) was to work on novel directions in the disease surveillance field targeting the early detection of infections. In the context of the existing disease surveillance systems that have been studying mainly the general population, our approach was to work with groups having special interest in infections such as patients suffering from chronic diseases, elderly individuals and infants. We defined these groups as Sensitive Population Groups – SPGs (new term introduced by our group) considering that these people may be at heightened risk even in non-outbreak settings. We also supported the identification of a threat before people even know that they have been infected, i.e. before the onset of the first symptoms, through the continuous monitoring of certain physiology parameters, e.g. blood glucose, white blood cell count. This is also in contrast to the current systems that are mainly based on people’s awareness of their health status reported either as pre-clinical and pre-diagnostic data (syndromic surveillance) or as diagnostic data (diagnosis-based surveillance).
As a first approach to our idea we considered that diabetes could be the ideal research area for the following main reasons:
- There is doubtless a huge interest from diabetics to monitor their infection status;
- Diabetes is a condition that has been extensively studied before and, thus, we expected to:
- get access to data sources with numerous variables and complete data
- attract the interest of other researchers in the field
- disseminate our ideas faster and easier;
- The diabetes monitoring technology has advanced more than the technology for other chronic conditions;
- We have had years of experience in diabetes field.
In diabetes condition blood glucose (BG) may increase at a very early stage of infestation, immediately after the infection manifestation and during the incubation period; however, this is an assumption and is not based on solid findings and should be further investigated. Also, it is a fact that White Blood Cells (WBC) play a key role in the body's defence against infections and that in most of the cases their count is increased at the early stages of incubation period. Based on these assumptions it would be possible to build an electronic Disease Surveillance System (eDSS) that could collect data for these parameters using a BG and WBC monitoring device. The subsequent processing of these and other personal data might offer indications of an infection during the incubation period.
The project objectives were decided upon but not limited to the initial selection of diabetics population group given that our approach is broader and should include other SPGs too. Our intention was to form the basis for a further exploitation of our findings in the disease surveillance for the general population.
- Botsis T, Walderhaug S, Dias A, van Vuurden K, Bellika JB, Hartvigsen G. Point-of-care devices for healthy consumers – a feasibility study. J Telemed Telecare (under publication).
Point of care (POC) devices are small portable instruments that perform diagnostic testing at the site of patient care, e.g. at the bedside. We are interested in the possible value of POC devices for long-term personal health monitoring of subjects at home. Internationally recognized organizations control the quality of POC devices and validate them before their introduction into service. We have investigated users’ attitudes towards the use of certain POC devices and their perceptions about the usability of the equipment, mainly focusing on the use of such equipment for disease surveillance purposes.
- Botsis, T., Hejlesen, O., Bellika, J.G., Hartvigsen, G. Electronic disease surveillance for sensitive population groups – The diabetics case study. Studies in Health Technology and Informatics, 2008;136: 365-370.
Diabetics are quite susceptible to infectious diseases and can easily spread them under certain circumstances. Their blood glucose levels are increased after infection and this can cause a hyperglycemic crisis. Our study indicates that this increase results in glucosylated hemoglobin elevation, even when a diabetic is monitored closely and his/her blood glucose is under tight control. Thus, it is important to detect infections at the very early stages of disease evolution in order to aid the patient. For this purpose, an electronic Disease Surveillance System could be developed to collect and analyze blood glucose data. Generally, we could extend the use of blood glucose data to the implementation of disease surveillance systems for the general population.
- T. Botsis, O. Hejlesen, J.G. Bellika, G. Hartvigsen. Disease surveillance systems for diabetics. Telemedicine Journal and e-Health. 2008; 14(s1): 108. (also presented at ATA 2008 conference, see below).
Diabetics are rather susceptible to infections and suffer more compared to normal subjects. This study tested the hypothesis that there is a strong correlation between elevated blood glucose (BG) levels and infection. This observation can lead to the development of a system for the early detection of infections in diabetics.
- Botsis T, Hejlesen O, Bellika JG, Hartvigsen G. Blood glucose levels as an indicator for the early detection of infections in type-1 diabetics. Advances in Disease Surveillance 2007; 4:147.
The aim of the study was to assess the correlation between blood glucose levels and infection and to propose the development of a model for the early detection of infections in diabetics.
- Botsis T, Bellika JG, Hartvigsen G. Disease surveillance systems for sensitive population groups. Advances in Disease Surveillance 2007; 4:148.
The aim of this study was to reveal the need for developing disease surveillance systems for sensitive populations.
- Botsis T, Bellika JB, Hartvigsen G. New directions in electronic disease surveillance: detection of infectious diseases during the incubation period. International Conference on eHealth, Telemedicine, and Social Medicine. eTELEMED 2009. February 1-7, 2009 - Cancun, Mexico (presented as full paper).
- Hartvigsen, G., Årsand, E., Botsis, T., van Vuurden, K., Johansen, M., Bellika, J.G Improved patient empowerment and continuity of care through electronic disease surveillance. ICICT 2008 (Samos, Greece, 11-13. July, 2008). Publ.: National and Kapodistrian University of Athens, Greece. pp. 230-235. (ISBN: 978-960-466-013-1 ISSN: 179-3904) (presented as full paper).
- van Vuurden, K., Hartvigsen, G., Bellika, J.G., Botsis, T., Models for Automatic Detection of Infectious Diseases a an Early Stage in Disease Progression. Tromsø Telemedicine and eHealth Conference (TTeC 2008) (Tromsø, Norway, 9-11. June, 2008).
- T. Botsis, O. Hejlesen, J.G. Bellika, G. Hartvigsen. Disease surveillance systems for diabetics. 13th Annual International Meeting and Exposition of the American Telemedicine Association, Washington State Convention Center, Seattle, Washington, USA, April 6-8, 2008 (accepted for poster presentation).
- T. Botsis, O. Hejlesen, J.G. Bellika, G. Hartvigsen. Electronic disease surveillance systems for diabetics.1stInternational Conference on Advanced Technologies and Treatments for Diabetes, Prague, Czech Republic, February 27 - March 1, 2008 (accepted for poster presentation).