Journal of the International Society for Telemedicine and eHealth <p>The Journal of the International&nbsp; Society for Telemedicine and eHealth (<strong>JISfTeH</strong>) is an official journal of the International Society for Telemedicine and eHealth whose stated mission is to "Facilitate the international dissemination of knowledge and experience in <strong>Telemedicine</strong> and <strong>eHealth</strong> and provide access to recognised experts in the field worldwide." <strong>JISfTeH</strong> is a peer reviewed, open access, online journal that seeks to publish information on all aspects of eHealth activity and research from around the World. Its primary focus is on original research, critical reviews, preliminary communications and case reports. Scientific letters and letters to the editor are also welcomed. <strong>JISfTeH</strong> encourages&nbsp; submission of&nbsp; preliminary communications and short reports from developing countries. Papers are published online immediately on acceptance of the final galley proofs to ensure rapid access to new work.</p> <p><strong>Editors-in-Chief:</strong> Prof. Maurice Mars, and Prof. Richard E. Scott</p> <p><strong>Online ISSN:</strong>&nbsp;2308-0310</p> The University of KwaZulu-Natal for the International Society for Telemedicine and eHealth en-US Journal of the International Society for Telemedicine and eHealth 2308-0310 <p>Authors who publish with this journal agree to the following terms:</p><p><br />Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p> Here We Go Again - 'Digital Health' Richard Scott Maurice Mars ##submission.copyrightStatement## 2019-01-22 2019-01-22 7 e1 (1 2) 10.29086/JISfTeH.7.e1 Adopting Digital Technology in Midwifery Practice – Experiences and Perspectives From Six Projects in Eight Countries (2014 – 2016) <p>This paper describes the cases of six midwifery projects of the Women Observatory for eHealth at the Millennia2025 Women and Innovation Foundation, to support the adoption of information and communication technologies (ICTs) in midwifery practice in eight countries from 2014 to 2016. The WeObservatory is a digital inclusion incubator aimed at reducing maternal and neonatal mortality in countries with limited resources by strengthening midwifery practice through the access to ICTs and eHealth applications. This paper describes how the collaboration with the WeObservatory supported these projects in the development and adoption of digital solutions for midwifery practice. It examines responses from the project leaders to an online survey conducted by the WeObservatory in January of 2018. Their responses provide insights on opportunities and challenges faced by these projects that can inform future midwifery eHealth projects. Building capacity among midwives for the adoption of digital competencies will help improve the quality of healthcare provided to mothers and their newborn babies in low-income countries.</p> Lilia Judith Perez-Chavolla Véronique Inès Thouvenot Doina Schimpf Amélie Moritz ##submission.copyrightStatement## 2019-01-05 2019-01-05 7 e2 (1 8) 10.29086/JISfTeH.7.e2 Profile and Motivation of Women Enrolled in the Brazilian Telemedicine and Telehealth Postgraduation Distance Education Programme <p><strong>Purpose:&nbsp; </strong>Women’s participation in Telehealth is increasing around the world and they should be prepared to work in this new job market. The aim of this study was to evaluate the profile and motivation of women enrolled in the Brazilian Postgraduate Programme on Telemedicine and Telehealth.<strong> Methods: </strong>A cross-sectional study was conducted from May to July 2018 of all women enrolled in the postgraduate programme using an anonymous online Google form. It consisted of a multiple choice form regarding: age, number of children, profession, date of graduation, current occupation, current number of jobs, workload, postgraduate programmes completed,&nbsp; duration of Telehealth experience&nbsp; and motivation to enrol on the Programme.&nbsp; Data collected were exported to an Excel® sheet, summarised and analysed. <strong>Results: </strong>Of 44 women, 36 completed the survey. Mean age and time passed since graduation were respectively 43.5±13.5 years and 18±17 years for student and 53±13.5 years and 31.5±8.5 for professors; 25 women have at least one child, work more than 30 hours weekly and 10 of them work in two jobs.&nbsp; Health professionals and health occupations were predominant in both groups. Most students had little or no experience in Telehealth.&nbsp; The decreasing order of frequency motivation was professional refinement (63.8%), job opportunity (55.5%), financial gain (52.7%) and innovation (38.8%).<strong> Conclusion: </strong>Regardless of age, children, workload and professional qualification, the major women's motivation for enrolling in the Telehealth Postgraduate Programme is to professional refinement in this field.</p> Alexandra Monteiro Barbara Monteiro Grisolia Juliana Cardoso Munique Santos ##submission.copyrightStatement## 2019-01-05 2019-01-05 7 e3 (1 4) 10.29086/JISfTeH.7.e3 The Contribution of Online Social Networks for Drug Abuse Treatment Referral: a Pilot Study <p><strong>Background:</strong> The consumption of psychoactive drugs is growing in Brazil, as well as the access of social networks. This study is a preliminary short report about the contribution of online social networks for drug abuse treatment. The study aimed to evaluate the role of an online social network to engage psychoactive drug users in treatment. <strong>Methods: </strong>A descriptive study was undertaken from July to September 2015. The study population were psychoactive drugs users who accessed voluntarily the webpage “Stay Free of Drugs” (SFD) from the social network Facebook. <strong>Results</strong><em>:</em> A total of 25 psychoactive drug users were enrolled in the study, and 16 (64%) accessed a healthcare centre seeking treatment. The average from the users’ online contact to their visit to the healthcare centre was 8.4 days. Half of the participants were exclusive alcohol users and accessed the webpage at night (65%). <strong>Conclusions: </strong>The use of a social network showed a potential importance in referring drug users to treatment, also acting as health education strategy.</p> Diogo Barbosa Luciana Tricai Cavalini Nádia Cristina Pinheiro Rodrigues ##submission.copyrightStatement## 2019-01-25 2019-01-25 7 e4 (1 3) 10.29086/JISfTeH.7.e4 Social Media as an Opportunity for Public Health Interventions: The #Metoo Movement as an Exemplar <p><strong>Background</strong>: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of communication for users around the world. One of the most popular free social media networks is Twitter, with more than 100 million active users per day worldwide. <strong>Purpose:</strong> The aim of this study was to analyse a sample of the public conversations generated, using the hashtag #MeToo, around the topic of sexual abuse on Twitter.&nbsp; <strong>Methods:</strong>&nbsp; Using social media marketing software, the use of the #MeToo hashtag was analysed over a period of 60 days (14 September 2017 to 13 November of 2017). <strong>Results: </strong>The #MeToo conversation was mainly in English (79.3%), located in the United States (48.2% of cases), but with global repercussions. The volume of mentions of the #MeToo hashtag was far greater (97.7%), compared with other hashtags related to violence over this period of time, using mostly Twitter (96.2%). <strong>Conclusions: </strong>These results suggest that it is possible to describe different groups using the social media, and analyse their conversations to identify opportunities for successful public health interventions.&nbsp; If the topic is relevant for the general public, it will generate interest and conversations at the global level, supported by a universal and borderless channel such as Twitter.</p> Raquel Gomez Bravo María Gómez Bravo Charilaos Lygidakis Claus Vögele ##submission.copyrightStatement## 2019-04-17 2019-04-17 7 e5 (1 7) 10.29086/JISfTeH.7.e5 Feminisation of Dentistry in Brazil from the Perspective of a MOOC-Type Distance Course - A Short Report <p>The Brazilian public healthcare system (SUS - Brazilian Healthcare System) provides free dental care, covering almost half of the Brazilian population. Providing continuing education to thousands of professionals is a difficult and expensive task given the country’s large size. SUS' Open University in partnership with public universities provides ongoing education to thousands of healthcare professionals using technological resources for distance learning. A distance learning course, in the MOOC (Massive Open Online Course) modality, was developed to provide continuing medical education for dental surgeons to assist patients with chronic diseases. The course is free and has registered 13,089 participants. <strong>Aim:</strong> The purpose of this study is to present the profile of the MOOC course participants. <strong>Methods:</strong> Secondary data were obtained from Federal Council of Dentistry, the National Registry of Health Facilities, the National Institute for Educational Studies and Research Anísio Teixeira and the Registry of Higher Education Institutions and Courses (e-MEC). Data of the MOOC course were collected in the Arouca Platform. <strong>Results</strong>: Dentists in Brazil are predominantly female. However, in some specialties there are more men than women. The majority of participants on the course were female 73.5% and in the age group of 21-40 years. <strong>Conclusion</strong>: This phenomenon is similar to other countries, and needs to be better investigated in Brazil, so that public policies of continuing education of healthcare professionals by means of distance learning, may take the profession's feminisation into consideration. &nbsp;</p> Deise Garrido Camila Maldonado Huanca Ana Emilia Oliveira Maria Celeste Morita Ana Estela Haddad ##submission.copyrightStatement## 2019-03-09 2019-03-09 7 e6 (1 4) 10.29086/JISfTeH.7.e6 Telefitting Between Kajetany and Odessa, Ukraine for Cochlear Implants <p>Hearing implant fitting is a key component of postoperative patients’ healthcare, by providing the optimum auditory nerve electrical stimulation parameters. It often entails time consuming and long travel to a medical centre, with associated costs. In 2009, the Word Hearing Centre introduced the National Network of Teleaudiology to reduce the burden to patients, and it now consists of 21 co-operating centres in Poland and four abroad in the Ukraine (Odessa and Lutsk), Kyrgyzstan (Bishkek), and Belarus (Brest). The centre in Odessa is sufficiently equipped but programming of cochlear implants cannot be conducted by their team there due to a lack of trained specialists and limited experience. This study reports the use of the telefitting service between Kajetany in Poland and Odessa in the Ukraine. <strong>Methods: </strong>Specialists in Poland connect by videoconference with patients and support specialists via the Internet, and use remote desktop software to access a remote computer and perform fitting. On completion of telefitting, patients completed a questionnaire in which they compared the telefitting experience with face to face conventional fitting. <strong>Results:</strong> Supported by a local specialist, 316 patients in Odessa underwent remote telefitting by specialists in Kajetany. &nbsp;Over 95% of respondents were; satisfied with telefitting, found it a suitable alternative to standard fitting, felt that they had good contact by videoconference with the audiologist in Poland, and that it saved them time and money.&nbsp; <strong>Conclusion:</strong> The development of the telefitting model has increased accessibility to hearing care services in Odessa and opens new possibilities for patients.</p> Piotr Henryk Skarżyński Weronika Świerniak Maciej Ludwikowski Łukasz Bruski ##submission.copyrightStatement## 2019-03-20 2019-03-20 7 e17 (1 6) 10.29086/JISfTeH.7.e17 A Train-the-Trainers (TtT) Program for Engineers for Hosting Multiparty International Clinical Teleconferences <p><strong>Background:</strong> International clinical teleconferencing connecting hospitals contributes to the standardisation of medical care. <strong>Introduction: </strong>The perception that participating in international teleconferences is easy while hosting and coordinating them is difficult has limited the expansion of these kinds of programmes. We evaluated the effectiveness of a Train-the-Trainer (TtT) programme on hosting international multiparty teleconferences targeted at hospital engineers. <strong>Methods: </strong>From 2015 to 2017, 20 engineers and physicians from 17 institutions in 10 countries participated in Kyushu University Hospital’s TtT programme. Hands-on training and hosting a Training Report Conference (TRC) were conducted. The impact of the programme was assessed using questionnaires about the participants’ confidence, perception of barriers, and teleconference activity before and one year after the training period. <strong>Results: </strong>The mean training period was 16.7 days (median, 19 days). Twelve TRCs were hosted by trainees connecting 56 institutions in 11 countries. All participants gave positive evaluations of the overall programme, 19 (95%) "very good" and 1 (5%) "good", and the trainers 9 (90%) "very good" and 1 (10%) "good"). Following the TtT programme, the mean number of trainee-hosted events increased significantly (0.8 to 1.3, p&lt;0.001), and more respondents (12/17, 71%) reported barriers to hosting a programme than participating in one (5/17, 29%, p&lt;0.001). Trainee confidence in both hosting and participating in international teleconferences was significantly higher after TtT. <strong>Conclusion: </strong>There are more barriers to hosting than participating in international clinical teleconferences. This TtT programmes for engineers could contribute to more active hosting engagement.</p> Kuriko Kudo Tomohiko Moriyama Shunta Tomimatsu Shintaro Ueda Shuji Shimizu ##submission.copyrightStatement## 2019-03-21 2019-03-21 7 e16 (1 8) 10.29086/JISfTeH.7.e16 Development and Presentation of an Ethical Framework for Health and Medical Apps <p>The ubiquity of mobile applications makes it difficult to weigh up opportunities and potential risks. One significant aspect of an ethical assessment regarding the development and use of health and medical apps is the lack of clear and consistent guidelines and measures of value. <strong>Aim</strong>: The aim of this paper was to identify the main ethical determinants associated in the context of health and medical apps and develop a framework for ethical reflection. <strong>Methods: </strong>A systematic literature search in the database PubMed was undertaken and the journal Biomed Central Medical Ethics was hand searched and 32 met the review criteria. On this basis of the review an interview guide was developed and five purposively selected experts on the field of payers, science, consumers, medical ethics and society were interviewed regarding health and medical apps. <strong>Results: </strong>There is a lack of consistent and clear guidelines regarding the use of health and medical apps in literature. Indeed, findings refer to established biomedical principles. The interviews identified that several insecurities related to legal and regulatory issues are common. On the other hand, many advantages of the use of health and medical apps have been pointed out by experts. <strong>Conclusion: </strong>Debates on ethics and the use of health and medical apps should play a significant role in public discussion. Ethical endpoints cannot be considered isolated from each other, and must be regarded as a complex network of aspects connected with each other. Further research should concentrate on the development of consistent guidelines and a framework for reflection of occurring ethical concerns.</p> Pinar Tokgöz Hannah Eger Sarah Sharlyn Funke Alexander Gutjar Thuy Nguyen-Thi Christoph Dockweiler ##submission.copyrightStatement## 2019-03-16 2019-03-16 7 e15 (1 8) 10.29086/JISfTeH.7.e15