Bogdan Asanin

Wireless patient monitoring for the e-inclusion of chronic patients and elderly people

e-Health has clearly started to become an important issue for implementation, operational deployment of services and a promising market for industry. The need for concentration of the information society technologies on the future so-called convergence generation has been specifically noted since FP6. The scope of this paper is to present an ambient, home based health and wellness measurement and monitoring architecture, especially targeting the elderly and chronic patients, aiming to facilitate their social inclusion (e-inclusion) by providing the means of easy follow-up from their home environment. The proposed paper presents a one-button functional, wireless monitoring system capable of acquiring 3 leads of ECG, pulse oxymetry and temperature measurements, and transmitting them over ZigBee to a computing device, which in turn is responsible for the transmission of the signal to a consultation unit. The authors envisage the development of a lightweight unobtrusive, belt-like wearable device that would enable patients to be monitored daily and at the same time allow them to perform their regular daily activities.

Prevalence of and contributing factors for overweight and obesity among Montenegrin schoolchildren.

BACKGROUND Newly emerging Western style economic systems provide new opportunities to study the prevalence and predictors of childhood obesity. We also provide for the first time a national study of childhood obesity using all three international anthropometric criteria. METHODS The sample included 4097 Montenegrin children, 2076 boys (50.7%) and 2021 girls. Anthropometric measurements were performed in school. The questionnaire for parents included questions on 24 potential contributing factors for childhood obesity. Nutritional status was assessed according to World Health Organization, US Center for Disease Prevention and Control and International Obesity Task Force (IOTF) criteria. RESULTS Overall percentage of Montenegrin children who are overweight or obese (IOTF) is 22.9% of which 5.3% are obese (7.0% boys vs. 3.5% girls). We found 10 factors to be independently associated with child obesity. Positive relations [odds ratio (95% confidence interval)] were found with maternal obesity [2.05 (1.68-2.51)], paternal obesity [1.67 (1.32-2.10)], paternal employment [1.40 (1.12-1.74)], maternal smoking [1.32 (1.08-1.61)], obesity at birth [1.33 (1.04-1.70)] and computer game playing [per hour--1.11 (1.00-1.24)]. Negative relations were found with female gender [0.64 (0.53-0.78)], the number of siblings [0.88 (0.78-0.98)], birth order [0.73 (0.64-0.83)] and age [0.92 (0.88-0.98)]. CONCLUSION One out of four Montenegrin children is overweight, with two times more frequent obesity among boys compared with girls. Some previously salient predictors did not appear salient in this sample. To enable worldwide comparability, we propose the use of all three childhood obesity criteria in national studies.

FPGA low-power implementation of QRS detectors

This paper presents a low power implementation of the algorithms for QRS complex detection in FPGA technology. We used cases of Balda and Pan-Tompkins algorithms for the case study. The optimization methodology is based on the use of heterogeneous logic blocks, pipelining, the variable code word lengths, on chip reorganizing of logic blocks and the control of the clocks. By applying the proposed techniques, the reduction of power consumption by 71% is achieved, in addition to the reduction of the chip occupancy by approx. 91%. The proposed optimization methodology and techniques are also applicable to other applications. The cases when the optimization could be justified in the term of project complexity are analysed and discussed.

Blood pressure among rural Montenegrin children in relation to poverty and gender

BACKGROUND Health inequalities may begin during childhood. The aim of this study was to investigate the main effect of poverty and its interactive effect with gender on childrens blood pressure. METHODS The study was performed in two elementary schools from a rural region near Podgorica, the capital of Montenegro. A questionnaire including questions on family monthly income, childrens physical activity and the consumption of junk food was self-administered by parents of 434 children (223 boys and 211 girls) aged 6-13 years. Childrens poverty level was assessed using the recommendations from the National Study on Poverty in Montenegro. Childrens body weight and height were measured and body mass index-for-gender-and-age percentile was calculated. An oscillometric monitor was used for measurement of childrens resting blood pressure in school. RESULTS A two-factorial analysis of variance with body mass index percentile, physical activity and junk food as covariates showed an interaction of gender and poverty on childrens blood pressure, pointing to synergy between poverty and female gender, with statistical significance for raised diastolic pressure (F = 5.462; P = 0.021). Neither physical activity nor the consumption of junk food explained the interactive effect of poverty and gender on blood pressure. CONCLUSION We show that poverty is linked to elevated blood pressure for girls but not boys, and this effect is statistically significant for diastolic pressure. The results are discussed in the light of gender differences in stress and coping that are endemic to poverty.

A single chip system for ECG feature extraction

This paper proposes an on-line system for feature extraction from ECG signal. The QRS detector, RR interval calculator, heart rate calculator and additional modules are developed in VHDL code and embedded in a single FPGA chip. The overall design has a low hardware occupation, 1838 LEs, and minimal number of setting parameters, only two, sampling and clock rates. The achieved accuracy is 97.5%. As such, it is very suitable for embedding in wearable health care systems, portable instruments and telemedicine devices. The methodology for QRS detection, system architecture and preliminary testing results are presented.

Hypertension and correlates among Montenegrin schoolchildren—a cross-sectional study

OBJECTIVES In one of the few national studies of children in a former Eastern bloc country emerging as a Western democracy and the first such study ever in Montenegro, this study establishes the prevalence and correlates of childhood hypertension (CH). STUDY DESIGN A cross-sectional national study. METHODS The study was conducted with 3254 children aged 7-13 years (50.3% male) from 39 elementary schools. We used a structured questionnaire to gather sociodemographic information as well as data on factors potentially related to CH. Childrens nutritional status was assessed using the criteria of the International Obesity Task Force. Waist circumference was also measured. Blood pressure was measured in schools using an oscillometric monitor. CH was defined as an average systolic blood pressure and/or diastolic blood pressure greater than or equal to the 95th percentile for sex, age, and height. RESULTS The prevalence of CH was 10.4% with no differences between boys and girls. Multiple regression revealed that the odds for child hypertension were lowered by 10% for each year of age. On the other hand, rural environment and child obesity raised the odds of hypertension by 38% and 68%, respectively. CONCLUSIONS We found hypertension in one out of ten Montenegrin schoolchildren, with no gender differences. Obesity and rural areas may be unfriendly to childrens blood pressure.

A FEASIBLE TEACHING TOOL FOR PHYSIOLOGICAL MEASUREMENT

This paper describes the development of a variety of classical biomedical experimental exercises by using interdisciplinary approach. A number of them have been developed integrating the knowledge of sensors, electronics, microprocessors and MATLAB software. The exercises depicted here are intended to introduce students to fundamental concepts of biomedical instrumentation, from the sensing requirements to subsequent data analyze. This not only enhances the fundamental knowledge, but also trains students in the application of complex concepts in real-world of practice and laboratory research. The emphasis is put on the measurement of physiological vital parameters. Similar concept can be applied to some other signals and systems, as well. Using proposed approach sophisticated and expensive equipment can be replaced successfully by a functional low cost hardware and/or versatile virtual instruments.

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed.

A single chip solution for pulse transmit time measurement

This paper proposes a methodology for Pulse Transmit Time measurement for purposes of cuff-less monitoring of Blood Pressure. The ECG and PPG signals are simultaneously acquired and Pulse Transmit Time is determined as a time between R peak in ECG and maximal slope in PPG. To distinguish characteristic points Discrete Wavelet Transform, Derivative Filtering, Modulus Maxima and additional functions are employed and translated in VHDL code and then embedded in a single chip from FPGA technology. The system works on-line, achieving accuracy of 97.53% and 97.09% for R peak and slope detection respectively. The emphasis is given to the description of signal processing approach, system architecture and working principles of fundamental components. Also, the preliminary testing results are presented.

A Fully Digital Approach in Sensing and Processing Photoplethysmographic Signal

A fully digital sensor-actuator has been developed for photoplethysmographic (PPG) measurements. Instead of classical sensor it uses standard light emitting diodes (LEDs) for both light emitting and detecting. Time-duration based conversion protocol is implemented by a field programmable gate array (FPGA) avoiding the need for analog amplifiers and precision analogue to digital converters (ADCs). The basic sensing configuration, presented here, consists of a pair of LEDs directly connected to two FPGA’s I/O pins and is capable of detecting the PPG signal from a finger or a toe. The better spectral sensitivity, increased and adjustable resolution, reduced noise, lower cost and dimensions are confirmed advantages. In this paper we introduce a sensing principle in conjunction with pulse-based measurement technique, signal filtering and data communication implemented in a single FPGA chip. The approach in general, as well as the prototype in particular, where evaluated through both qualitative and quantitative experiments. Keywords; PPG, measurement, microcontroller, sensor