TOURIST: Tracking of Urgent Risks in Swiss Travelers

Transcription

1 TOURIST: Tracking of Urgent Risks in Swiss Travelers A study using mhealth to describe health risks to travelers Andrea Farnham 1, MPH, Emily Stone 1, MPH, Silja Bühler 1, MD, MSc, Ulf Blanke 2, PhD, Milo Puhan 1, MD, PhD, Christoph Hatz 1,3, MD 1 Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland 2 Wearable Computing Laboratory, ETH, Zurich, Switzerland 3 Swiss Tropical and Public Health Institute 11/4/2016 Page 1

2 Agenda Why was this study needed? Background of the study aims Methodology of data collection using mobile application during travel How successful has enrollment and data collection been in practice? Description of study population A look at some initial results What are the next steps? Discussion/Questions 4/19/2016 TOURIST, Farnham Page 2

3 Background Travel medicine focuses on infectious disease We seek to broaden understanding of risks: Accidents (e.g. motor vehicle or leisure) Chronic conditions (e.g. poor compliance with medication or change in routine during travel) Preliminary Focus: Travelers in Thailand 8/9/2015 TOURIST, Farnham Page 3

4 mhealth Technology Smartphones and other mobile technology are becoming an ever more important part of travel Opportunity to gather an unprecedented amount of health data Almost real-time data collection minimizes recall bias and underreporting In Switzerland alone, smartphone users have increased from 43% of the population in 2012 to 72% in /19/2016 TOURIST, Farnham Source: The Connected Consumer Survey 2014 / 2015 Page 4

5 mhealth Technology Partner: ETH Wearable Computing Lab Multiple Data Sources: Smartphone data collection: Streaming Data (GPS-tracking, weather, location data) Electronic questionnaires from travelers on risky behaviors (i.e. drinking local tap water) and symptoms (i.e. fever). Traditional pre-travel paper questionnaires Publically available data collected: Examples: disease epidemiology, traffic patterns 4/19/2016 TOURIST, Farnham Page 5

6 Data Collection via Smartphone App

7 Case Study: The Do It All Traveler 4/19/2016 TOURIST, Farnham Page 7

8 Patterns in Symptoms during the Trip 1 week island hopping: cluster of symptoms including vertigo, headache, diarrhea, restless thoughts, exhaustion, feeling tense or irritable Rural National Parks: few symptoms 3 days Bangkok: runny nose, rash, constipation, diarrhea, nausea, exhaustion 4/19/2016 Title of the presentation, Author Page 8

9 Environmental Conditions Encountered during the Trip Location data collected via GPS fix every 15 minutes Open source social media data used for location information 4/19/2016 Title of the presentation, Author Page 9

10 Study Objectives Primary: To characterize risk behaviors of travelers, including the subpopulation of travelers with chronic diseases, and their consequences on health. 4/19/2016 TOURIST, Farnham Page 10

11 Study Objectives Primary: To characterize risk behaviors of travelers, including the subpopulation of travelers with chronic diseases, and their consequences on health. Secondary: To assess the feasibility of a smartphone app (TRAVEL app) for real-time travel health data collection for risk assessment. To investigate the relations between travelers' specific risk profile and symptom development. 4/19/2016 TOURIST, Farnham Page 11

12 An Innovative Data-Driven Analysis 4/19/2016 TOURIST, Farnham Page 12

13 Primary Outcome: Clinically Relevant Risk Profiles 4/19/2016 Title of the presentation, Author Page 13

14 How successful has enrollment and data collection been in practice? 4/19/2016 TOURIST, Farnham Page 14

15 How did recruitment go? Enrollment rate of 17% (85/487) in Zürich, although the denominator includes clients who may not have been otherwise eligible for the study. 16% of those who actually went to Thailand dropped out None reported answering questionnaires too difficult during travel 4/19/2016 TOURIST, Farnham Page 15

16 Basic Population Description Mean Age (Median) Study Population 30.3 (27) Age Range % Male 38% (29/77) 4/19/2016 TOURIST, Farnham Page 16

17 Data Completeness Only 2/75 participants did not return baseline questionnaire (97.3% response rate) Avg surveys/traveler (median: 12.0, range: 1-30), or 0.83 surveys per day in Thailand Women on average filled out more surveys than men (13.6 vs. 10.6) 4/19/2016 TOURIST, Farnham Page 17

18 Completeness was best for trips <21 days 4/19/2016 Title of the presentation, Author Page 18

19 Health outcomes with non-infectious disease causes are common PERCENTAGE REPORTING DURING TRAVEL SYMPTOM 4/19/2016 TOURIST, Farnham Page 19

20 Accidents Reported in 22% of Sample 32 total accidents happened to 17 individuals (traffic accident, fall or sprain, sport accident, other accident or injury) 35% (6/17) male Mean age 30.3 (median: 27) 4 incidents (12.5%) were self-rated as severe (level 3 or 4)

21 Even in a small sample, self-rated severe noninfectious disease outcomes occur Severe Moderately Severe Moderate Mild Number of Days Reported Bite, lick, or sting from animal Accident Wound or cut Mental distress 4/19/2016 TOURIST, Farnham Page 21

22 «Risky» health behaviors are common during travel PERCENTAGE OF TRAVELERS Ate raw fruit or vegetables Felt the effects of alcohol Drank tap water Came in contact with Thai healthcare Bought a medication locally Took marijuana Attended Full Took another Moon Party drug HEALTH BEHAVIOR 4/19/2016 TOURIST, Farnham Page 22

23 Summary: an E-Doctor in Your Pocket Revolutionary new data collection tool utilizing mhealth technology Potential for almost real-time data collection during travel, limiting recall bias Initial findings support importance of research beyond infectious disease in travel medicine 4/19/2016 TOURIST, Farnham Page 23

24 What are the next steps? Expansion to new regions and research questions Eventually, an interactive device that will help individuals and their at-home physicians to monitor health while traveling 4/19/2016 Title of the presentation, Author Page 24

25 Current Travel Medicine Model Travel Medicine Consult Advice Based on Travel Destination Consult Doctor after Trip about Health Problems Unknown Health Outcomes during Trip 4/19/2016 Title of the presentation, Author Page 25

26 How can a smartphone application impact travelers and travel medicine specialists? Travel Medicine Consult Specialized Advice based on Itinerary and traveler profile Better Preparation for Trip Database of Traveler Health Outcomes Follow-Up After Travel Monitoring Emergent Health Situations During Travel 4/19/2016 Title of the presentation, Author Page 26

27 What is next? Swiss National Foundation Grant (funded) Starting January 2017 Larger sample size, focused on elderly and chronic disease traveler EU COST Action (ongoing) Collaboration of European partners to develop EU grant application Aim to use mhealth technology to address a range of topics in travel medicine research 4/19/2016 Title of the presentation, Author Page 27

28 EU COST (European Cooperation in Science and Technology) Action European funding instrument supporting cooperation among scientists and researchers across Europe Objective: To identify and address common research questions in travel medicine with regard to infectious diseases, to travelers with chronic underlying diseases and to the occurrence of accidents & injuries (including high altitude sickness) using mhealth technology for data collection. Currently developing ideas with partners from 8 countries Interested in joining? Application deadline 25th April /19/2016 Title of the presentation, Author Page 28

29 Thank you! Contact information Andrea Farnham, MPH Epidemiology, Biostatistics and Prevention Institute (EBPI) University of Zurich Hirschengraben 84 CH-8001 Zurich Phone /19/2016 TOURIST, Farnham Page 29