Global Tobacco Prevention using

Tele-health/E-health in Youth in
21st Century

Dr. Ali Imran

M.B.B.S., M.P.H. ( NY, USA)
RESEARCH FELLOWSHIP IN GLOBAL PUBLIC HEALTH,

MHC, NEW YORK MEDICAL COLLEGE, USA

Assistant Professor,
Head, Community Health Sciences Department
UNITED MEDICAL AND DENTAL COLLEGE,KARACHI
 eHealth
Definition
e=electronic
elitist, exclusive, exhausting, ephemeral, and exasperating

e=efficient
ethical, equity-based, empowered, encouraged,
educational, enhancement of quality, evidence-informed,
extension of the scope of healthcare, and enablement of
information exchange and communication in
standardized ways
 eHealth
Definition
eHealth:
consumer-centered model of healthcare
where stakeholders collaborate using
ICTs including Internet technologies to
manage health, arrange, deliver, and
account for care, and manage the
healthcare system.
(Ontario Hospitals e-Health
Council)
ICT Health
 eHealth
Why eHealth?

Pakistan goes from 300,000

to 90 million cell phone us
ers in under 8years
 eHealth
Applications
eHealth

Telehealth/Telemedicine eLearning Health Informatics

Use of ICTs to Delivery of Storage, retrieval

deliver health individualized, and optimal use
services, and comprehensive, of biomedical
expertise over dynamic learning data,
distance content, and linking information, and
with experts. knowledge
Mobile Health (mHealth)
 eHealth
Why eHealth?
Trends due to technology growth
Needs-based
Addressing existing issues and gaps
Opening new avenues
New demands on healthcare
Continuum of care
Public Health
Evaluation
 eHealth
Components
e-Health

Telehealth eLearning Health Informatics

Synchronous Asynchronous
 eHealth
Why eHealth?
Council of Europe (2003) stated:

eHealth is the single most

important healthcare system
revolution, on a par with the
use of modern medicines,
vaccines or even such
healthcare measures as
sanitation or clean water.
Never before in history has
innovation offered promise of so
much to so many in so short a time
Bill gates
 Telehealth
Definitions
Telehealth is the delivery of health related
services and information via
telecommunications technologies

'Telehealth' is an expansion of the functionality

Telemedicine and unlike Telemedicine (which
focuses on the curative aspect), it encompasses
Preventive, Promotive AND Curative
aspects.

Maheu, Marlene M.; Whitten, Pamela; & Allen, Ace (2001). E-Health, Telehealth, and
Telemedicine: A Guide to Start-up and Success. San Francisco: Jossey Bass.
ISBN 0-7879-4420-3.
 Telehealth
Definitions
The use of telecommunication technology to assist
in examination, monitoring, treatment,
management of patients, and education of
patients and personal; by systems giving
immediate access to expertise and patient
information, independent of where patient or
relevant information is located geographically

Guler FN, Ubeyli DE,Theory and Applications of Telemedicine,

Journal of Medical Systems, Volume 26, Number 3, 199-220
 Telehealth
Definitions
Telehealth can best be described as the sharp
end of eHealth. It is where the information
or data generated through the related
discipline of Health Informatics is used in
some form of direct (e.g. one on one) or
indirect (e.g. website) interaction with a
well citizen, ill patient, or fellow healthcare
provider in any location.
(Canadian Telehealth Forum http://www.coachorg.com/CTF//about_telehealth)
 Telehealth
Scope of Telehealth
A modified acronym CREAm can remind us of
the various ways in which telehealth can be
applied, (adapted from Richard Scott 2009)

Clinical,

Research,

Education (e-learning),

Administration, and

m-health
 Telehealth
Modalities

Telehealth

Clinical,

Research,

Education (e-
Synchronous learning),
Asynchronous
Administration, and

m-health
 Telehealth
Synchronous Telehealth
Presence of two or more parties at the same time
and a communication link between them that allows
a real-time interaction to take place.

Video-conferencing is one of the most common

technologies used in synchronous telehealth.

Peripheral devices can be attached to computers or

the video-conferencing equipment which can aid in
an interactive examination.

For instance, a tele-otoscope allows a remote

physician to 'see' inside a patient's ear;
a tele-stethoscope allows the consulting remote
physician to hear the patient's heartbeat.
 Synchronous Telehealth
Technology
Hardware Software
Video-
conferencing Mainly for
Computers information
Cameras transfer and
Speakers and administration
microphones
Accessories
Network Interface
device (modem)
Connectivity
Mostly High-bandwidth
Internet, Mobile, ISDN or Satellite
 Synchronous Telehealth
Uses
Replacing F2F consultations
Emergency consults
Case Discussions
Procedures/Telesurgery
Grouped with eLearning
 Asynchronous Telehealth
Definition
Store-and-forward Telehealth involves acquiring
medical data (such as medical images, biosignals,
etc.) and then transmitting this data to a doctor or
medical specialist at a convenient time for
assessment offline.

It does not require the presence of both parties at

the same time

Most common examples of store & forward are

emails
 Take Home
Synchronous Vs Asynchronous
REAL TIME
Real-time transmission
(interactive)
All participants must be available at
the same time for consultation
Consultation takes comparatively
longer
Transmission requires higher
bandwidth
Higher costs for equipment and
connections
Equipment must usually remain in
one location and is not portable
STORE-AND-FORWARD
Delayed transmission
Participants do not need to be
available at the same time for
consultation
Consultation takes comparatively
less time
Transmission requires lower
bandwidth (telephone connection is
sufficient)
Lower costs for equipment and
connections
Equipment is light and portable
 Technology Combinations
Hardware
Hardware requirements for
Synchronous Telehealth

Videoconferencing
sets
PCs with power
supply
Audio-Visual Support
 Hardware
Video-
conferencing
PC Systems

Resemble a standard
computer workstation
with a camera
Echo-cancellation
microphony
Alternate camera sources
Connectivity of
accessories possible
 Initial Assessment for Telehealth

Mode of delivery
(Asynchronous, Synch, hybrid)

Type of Connectivity
(Web, Mobile, Wimax, LAN, ISDN,
Satellite)
Type of Hardware
(PCs, Video-conf, cameras, other
accessories)
Type of Software
(Platform, Open source, Proprietary,
in-house)
 Needs Assessment
How?
Clients Provider
s
Health
considerations
Health Services
considerations

Economic
Technological considerations
considerations

Manage Syste
rs Modified from Doolittle and Cook. 1999 ms
 Factors Influencing eHealth
Adoption
Physical
Political will Appropriate Technology

Legal/Regulatory FW
Affordability

eHealth readiness

Trust Capacity

Socio-cultural factors Relevant content

Integration
 Readiness Assessment
eHealth Readiness
Core readiness
(needs-assessment, planning,
Awareness, trust, integration)
Policy Technological
Readiness Readiness
(legal and (Appropriate.tech,
Regulatory FW, availability,
political will) eHealth Readiness affordability)

Societal readiness
Learning Readiness
(Communication, relevance,
(Capacity building)
socio-cultural)
 Needs and Readiness Assessment
Key Messages
Telehealth planning should start with proper
Needs-Assessment
Needs-Assessment should include existing
gaps and future opportunities
Involve all stakeholders
Conduct Readiness Assessment
Act
Evaluate
 ooVoo software
Overview: ooVoo is changing the way people communicate
and connect online with its high-quality video and audio and
multi-user capabilities that allow up to six people to talk face-
to-face with each other at the same time.

Using ooVoo is easy and fun, all consumers need is a

computer, a broadband connection and a Web camera.

In addition, ooVoo offers video messaging to an email or

another ooVoo account, text messaging, and file sharing.

Format: Software | Size: 15,240KB | Version: 2.0.0.94 |

SystemRequirements: 1GHz Pentium 4 Processor, 256MB
RAM, 20MB HDD Space. | License: Free | Downloads: 32
ooVoo is a startup videoconferencing and instant
messaging application, similar to Skype Video.
ooVoo allows video chats with up to 6
participants, and unlike Skype Video, does not
use a P2P network.

Using ooVoo is easy and fun, all consumers need

is a computer, a broadband connection and a
Web camera. In addition, ooVoo offers video
messaging to an email or another ooVoo account,
text messaging, and file sharing. You can also
even send video messages to users who don't
have the software installed.
 ooVoo
ooVoo, launched in June 2007, is privately held and headquartered in New York City.
ooVoo is remarkably easy to use: easy to download, easy to install, and best of all: it's FREE!

Features:

* FREE Phone Calls. FREE calls from ooVoo to a landline or mobile phone in the USA or Canada.
* ooVoo Video Call. Start a face-to-face conversation and include up to six people.
* ooVoo Video Message. Tired of typing emails? Give your fingers a break and send a video
message to one friend or a group.
* Find Friends. Import contacts from the most popular email programs: Office Outlook, Gmail,
MSN Hotmail, Yahoo mail, AOLmail and more.
* Record video call. Create instant memories by recording your ooVoo video calls.
* Video Effects. Do you want to grow a virtual mustache or become a Superman all while on a
video call? Now you can.
* Chat. Text chat with up to six friends at a time!
* Send Files. With ooVoo its easy to share files with your friends!
* Sidebar View. Enable sidebar view to clearly view documents or other tasks on your screen.
* ooVoo me Link. Build your blog or MySpace page to life with an ooVoo link.
* Privacy. ooVoo is an exciting and fun new way to communicate and we want every one of your
ooVoo experiences to be safe and secure.
 Smoking Tobacco (Cigarette) and
Chewing Tobacco (Gutka)
How you use teleducation to prevent tobacco use
in youth?
What Cigarette Contain?
 Woman and Girls, globally smoke and use
tobacco in all religions, color and races.
How tele-education can make them quit or never
start in first place?
Smoking Statistics General Facts

how many people smoke, which age group

and how much money is spent on smoking.
tell us about what percentage of women smoke,
smoking related diseases suffered by both men
and woman
tell us about the people at higher risk of heart
attack and stroke.
smoking is said to be falling in the developed
world.
smoking is increasing in the developing
world.
 Smoking Statistics General Facts
General facts about smoking- smoking statistics 2008

General facts about smoking- smoking statistics 2008

Smoking kills. Smoking-related diseases kill one in 10 adults globally, or cause four
million deaths. If the same rate continues, by 2030 smoking will kill one in six people.
About a third of the male adult global population smokes.
Cigarette smoke contains 11 chemical compounds that are known to cause cancer.
Someone dies every eight seconds from tobacco use
Every minute 10 million cigarettes are sold
Among young teens (aged 13 to 15), about one in five smokes worldwide.
Half of long-term smokers will die from tobacco. Every cigarette smoked cuts at least
five minutes of life on average about the time taken to smoke it.
Smoking is the single largest preventable cause of disease and premature
death. It is a prime factor in heart disease, stroke and chronic lung disease.
It can cause cancer of the lungs, larynx, oesophagus, mouth, and bladder,
and contributes to cancer of the cervix, pancreas, and kidneys.
More than 4,000 toxic or carcinogenic chemicals have been found in tobacco smoke.
 Statistics for Death Caused due to Smoking and Tobacco Use

Cigarette smoke contains benzene, carbon monoxide, arsenic, hydrogen cyanide and polonium 210.
Tobacco is an addictive substance. Smokers who use other drugs such as heroin,
methadone, amphetamines and barbiturates rate tobacco as their most addictive drug.
At least a quarter of all deaths from heart diseases and about three-quarters of worlds chronic
bronchitis are related to smoking.
A 1998 survey found that tobacco companies were among the top 10 advertisers in 18 out
of 66 countries surveyed.
Through advertising, tobacco firms try to link smoking with athletic prowess, sexual attractiveness,
success, adult sophistication, adventure and self-fulfilment
Evidence shows that around 50% of those who start smoking in adolescent years go on to
smoke for 15 to 20 years.
Peer-reviewed studies show teenagers are heavily influenced by tobacco advertising.
The tobacco industry has changed the way it advertises in the last 30 years. Now, only 10%
of advertising expenditure goes to print and outdoor advertisements, while more than half
goes to promotional allowances and items, such as t-shirts for young people or lighters
and key rings.

==============================================================================

SOURCE: http://smoking.ygoy.com/smoking-statistics-general-facts/
 Tobacco is no doubt the single most cause of death in the world. Tobacco kills more then 5 million people which is much
much more then HIV/Aids, tuberculosis, malaria combined. By 2030 tobacco is going to kill 8 million people a year.
Tobacco use is a risk factor for 6 of 8 leading cause of death in the world. (smoking death statistics)

Source: WHO Report 2008

Areas which are hatched indicate proportions of death that are related to tobacco and are colored according to the
column of the respective cause of death.
How Tobacco Affects Your
Body
 Tobacco and Smoking related death which can be
prevented by avoiding or quitting?
Cancers caused by Smoking

Larynx
Oropharynx
Oesophagus
Trachea, bronchus or lung
Acute myeloid leukemia
Stomach
Kidney and Ureter
Pancreas
Colon
Cervix
Bladder
Chronic Diseases caused by smoking
(heart and lungs)

Stroke
Blindness, Cataracts
Coronary heart disease
Periodontitis
Aortic aneurysm
Pneumonia
Atherosclerotic peripheral vascular disease
Chronic obstructive pulmonary disease (COPD),
asthma, and other respiratory effects
Reproductive effects in women (including reduced
fertility)
Diseases caused by second hand
smoking Children
Middle ear disease
Respiratory symptoms, Impaired lung
function
Asthma
Sudden Infant Death, Syndrome
(SIDS)
Leukemia
Lower respiratory illness
Brain tumours
Diseases caused by second hand
smoking Adults
Stroke
Nasal irritation, Nasal sinus cancer
Breast cancer
Coronary heart disease
Lung cancer
Atherosclerosis
Chronic obstructive pulmonary disease (COPD) , Chronic
repiratory symptoms , Asthma , Impaired lung function
Reproductive effects in women: Low birth weight; Pre-term delivery

=========================================
================
SOURCE : http://smoking.ygoy.com/2009/05/23/statistics-for-death-caused-due-to-smoking-and-
tobacco-use
 Smoking and Weight
Control
Most smokers gain a modest amount of weight when they quit smoking.
A few extra kilograms are a much lower health risk than continuing to
smoke.
Most women and teenagers are apprehensive about gaining weight while
quitting the habit of smoking.
Weight gain can be controlled by managing ones craving for cigarettes
and food.
Not everybody is subject to weight gain on quitting smoking.
About 80 percent of the smokers experience a modest increase in weight
when they stop smoking.
Women tend to gain more of about 3-5.5kg in their first year of giving up
than men. This could be one reason why women are so worried about
quitting
============================================
====================
Source: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/(Pages)/Smoking_weight_gain_and_quitting?
OpenDocument
 Point to Ponder
Where do you see the trend to
control weight in Pakistani and
global women and girls ?
Examples:
Models
Actors
School and College Girls ( Pan,
Shesha,Cigratte, Gutka,Chalia)
Prevention of Tobacco by Tele-health

Internet ( global communication all

languages)
- School, Colleges, Universities and Workplaces awareness and education using

.
audio-video-teleconferencing or using webcam

SMS (cell phones healthy messages)

Cell and telephone
E-mails
Website ( Urdu)
Facebook -
www.facebook.com/stoptobaccomuslims
Prevention of Tobacco and Smoking
by:
Schools and Colleges by teachers and Doctors
Homes by educated parents
communication with children
Workplace by employer policy and smoking
cessation services to employees
Public places ( parks, cinemas, trains,
aero planes) by government legislation
Hospitals by health care providers (doctors,
nurses and public health educators and
others)and smoking cessation programs
STOP TOBACCO ( SMOKING)
Women and Girls Tobacco use Pakistan and USA.
What is the difference ?
Possibility to get infected by germs ( hepatitis and other in Shesha)

Shesha Smoking Cigarette Smoking

( Pakistan ) ( USA)
 Diseases prevented by stopping
Tobacco and Smoking . Fill the blanks
Tobacco and
Smoking
cause______ of oral
cavity .
Tobacco and
Smoking
cause______
diseases like
g--------.
Tobacco and
Smoking
cause______ in
 Smoking and Virility
Smoking was a privilege of men. A
woman with a cigarette was not
accepted and thought of as a
indecent or bad habit
Now things are different and the
chances to see a smoking woman
are as high as a man-smoker.
Recently the researchers started
talking about smoking being a
reason for breast cancer, child birth
defects and other harmful effects of
nicotine of womans body, but not
many people know that smoking
affects mens virility or sex power.
Media messages to Stop Tobacco.
What difference you See?
 Now Few Questions to Ponder?

1. Hope you all agree tele-health and e-health is now glocal

health (local and global health).

2. Tele-medicine and Tele-health/e-health will make us

global/glocal health care providers (doctors, nurses and etc).

3. We be now soon be having Virtual Medical and Dental

College/ Universities ,where global/glocal students and
global/glocal doctors in global /glocal medical colleges and
hospitals will learn, prevent, screen, diagnose, treat and
rehabilitate global/glocal patients in CYBERSPACE OF
CYBERMEDICINE , with no boundaries and we be global/glocal
licensed physicians.
Thanks You

Thanks You