Auswahl der wissenschaftlichen Literatur zum Thema „Health and workout applications“

Fitness and physical exercise are preferred in the pursuit of healthier and active lifestyles. The number of mobile applications aiming to replace or complement a personal trainer is increasing. However, this also raises questions about the reliability, integrity, and even safety of the information provided by such applications. In this study, we review mobile applications that serve as virtual personal trainers. We present a systematic review of 36 related mobile applications, updated between 2017 and 2020, classifying them according to their characteristics. The selection criteria considers the following combination of keywords: “workout”, “personal trainer”, “physical activity”, “fitness”, “gymnasium”, and “daily plan”. Based on the analysis of the identified mobile applications, we propose a new taxonomy and present detailed guidelines on creating mobile applications for personalised workouts. Finally, we investigated how can mobile applications promote health and well-being of users and whether the identified applications are used in any scientific studies.

Purpose – This paper aims to describe the development of WorkOut, an Internet-based program designed to help young men overcome the barriers towards help-seeking and to build the skills they need to understand and manage their own mental health. Information and communication technologies (ICT) hold great potential to significantly improve mental health outcomes for hard-to-reach and traditionally underserved groups. Internet-based programs and mobile phone applications may be particularly appealing to young men due to their convenience, accessibility and privacy and they also address the strong desire for independence and autonomy held by most men. Design/methodology/approach – In this paper, we describe the design process itself, and the strategies used for multi-disciplinary collaboration. The initial evaluation process and results are also described which consisted of three distinct phases: website statistics; one-on-one user testing; and pilot interviews. Findings – The results suggest that WorkOut has the potential to attract young men. However, further work is needed to ensure that users remain engaged with the program. Originality/value – The difficulties encountered and lessons learned provide an insight into the factors that should be considered in the design and evaluation of future ICT-based strategies within the mental health domain, as well as their potential applicability to clinical and educational settings.

Background/Objectives: As u-health becomes common that monitors body condition real time in the ubiquitous environment, people are increasingly interested in promoting their health using biometric information identified by various health equipment.Methods/Statistical analysis: the concept of digital health has emerged that encompasses the followings: u-health that is expected to improve efficiency in medical service and monitor patients’ condition with wireless communication through convergence of ICT and health care industry; smart health(s-health) that manages their own workout, calorie intake and sporting activities with their smart device; and, mobile health (m-health) that uses wearable and mobile devices as a means of healthcare.Findings: In this study, we aim to develop a health care platform that receives diabetes information generated from various IoT based on remote inputs, stores, analyzes, processes and provides visualized information. The purpose of this study is to develop and test IoT-based diabetes health big-data platform for diabetes mellitus patients. To achieve this goal, we suggest the development result of service and contents oriented “An IoT-based diabetes health big-data Offloading platform” that comprehensively manages healthcare products created in many IoT-based diabetes information to build a personal health management system. We also developed android 4.x-based application so that the health management service and contents provided by a third party can be checked with the client PC as well as health management service and contents offered by web-based client application and third party can be operated in the mobile environment such as smartphone or tablet.Improvements/Applications: The results of this study are verified by applying it to patients with diabetes or suspected cases. In order to increase the efficiency of real-time processing, we used off-loading technology to utilize big data related to diabetes generated from wearable IoT device. The results of this study will be used for telemedicine in two hospitals in Malaysia after various laboratory verification procedures.

Heart rate monitoring in physical exercise regimens is the key indicator of the workout intensity level. Day-to-day exercise variation of the heart rate reflects any progress achieved by the trainee and helps the trainer or the trainee himself to adjust the exercise work plan accordingly. However, timely decision upon changing intensity level of exercise is of crucial importance so as to maximize the health outcomes. Prediction of future heart rate values based on the trainee's history profile may prove to be a useful decision making tool in that case. The minimum set of available heart rate measurements in combination with the existence of outliers pose restrictions so to achieve reliable predictions. Time-series forecasting state-of-the-art algorithms such as Support Vector Regression and Gaussian Processes have been used in order to extract the best forecaster for these data. Heart rate data during and at the end of an exergaming intervention of 90 seniors were analyzed and compared in different cases. No single method outperformed the others. However, forecasting error was considered acceptable and all algorithms proved to be robust enough, even in the presence of outliers and irrespective the forecasting horizon, be it short or long term.

CrossFit® training is one of the fastest-growing fitness activities in the world due to its varied functional movement and competition experience. The performance is present in almost every workout of the day (WOD); however, there is a lack of knowledge in the science that did not allow us to fully understand the performance determinants of CrossFit WOD’s like we do for other individual or team sports. The purpose of this study was to analyze the physical and physiological variables of recreational trained CrossFit athletes during one of the most famous WOD, FRAN, and to identify which variables best determine performance. Methods: Fifteen CrossFit practitioners performed, alone on separate days, 1RM and a maximum of repetitions of pull-ups test, 1RM and a maximum of repetitions of thrusters with 95 lb/43.2 kg, FRAN CrossFit WOD, and 2K Row test. Results: Blood lactate concentrate, HRmax, HRav, and RPE achieved higher values for 2K Row and maximum repetitions of thrusters. Maximum repetition of thrusters and pull-ups, 1RM of thrusters, and 2K Row resulted in moderate to strong correlation with FRAN performance (r = −0.78; r = −0.58; r = −0.67; r = 0.63, respectively). Conclusions and practical applications: FRAN performance was strongly related to maximal and endurance strength training of thrusters, which should be prioritized.

Inflammation is an adaptive response to both external and internal stimuli including infection, trauma, surgery, ischemia-reperfusion, or malignancy. A number of studies indicate that physical activity is an effective means of reducing acute systemic and low-level inflammation occurring in different pathological conditions and in the recovery phase after disease. As a proof-of-principle, we hypothesized that low-intensity workout performed under modified oxygen supply would elicit a “metabolic exercise” inducing a hormetic response, increasing the metabolic load and oxidative stress with the same overall effect expected after a higher intensity or charge exercise. Herein, we report the effect of a 5-week low-intensity, non-training, exercise program in a group of young healthy subjects in combination with the exposure to hyperoxia (30% and 100% pO2, respectively) or light hypoxia (15% pO2) during workout sessions on several inflammation and oxidative stress parameters, namely hemoglobin (Hb), redox state, nitric oxide metabolite (NOx), inducible nitric oxide synthase (iNOS), inflammatory cytokine expression (TNF-α, interleukin (IL)-6, IL-10), and renal functional biomarkers (creatinine, neopterin, and urates). We confirmed our previous reports demonstrating that intermittent hyperoxia induces the normobaric oxygen paradox (NOP), a response overlapping the exposure to hypoxia. Our data also suggest that the administration of modified air composition is an expedient complement to a light physical exercise program to achieve a significant modulation of inflammatory and immune parameters, including cytokines expression, iNOS activity, and oxidative stress parameters. This strategy can be of pivotal interest in all those conditions characterized by the inability to achieve a sufficient workload intensity, such as severe cardiovascular alterations and articular injuries failing to effectively gain a significant improvement of physical capacity.

Blockchain technology has recently inspired remarkable attention due to its unique features, such as privacy, accountability, immutability, and anonymity, to name of the few. In contrast, core functionalities of most Internet of Things (IoT) resources make them vulnerable to security threats. The IoT devices, such as smartphones and tablets, have limited capacity in terms of network, computing, and storage, which make them easier for vulnerable threats. Furthermore, a massive amount of data produced by the IoT devices, which is still an open challenge for the existing platforms to process, analyze, and unearth underlying patterns to provide convenience environment. Therefore, a new solution is required to ensure data accountability, improve data privacy and accessibility, and extract hidden patterns and useful knowledge to provide adequate services. In this paper, we present a secure fitness framework that is based on an IoT-enabled blockchain network integrated with machine learning approaches. The proposed framework consists of two modules: a blockchain-based IoT network to provide security and integrity to sensing data as well as an enhanced smart contract enabled relationship and inference engine to discover hidden insights and useful knowledge from IoT and user device network data. The enhanced smart contract aims to support users with a practical application that provides real-time monitoring, control, easy access, and immutable logs of multiple devices that are deployed in several domains. The inference engine module aims to unearth underlying patterns and useful knowledge from IoT environment data, which helps in effective decision making to provide convenient services. For experimental analysis, we implement an intelligent fitness service that is based on an enhanced smart contract enabled relationship and inference engine as a case study where several IoT fitness devices are used to securely acquire user personalized fitness data. Furthermore, a real-time inference engine investigates user personalized data to discover useful knowledge and hidden insights. Based on inference engine knowledge, a recommendation model is developed to recommend a daily and monthly diet, as well as a workout plan for better and improved body shape. The recommendation model aims to facilitate a trainer formulating effective future decisions of trainee’s health in terms of a diet and workout plan. Lastly, for performance analysis, we have used Hyperledger Caliper to access the system performance in terms of latency, throughput, resource utilization, and varying orderer and peers nodes. The analysis results imply that the design architecture is applicable for resource-constrained IoT blockchain platform and it is extensible for different IoT scenarios.

NiTi is a metal alloy with unconventional functional characteristics: Shape memory and pseudoelasticity. Its use in the field of rehabilitation is very innovative. This work presents applications in lower limb orthotics. Three different devices were assembled and tested: An equinus gait dynamic splint, a compliant ankle positioning brace, and a dual-mode haptic/active exerciser for the dorsiflexors. Results are derived from technical and preclinical trials. The gait splint improves several walking parameters even better than a traditional flexible ankle-foot orthoses (AFO). In particular, it supports mid-stance and propulsion biomechanics and affects physiological activation of tibialis anterior during swing much less than posterior leaf AFO. The haptic/active exerciser, able to provide dorsiflexion through a suitable articular range, could be controlled on the basis of minimal surface electromyo-graphic (sEMG) signals, suggesting its use as an aid for early active workouts as soon as patients start to recover voluntary control of tibialis anterior. Further evidence must be sought in future to confirm for the ankle joint the promising results obtained in repositioning applications in prior upper limb studies. The work done so far on the tested prototypes is encouraging: Material characteristics and dimensioning will be optimized so that customized NiTi devices can be prescribed to best meet individual patients' requirements.

The purpose of the present study is to investigate the health issues of Romanian master athletes who practice endurance running and the methods for recovering after their workout. The research method was the investigation. The tool which is used is a questionnaire developed for the present research. Of the 111 respondents, 61.8% are men and 38.2% are women. The results collected show that 46.8% of the athletes came across health issues and that there is a certain correlation between the medical conditions suffered by master athletes and the recovery methods (p <1%). Conclusions: we consider that the attention paid to the “training” of the athletes regarding the crucial role of adequate recovery after the workout reduces the risk of injury. In the first weeks after a serious injury, in order to avoid any recurrence, a full recovery and a progressive increase of the workout level are necessary.

Samhället vi lever i är uppbyggt av ett genussystem som baserar sig på könsnormer. Könsnormerna bygger på bland annat principen separation, som bygger på tanken att män och kvinnor utgör två separata grupper som anses ha olika könsspecifika egenskaper. Genussystemet skapar därmed en skillnad där det maskulina anses som en standard och det feminina som avvikande från denna standard. Hälsa och träning är ett bekönat område, där hälso- och träningsapplikationer ofta kodas utifrån normer om maskulinitet och femininitet. För att utmana och skapa medvetenhet om dessa könsnormer, kan kritisk design användas. Den kritiska designansatsen bygger därför på tanken om att designelement kan användas för att synliggöra könsnormer. På sikt kan detta leda till att individer blir medvetna om dem och kan bidra till en förändring i samhället genom att skapa ett mer jämställt samhälle. I denna studie har det utforskats hur könsnormer kan synliggöras i design av hälso- och träningsapplikationer. Studien har genomförts med en kritisk designorienterad ansats, där en prototyp har utvecklats med hjälp av metoden dekonstruktion i syfte att undersöka hur normerna kan synliggöras. Studien har resulterat i kunskaper om hur metoden dekonstruktion kan användas för att synliggöra könsnormer, samt ett antal designriktlinjer som beskriver hur designelement kan kombineras för att synliggöra normerna.<br>The society we live in is made up of a gender system based on gender norms, including the principle of separation. This principle is based on the idea that men and women constitute two separate groups that are considered to have different gender-specific characteristics. The gender system thus creates a society where masculine qualities are considered to be the standard and the feminine qualities as deviating from this standard. Health and workout applications are often built upon these norms about masculinity and femininity. To challenge and create awareness of these gender norms, critical design can be implemented. The critical design approach is based on the idea that design elements can be used to make gender norms visible. In the long run, this can lead to individuals becoming aware of these norms and can contribute to a change in society by annihilating them. In this study, it has been investigated how gender norms can be made visible in the design of health and workout applications. The study has been conducted with a critical design-oriented approach, where a prototype has been developed using deconstruction as a design method in order to investigate how the norms can be made visible. The study has resulted in knowledge about how the deconstruction method can be used in order to create awareness of gender norms, as well as design guidelines which describe how design elements can be combined in order to achieve this awareness.

This thesis project reconsiders the purpose and effectiveness of public, free-to-use outdoor gyms, resulting in the Health Loop nine-station outdoor gym. The project identifies three key areas of failings in existing gyms: intimidation, lack of understanding, and lack of enjoyment.The design solution creates a gym which focuses firstly on providing a comfortable, appealing, approachable space and equipment. This is achieved through simplicity, a non-sporting atmosphere, and targeting the workout to relatively inactive people. The second key focus is on quick-to-understand, engaging, enjoyable workout routines for each station. This aspect is delivered through an interactive digital display and sensors to provide gamified routines and feedback.

L'obiettivo della tesi è progettare un'architettura abilitante per scenari smart health, concentrandosi sulla parte end-user (non sulla parte server-cloud), ossia sperimentando l'ambito dei wearable devices e facendo riferimento al binomio fitness-Apple Watch, comodo perchè presente nell'azienda FitStadium che ci fornisce motivazioni, requisiti e goals. Nel primo capitolo si analizzeranno le soluzioni offerte attualmente dal mercato per la realizzazione di servizi legati al fitness, focalizzandosi in particolare sulle architetture proposte e come quest'ultime possano convivere con l'ecosistema FitStadium. Il secondo capitolo è riservato invece all'approfondimento delle tecnologie Apple, che verranno utilizzate concretamente per la realizzazione del caso di studio. Ancora una volta si farà attenzione alle possibilità architetturali offerte da queste tecnologie. Nel terzo capitolo viene trattato nella sua interezza il caso di studio, analizzandone in particolare lo stato pre e post tesi. Verrà cioè descritta l'applicazione implementata insieme alla presentazione di un'architettura abilitante anche per gli scenari smart health. Infine, all'interno del capito 4 viene descritto più precisamente il concetto di smart health e il percorso che ha condotto alla sua definizione.

As mobile devices become more prevalent in healthcare scenarios, it is becoming necessary to develop infrastructure to allow these devices to securely participate in emergency healthcare response scenarios. In this work, the scenario of an emergency response team requesting access to the health care records of a patient is analyzed. As these records may not be immediately available to the requesting party, several parties may need to be contacted to ensure to validate the identity of the requester and deliver the records. Existing works exploring this topic are briefly analyzed. Using recommendations found in these works as well as standard technologies such as SSL, X.509, and AES, a proposed protocol for such a scenario is presented. The construction of a prototype using Android as the mobile phone OS and Tomcat as the Java HTTP Servlet container and web server is discussed, focusing on the implementation decisions as well as the difficulties encountered during development. Finally, weaknesses of the proposed protocol that were realized during prototype implementation are discussed and future improvements are proposed.

Background: This thesis aims to investigate if the use of mobile health (mHealth) applications have positive effects on health.   Objectives: This research are to provide an insight of how people are using mHealth applications but also provide an insight of the target group. Additionally, the thesis will provide an analysis of the proposed Structural Equation Model (SEM) to understand the influencing factors (constructs) for health improvement.    Method: In this research a Structural Equation Model (SEM) approach was used in which a questionnaire with closed ended questions related to each construct were provided to collect the data. The data were analyzed by the computer program IBM SPSS 25 and the SEM was made by the IBM SPSS AMOS 25.   Results: The proposed theoretical SEM model showed validity and the proposed hypotheses 1 and 2 were significant for this model. The corresponding contributed construct to improve health, were “Healthcare Service” and “mHealth App Behavior”. “New Technology” did not contribute to improvement of health directly, but it correlated strongly to “Healthcare Service” but also to “mHealth App Behavior”.   Conclusions: The target group was defined as a group of early adopters who used mobile health applications and more specifically, they used fitness apps to enhance health. People in the target group were high educated and had occupations which corresponded well with their education. Additionally, this group used their knowledge by reading and understanding health information when they needed healthcare service to improve health.  Keywords: Adoption, Health, mHealth, New Technology

Aquesta tesi està formada per dues parts relacionades amb l'estudi de la salut d'una regió geogràfica dividida en un conjunt de zones (àrees petites). La primera part es basa en un estudi amb informació de salut agregada per cadascuna de les àrees que formen la regió d'estudi. En concret, es tracta d'una aplicació de mapes de salut (disease mapping), que utilitza mètodes Bayesians empírics per generar un Atles de mortalitat en àrees petites de Catalunya en el període 1984-1998. La segona part utilitza una nova perspectiva basada en la integració de les dades agregades i individuals de salut per cadascuna de les zones que formen la regió d'estudi, mitjançant equacions d'estimació (estimating equations). Aquesta nova perspectiva és una extensió de la regressió geogràfica.<br/>L'elaboració de la primera part d'aquesta tesi està justificada per diferents raons. En primer lloc, els atles de salut i en general els mapes d'indicadors de salut, ens han mostrat la seva gran utilitat per identificar les localitzacions geogràfiques de les malalties, formular hipòtesis sobre les causes de la malaltia i monitoritzar intervencions en salut pública. En segon lloc, els atles de mortalitat en àrees petites presenten la distribució del risc relatiu per les causes de mortalitat més importants utilitzant mapes amb un alt nivell de resolució geogràfica.<br/>El primer objectiu d'aquesta tesi va ser construir un atles de mortalitat en 289 àrees petites (municipis o municipis agregats) de la Comunitat Autònoma de Catalunya i 66 àrees bàsiques de salut de la ciutat de Barcelona (l'àrea petita analitzada amb una major població) per al període 1984-1998. Per obtenir els indicadors de salut en àrees petites s'han utilitzat mètodes Bayesians. Aquests mapes presenten, en un format de doble pàgina, els riscs relatius ajustats per edat, les àrees significatives d'alt i baix risc, el risc relatiu de la ciutat de Barcelona respecte a Catalunya i internament respecte a Barcelona, el risc relatiu per grups d'edat (0-64 i &#61619;65) i addicionalment l'evolució temporal del risc relatiu en cada àrea resumida en un únic mapa. En concret, per estudiar l'evolució del risc relatiu de mortalitat s'inclou: 1) l'evolució del risc relatiu en el període d'estudi de cada àrea comparada amb la tendència global de Catalunya i 2) l'evolució absoluta del risc relatiu a cada àrea. Segons el nostre coneixement, aquesta és la primera vegada que aquests dos tipus d'informació es combinen en un únic mapa. A més, aquest és el primer Atles que presenta informació sobre la distribució geogràfica de zones que formen àrees petites de gran població, com ciutats d'un país, i inclou l'esperança de vida obtinguda amb mètodes Bayesians empírics.<br/>La segona part d'aquesta tesi és útil per estudis epidemiològics on s'inclouen variables d'exposició i confusió que poden tenir diferents fonts de variabilitat (variabilitat dins les poblacions i entre les poblacions). Específicament, els anàlisis individuals que valoren la relació entre la malaltia i l'exposició dins d'una població són útils quan l'exposició presenta variabilitat dins la població. Quan aquesta variabilitat és limitada, la força dels anàlisis individuals es debilita. En aquesta situació, un anàlisis de dades agregades de la malaltia entre poblacions, amb una mostra de dades individuals d'exposició, pot ser eficaç en l'estimació de l'efecte d'exposició si aquest presenta gran variabilitat entre poblacions. No obstant, encara que es pugui conèixer quina de les dues variacions domina en la variable d'exposició, es poden considerar conjuntament variables d'exposició i/o confusió amb diferents tipus de variació. El segon objectiu d'aquesta tesi va ser considerar una nova perspectiva, combinació dels anàlisis de dades individuals i agregades, basat en equacions d'estimació (perspectiva population-based estimating equation (PBEE)). En funció de la variabilitat que domina en la exposició, la anàlisis proposada pren força de la perspectiva basada en dades individuals i agrades de salut, per estimar els efectes d'exposició. Es van realitzar estudis de simulació en diferents escenaris per a mostrar el poder de la perspectiva proposada en l'estimació dels efectes d'exposició d'interès.<br/>Finalment, esperem que els mètodes i els diferents aspectes utilitzats en aquesta tesi puguin ser d'utilitat per a aquells investigadors que vulguin millorar l'estudi de la salut a l'espai i temps.<br>Esta tesis esta formada por dos partes relacionadas con el estudio de la salud en una región geográfica dividida en un conjunto de zonas (áreas pequeñas). La primera parte considera un estudio con información de salud agregada para cada una de las áreas que forman la región analizada. En concreto, se trata de una aplicación de mapas de salud (disease mapping), consistente en el uso de métodos Bayesianos empíricos para generar un Atlas de mortalidad en áreas pequeñas de Cataluña en el periodo 1984-1998. La segunda parte considera un nuevo enfoque que realiza una integración de los datos agregados e individuales de salud para cada una de las zonas que forman la región en estudio, mediante ecuaciones de estimación (estimating equations). Se considera que este nuevo enfoque es una extensión de la regresión geográfica. <br/>La elaboración de la primera parte de esta tesis esta justificada por diferentes razones. Primero, los atlas de salud y en general los mapas de indicadores de salud, han mostrado su gran utilidad para identificar localizaciones geográficas de las enfermedades, formular hipótesis sobre las causas de la enfermedad y monitorizar intervenciones en salud pública. En segundo lugar, los atlas de mortalidad en áreas pequeñas presentan la distribución del riesgo relativo para las causas de mortalidad más importantes usando mapas con un alto nivel de resolución geográfica. <br/>El primer objetivo de esta tesis fue construir un atlas de mortalidad en 289 áreas pequeñas (municipios o municipios agregados) de la Comunidad Autónoma de Cataluña y 66 áreas básicas de salud de la ciudad de Barcelona (el área pequeña analizada con mayor población) para el periodo 1984-1998. Para obtener los indicadores de salud en las áreas pequeñas se han aplicado métodos Bayesianos. Estos mapas presentan, en un formato de página doble, los riesgos relativos ajustados por edad, las áreas significativas de alto y bajo riesgo, el riesgo relativo de la ciudad de Barcelona con respecto a Cataluña e internamente con respecto a Barcelona, el riesgo relativo por grupos de edad (0-64 y &#61619;65) y adicionalmente la evolución temporal del riesgo relativo en cada área resumida en un único mapa. En concreto, para estudiar la evolución del riesgo relativo de mortalidad se incluye: 1) la evolución del riesgo relativo en el periodo de estudio de cada área comparada con la tendencia global de Cataluña y 2) la evolución absoluta del riesgo relativo en cada área. Según nuestro conocimiento, esta es la primera vez que ambos tipos de información se combinan en un único mapa. Además, este es el primer Atlas que presenta información sobre la distribución geográfica de zonas que forman áreas pequeñas de gran población, como ciudades de un país, e incluye la esperanza de vida obtenida mediante métodos Bayesianos empíricos. <br/>La segunda parte de esta tesis es útil en estudios epidemiológicos donde se incluyen variables de exposición y confusión que pueden tener diferentes fuentes de variabilidad (variabilidad dentro de las poblaciones y entre poblaciones). Específicamente, los análisis individuales que valoran la relación entre enfermedad y exposición dentro de una población son útiles cuando la exposición presenta variabilidad dentro de la población. Cuando dicha variabilidad es limitada el poder de los análisis individuales se reduce. En esta situación, un análisis de datos agregados de enfermedad entre poblaciones, con una muestra de datos individuales de exposición, puede ser eficaz en la estimación del efecto de exposición si este presenta gran variabilidad entre poblaciones. No obstante, aunque se pueda conocer cual de las dos variaciones domina en la variable de exposición, se pueden considerar conjuntamente variables de exposición y/o confusión con diferentes tipos de variación. El segundo objetivo de esta tesis fue considerar un nuevo enfoque, combinación de los análisis de datos individuales y agregados, basado en ecuaciones de estimación (enfoque population-based estimating equation (PBEE)). Dependiendo de la variabilidad que domina en dicha exposición, el análisis propuesto toma fuerza de los enfoques basados en datos individuales y agregados de salud, para estimar los efectos de exposición. Estudios de simulación bajo diferentes escenarios fueron realizados para mostrar el poder del enfoque propuesto en la estimación de los efectos de exposición de interés.<br/>Finalmente, esperamos que los métodos y diferentes aspectos empleados en esta tesis puedan ser de utilidad para aquellos investigadores que quieran mejorar el estudio de la salud en el espacio y en el tiempo.<br>This thesis consists of two related parts based on the study of health in a geographical region divided in a set of zones (small areas). The first part considers studies based on health information aggregated for each area into which the region under study has been divided. Specifically, it is a disease mapping application, based on generation of an Atlas of mortality in small areas of Catalonia over the period 1984-1998, using empirical Bayes methods. The second part considers an innovative approach, based on an integration of aggregated and individual health data in each of the zones of the region under study, using an estimating equation approach. Specifically, we consider this new approach as an extension of geographical regression. <br/>The elaboration of the first part of this thesis is justified for different reasons. First, health atlases and the mapping of health indicators in general, has demonstrated its great utility in identifying geographical localizations of health problems, in formulation of hypotheses about disease causes, and in monitoring public health interventions. Second, most atlases of mortality at the small area level present patterns of relative mortality risk for the most important causes of death using maps with a high level of geographical resolution. The first goal of this thesis was to construct a mortality Atlas involving a decomposition of the Autonomous Community of Catalonia into 289 small areas (municipalities or aggregates thereof) and 66 primary health areas of Barcelona city (being a small area but with a large population) for the period 1984-1998. For Catalonia as a whole, these maps presented, using a double-page format, the age adjusted relative risk, significantly high and low relative risk areas, relative risk in Barcelona City with respect to Catalonia and internally with respect to Barcelona, relative risk by age group (0-64 and &#61619;65) and additionally the relative risk evolution over time in each area summarized in an single map, using spatial and temporal information modeled through Bayesian methods. Specifically, the atlas uses a strategy to include both: 1) relative risk evolution throughout the study period of each area compared to the average trend for all Catalonia and 2) the absolute relative risk evolution of each area. To our knowledge, this is the first time that both types of information have been combined in a single map. In addition, this is the first Atlas that presents information about geographical patterns in zones within small areas having a large population such as the cities of a country and includes life expectancy obtained with an empirical Bayes approach.<br/>The second part of this thesis can be useful in epidemiological studies where we include exposure and confounding variables that may have different sources of within and between-population variability. Specifically, analyses of individual disease-exposure data within a population are useful when exposure of interest varies sufficiently within the population. When the within-population variance of exposure is limited power of the individual-data analysis within a population is reduced. In such situations, aggregated-data analyses of disease data across populations, with a sample of individual exposure data from populations, can be powerful in estimating the exposure effect if between-population variation of exposure is large. However, although we may have knowledge of which variations dominate in each variable, exposure and/or confounding variables with different types of variation can be considered jointly. The second goal of this thesis was to consider a new analytical framework that is a combination of the individual- and aggregated-data analyses, based on an estimating equation approach ("population-based estimating equation" (PBEE) approach). The proposed analysis utilizes strengths from individual and aggregated health data approaches in the estimation of the exposure effect of interest, depending on which of the exposure variations (within- vs. between-population) dominates. Simulation studies under different scenarios were performed to show the strengths of the proposed approach in the estimation of the exposure effects of interest.<br/>Finally, we hope that some of the methods and topics employed may be of use to researchers who want to improve the study of health in space and time.

Background Genetic epidemiology is at the interface of translational and basic research and the pace of progress has been unprecedented, with findings representing some of the most robust available in the Scientific literature. However, how we can translate this high- fidelity genomic information into improvements in health of the population? Two dis¬tinct translational opportunities include personalized medicine (pharmacogenetics) and using Mendelian randomization to investigate disease aetiology to inform public health policy and develop new therapies. Objectives In this PhD thesis, I investigated the evidence base underlying the well-publicized use of the pharmacogenetic biomarker CYP2C19 genotype to predict the response to clopi¬dogrel, a widely prescribed antiplatelet drug. Second, I used Mendelian randomization to investigate the role of an endogenous biomarker, secretory phospholipase A2-IIA (sPLA2-IIA), thought to be a pro-atherogenic enzyme and a potential drug target for the prevention of cardiovascular disease (CVD). Third, I used Mendelian randomization to investigate the relationship between alcohol, an exogenous exposure, and cardiovas¬cular traits and disease events. Results CYP2C19 and cardiovascular disease I identified 32 studies of 42,016 patients reporting 3545 CVD events. Only 6 studies were set within randomized trials (“effect-modification” design) and the remaining 26 reported individuals exposed to clopidogrel (“treatment-only” design). In treatment- only studies, possession of one or more *2-*8 CYP2C19 alleles was associated with lower cytochrome P450 C19 (CYP2C19) enzyme activity and a higher risk of CVD events (RR 1.18; 95%CI:1.09, 1.28), however, there was strong evidence of small-study bias (Harbord test P=0.001) and, when restricted to large studies (≥200 events), the association of CYP2C19 *2-*8 carrier status with CVD was null (RR 0.97; 95%CI: 0.86, 1.09). In the effect-modification studies, CYP2C19 genotype did not modify the effect of clopidogrel on CVD end-points. These findings cast doubt on whether information on CYP2C19 genotype would be helpful to guide selection of the dose of clopidogrel or use of an alternative antiplatelet agent. The role of secretory phospholipase A2-IIA (sPLA2-IIA) in CVD I used Mendelian randomization to make causal inference on the role of sPLA2-IIA in CVD. I identified a single nucleotide polymorphism (SNP) in PLA2G2A (rs11573 156) that was specific for and had a very strong impact on circulating levels of the sPLA2-IIA isoform. Using data from 36 studies and over 100,000 participants, instrumental variable analysis found no association between sPLA2-IIA with incident, prevalent or recurrent CVD events. These findings suggest sPLA2-IIA is not a valid therapeutic target for CVD prevention, which was in keeping with a phase III randomized clinical trial that was halted for futility in 2012 (during this thesis). Alcohol and CVD I used a SNP in ADH1B to investigate the relationship between alcohol and coronary heart disease (CHD) in >260,000 participants. The genetic variant (ADH1B rs1229984 A-allele) showed very strong association with reduced alcohol consumption when evalu¬ated as volume of alcohol consumed, binge drinking and abstaining from alcohol. The A-allele of rs1229984 showed associations with SBP, CRP, IL-6, BMI and waist circum¬ference that were all directionally concordant with a reduced risk of CHD. Indeed, when the clinical outcome CHD was investigated, individuals carrying the A-allele (who con¬sumed less alcohol than non-carriers) had a reduced risk of CHD at all levels of alcohol consumption. No evidence of a cardioprotective association of alcohol with CHD was identified. Conclusions My investigation into use of CYP2C19 genotype as a pharmacogenetic biomarker for clopidogrel response did not identify evidence to support its clinical use and limitations were identified that could apply to other pharmacogenetic tests. Use of Mendelian randomization revealed no evidence to support a causal role of sPLA2- IIA in CVD, which paralleled findings from a phase III randomized clinical trial, and provides support for the use of Mendelian randomization studies more widely to in¬form drug development. Finally, using the ADH1B gene to interrogate the relationship of alcohol yielded findings that argue against a cardioprotective effect of alcohol con¬sumption. These findings should encourage rethinking of public health advice about the cardiovascular benefits of moderate levels of alcohol consumption.

This dissertation deals with three problems in health care. In the first, we consider the incentives to change prices and capital levels at hospitals, using optimal control under the assumption that private payers charge higher prices if patients consume more hospital services. The main results are that even with fixed technology, investment and prices exhibit explosive growth, and that prices and capital stock grow in proportion to one another. In the second chapter, we study the flow of nosocomial infections in an intensive care unit. We use data from Cook County Hospital, along with numerous results from the literature, to construct a discrete event simulation. This model highlights emergent properties from treating the flow of patients and pathogens in one interconnected system, and sheds light on how nosocomial infections relate to hospital costs. We find that the system is not decomposable to individual systems, exhibiting behavior that would be difficult to explain in isolation. In the third chapter, we analyze a proposed change in diversion policies at hospitals, in order to increase the number of patients served, without an increase in resources. Overcrowding in hospital emergency departments is caused in part by the inability to send patients to main hospital wards, due to limited capacity. When a hospital is completely full, the hospital often goes on ambulance diversion, until some spare capacity has opened up. Diversion is costly, and often leads to waves of diversions in systems of hospitals, a situation that is regarded as highly problematic in public health. We construct and analyze a continuous-time Markov chain model for one hospital. The intuition behind the model is that load-balancing between various hospitals in a metro area may hinder full congestion. We find that a more flexible contract may benefit all parties, through the partial diversion of federally insured patients, when a hospital is very close to full. Discrete event simulation models are run to assess the effect, using data from DeKalb Medical Center, and also to show that in a two-hospital system, more federally insured patients are served using this mechanism.

Abstract A detailed model of human thermoregulation and a numerical algorithm to predict thermal comfort is a novel field of research and has wide applications in the auto/transportation industry and in the heating, ventilating, and air-conditioning (HVAC) industry. Anatomically specific convective and radiative heat transfer coefficients for the human body will be required to understand the human thermal physiological and comfort models. It necessitates to create hygienic and thermally comfortable spaces for the best productivity of the users. The physiological nature of thermal comfort during a transient condition such as a physical exercise or travel in an automobile are not yet well understood. In this paper, thermography has been applied to measure the convective and radiative heat transfer coefficients which has not been done before. Three different recovery processes were considered after the running of a human model on a treadmill with a range of speeds starting from 2 miles/hour to 10 miles/hour for stretch of twenty minutes. The recovery process included, (a) fan-assisted cooling with an air velocity of 0.5 m/s for 30 minutes, (b) fan-assisted cooling with an air velocity of 1.5 m/s for 30 minutes, and (c) natural cooling with no assistance of fan for 30 minutes. Thermal images were taken for forehead, trunk, arms, hands, legs of the models and the convective heat transfer coefficient and radiative heat transfer coefficient were calculated. The human models included both male and female, and belonged to two different age groups of less than 15 and above 40 with a total of 24 participants. The results show that though the temperatures, measured using thermography, for various parts of the human body changed locally, the overall calculated radiative heat transfer coefficients matched with the ASHRAE handbook values, and the calculated convective heat transfer coefficient increased with the increase of air velocity, while the models cooled down after the workout. Interestingly, the skin temperature decreased, initially, as the exercise progressed. After the completion of exercise, the skin temperature exhibited a quick rise during the recovery period with a subsequent decrease in the temperature, later. This trend was the same with all different age groups and sex of the models. The results also confirm that thermal images can be relied on for calculating the convective and radiative heat transfer coefficients of the human body to determine the heat transfer rate.