eHealth is promoted as a means to strengthen health systems and facilitate universal health coverage. Sub-components (e.g. telehealth, telemedicine, mhealth) are seen as mitigators of healthcare provider shortages and poor rural and remote access. Teleradiology (including mobile teleradiology), widespread in developed nations, is uncommon in developing nations. Decision- and policy-makers require evidence to inform their decisions regarding implementation of mobile teleradiology in Nigeria and other sub-Saharan countries. To gather evidence, Scopus and PubMed were searched using defined search strings (September 2020). Duplicates were removed, and titles and abstracts reviewed using specified selection criteria. Full-text papers of selected resources were retrieved and reviewed against the criteria. Insight from included studies was charted for eight a priori categories of information: needs assessment, implementation, connectivity, evaluation, costing, image display, image capture and concordance. Fifty-seven articles were identified, duplicates removed and titles and abstracts of remaining articles reviewed against study criteria. Twenty-six papers remained. After review of full-texts, ten met the study criteria. These were summarised, and key insights for the eight categories were charted. Few papers have been published on teleradiology in sub-Saharan Africa. Teleradiology, including mobile teleradiology, is feasible in sub-Saharan Africa for routine X-ray support of patients and healthcare providers in rural and remote locations. Former technical issues (image quality, transmission speed, image compression) have been largely obviated through the high-speed, high-resolution digital imaging and network transmission capabilities of contemporary smartphones and mobile networks, where accessible. Comprehensive studies within the region are needed to guide the widespread introduction of mobile teleradiology.

ABSTRACT BACKGROUND: Instant messaging services (IMS) are widely used in medical practice. OBJECTIVE: To evaluate perceptions regarding use and usability of IMS within clinical practice and assess users’ knowledge of the ethical and legal context involved in using IMS within medical practice. DESIGN AND SETTING: Cross-sectional study conducted in different hospitals and medical institutions in Minas Gerais, Brazil. METHODS: Medical students, medical residents, primary care physicians and specialist doctors answered an online questionnaire regarding epidemiological data, graduation level and use of IMS for medical communication. Responses were collected over a five-month period and data were assessed using the IBM-SPSS software. RESULTS: 484 people answered the questionnaire: 97.0% declared that they were using IMS for medical-related purposes; 42.0%, to elucidate medical concerns every week; 75.0%, to share imaging or laboratory tests and patients’ medical records; and 90.5%, to participate in clinical case-study private groups. Moreover, only 37.0% declared that they had knowledge of the legislative aspects of use of smartphones within clinical practice. Differences in the frequency of discussion of medical concerns within the daily routine between student/residents and general practitioners/specialists, and in the frequency of image-sharing and patient-guiding/assistance between students and medical doctors, were observed. CONCLUSIONS: Our results provide reliable proof that medical doctors and students use IMS, as a tool for clinical case discussions, interactions between healthcare providers and patients, or dissemination of knowledge and information. Nonetheless, because of limitations to the ethical and legal regulations, evidence-based discussions between authorities, academics and medical institutions are needed in order to fully achieve positive outcomes from such platforms.

The value proposition of full-scale teledermatology is evidenced in the literature. The public health sector of South Africa's KwaZulu-Natal province began synchronous teledermatology in 2003, followed by spontaneous asynchronous (mobile) teledermatology in 2013. No scale-up has been formally planned. This paper establishes design requirements that will inform the identification or de novo development of a teledermatology scale-up framework. METHODS: A requirements definition process with inductive reasoning approaches was applied. Analysis of semi-structured interviews (19) with key teledermatology stakeholders (17) and observations from two teledermatology programmes, informed by lessons learned from prior teledermatology implementation attempts, eHealth scale-up literature and authors' expert opinion, led to identification of themes, and iterative reflection gave rise to categories and requirements RESULTS: Teledermatology scale-up framework design requirements emerged comprised of themes (4), categories (12), and specific design requirements (30 DISCUSSION: This paper describes a process and resulting evidence-based (stakeholder interviews; programme observations; literature) and experience-based (expert opinion) design requirements to inform the identification and adoption / adaptation or de novo development of a Teledermatology Scale-up Framework (TDSF) for KwaZulu-Natal's public health sector. The proposed approach is recommended as a pre-requisite for scaling, including in other settings and for other telehealth applications

BACKGROUND: Asynchronous automated telehealth-based hearing screening and diagnostic testing can be used within the rural school context to identify and confirm hearing lossOBJECTIVE: The aims of the study were to evaluate the efficacy of an asynchronous telehealth-based service delivery model using automated technology for screening and diagnostic testing as well as to describe the prevalence, type and degree of hearing lossMETHOD: A comparative within-subject design was used. Frequency distributions, sensitivity, specificity scores as well as the positive and negative predictive values were calculated. Testing was conducted in a non-sound-treated classroom within a school environment on 73 participants (146 ears). The sensitivity and specificity rates were 65.2% and 100%, respectively. Diagnostic accuracy was 91.7% and the negative predictive values (NPV) and positive predictive values (PPV) were 93.8% and 100%, respectivelyRESULTS: Results revealed that 23 ears of 20 participants (16%) presented with hearing loss. Twelve per cent of ears presented with unilateral hearing impairment and 4% with bilateral hearing loss. Mild hearing loss was identified as most prevalent (8% of ears). Eight ears obtained false-negative results and presented with mild low- to mid-frequency hearing loss. The sensitivity rate for the study was low and was attributed to plausible reasons relating to test accuracy, child-related variables and mild low-frequency sensory-neural hearing lossCONCLUSION: The study demonstrates that asynchronous telehealth-based automated hearing testing within the school context can be used to facilitate early identification of hearing loss; however, further research and development into protocol formulation, ongoing device monitoring and facilitator training is required to improve test sensitivity and ensure accuracy of results

BACKGROUND: Most developing countries, including Uganda, have embraced the use of e-Health and m-Health applications as a means to improve primary healthcare delivery and public health for their populace. In Uganda, the growth in the information and communications technology industry has benefited the rural communities and also created opportunities for new innovations, and their application into healthcare has reported positive results, especially in the areas of disease control and prevention through disease surveillance. However, most are mere proof-of-concepts, only demonstrated in use within a small context and lack sustainability. This study reviews the literature to understand e-Health's current implementation status within Uganda and documents the barriers and opportunities to sustainable e-Health intervention programmes in Uganda. METHODS: A structured literature review of e-Health in Uganda was undertaken between May and December 2015 and was complemented with hand searching and a document review of grey literature in the form of policy documents and reports obtained online or from the Ministry of Health's Resource Centre. RESULTS: The searches identified a total of 293 resources of which 48 articles met the inclusion criteria of being in English and describing e-Health implementation in Uganda. These were included in the study and were examined in detail. CONCLUSION: Uganda has trialled several e-Health and m-Health solutions to address healthcare challenges. Most were donor funded, operated in silos and lacked sustainability. Various barriers have been identified. Evidence has shown that e-Health implementations in Uganda have lacked prior planning stages that the literature notes as essential, for example strategy and need readiness assessment. Future research should address these shortcomings prior to introduction of e-Health innovations.

The effect that compressed air massage (CAM) has on skeletal muscle has been ascertained by the morphological and morphometric evaluation of healthy vervet monkey and rabbit skeletal muscle. How CAM may influence the process of healing following a contusion injury is not known. To determine how CAM or other physiotherapeutic modalities may influence healing, it is necessary to create a minor injury that is both reproducible and quantifiable at the termination of a pre-determined healing period. An earlier study described changes in the morphology of skeletal muscle following a reproducible contusion injury. This study extended that work in that it attempted to quantify the 'severity' of such an injury. A 201 g, elongated oval-shaped weight was dropped seven times through a 1 m tube onto the left vastus lateralis muscle of four New Zealand white rabbits. Biopsies were obtained 6 days after injury from the left healing juxta-bone and sub-dermal muscle and uninjured (control) right vastus lateralis of each animal. The tissue was fixed in formal saline, embedded in wax, cut and stained with haematoxylin and phosphotungstic haematoxylin. The muscle was examined by light microscopy and quantification of the severity of injury made using a modified, 'in-house' morphological index and by the comparative morphometric measurement of the cross-sectioned epimysium and myofibres in injured and control muscle. The results showed that a single contusion causes multiple, quantifiable degrees of injury from skin to bone - observations of particular importance to others wishing to investigate contusion injury in human or animal models.

The minimum diameter method of morphometry (MDM) is used to measure and detect changes in myofibre diameters (FD). The MDM is used to identify pathology in skeletal muscle. In such studies, an assumption is made that the mean FD in a particular muscle in both limbs is essentially the same. This study explored this premise to determine the accuracy of MDM as a means of morphometric analysis. Muscle biopsies were obtained from the left (G1) and right (G2) tibialis anterior of four vervet monkeys and from the massaged left (G3) and untreated right (G4) tibialis anterior of four animals. Wax sections were prepared for MDM and FD was measured. Three specimens were re-measured on four occasions. The mean FD of each biopsy from G1 and G2 limbs were compared and the number of measurements necessary to produce a meaningful result determined. Repeated measurement showed a difference of < 3.0% in FD means between the first and three subsequent measurements. There was no significant difference of FD means between G1 and G2, whilst the difference between G3 and G4 was 11.2%. When > 175 FD were measured, the difference from the final mean was less than 2.0%. These data show that, (1) FD data derived from a muscle in an untreated limb can be used as a control for experiment mediated changes of FD in the other, (2) MDM is a reliable means of measuring FD and (3) 150-175 FD are needed to provide a dependable result.

CONTEXTE: La santé par téléphone portable peut faciliter les services de télémédecine, en particulier dans les pays en voie de développement. Certains craignent le manque de confidentialité des informations de santé transmises par téléphone portable. OBJECTIF: Nous examinons les habitudes et pratiques d'utilisation des portables par les patients au KwaZulu-Natal, en Afrique du Sud. MÉTHODES: Nous avons mené une enquête descriptive sur deux groupes de patients: 137 patients urbains consultant des médecins privés et 139 patients dans les régions rurales éloignées en consultation externe dans les hôpitaux gouvernementaux. Le questionnaire couvrait plusieurs domaines: la démographie, l'utilisation des portables, la privauté et confidentialité, et l'utilisation future pour les questions liées à la santé. RÉSULTATS: Deux cent soixante seize patients ont rempli le questionnaire. Nous avons trouvé qu'un tiers de nos participants partageaient leur portable avec d'autres personnes, que 24% le prêtaient à d'autres et que plus de la moitié recevaient des messages liés à la santé pour d'autres personnes. Les vols de portables étaient courrants ainsi que le changement de numéro. Trente-huit pour cent des gens n'avaient pas les moyens d'acheter du temps d'appel pour plus d'une semaine au cours de l'année passée et 22% des patients ruraux ne pouvaient pas garder leur portable chargé. La réception des portables était plus mauvaise dans les régions rurales qu'en ville. CONCLUSION: Cette étude souligne les ramificationslégales et morales que ces pratiques et résultats auront sur les programmes de santé mobile dans notre situation. Les prestataires de soins de santé et les autorités devront examiner comment les patients utilisent et gèrent leur téléphone portable dans le développement des services et règlements.

BACKGROUND: mHealth has the potential to facilitate telemedicine services, particularly in the developing world. Concern has been expressed about the confidentiality of health information that is relayed by mobile phone AIM: We examined the habits and practices of mobile phone use by patients in KwaZulu-Natal, South Africa. METHODS: We conducted a descriptive survey of two patient populations: 137 urban patients attending private practitioners and 139 patients in remote rural areas attending outpatient departments in Government-funded hospitals. The questionnaire covered several domains: demographics, mobile phone use, privacy and confidentiality and future use for health-related matters. RESULTS: Two hundred and seventy-six patients completed the questionnaire. We found that a third of our participants shared their mobile phone with others, 24% lent their phone to others and more than half received health-related messages for other people. Mobile phone theft was common, as was number changing. Thirty-eight percent of the people were not able to afford airtime for more than a week in the past year and 22% of rural patients were unable to keep their phone charged. Mobile phone signal coverage was significantly worse in the rural areas than in urban areas. CONCLUSION: This study highlights the legal and ethical ramifications that these practices and findings will have on mHealth programmes in our setting. Healthcare providers and regulators will need to consider how patients use and manage their mobile phones when developing services and regulations.

This study reports our experience in developing a simple, minor injury. After reviewing the literature, a 'drop-mass' method was selected where a 201 g, elongated oval-shaped weight was dropped up to 15 times through a 1 m tube onto the left vastus lateralis of New Zealand white rabbits. To determine the extent of injury and degree of healing, biopsies were obtained six days after injury from the healing vastus lateralis of each animal. The tissue was fixed in formal saline, embedded in wax, cut and stained with haematoxylin and eosin (H&E) and phosphotungstic acid haematoxylin (PTAH) and examined by light microscopy (LM). The 'optimal' injury was created after seven drops, where quite severe, mild and moderately severe trauma was caused to muscle in the juxta-bone, mid and sub-dermal regions respectively. In each region, the muscle exhibited features of healing six days after injury. The 'drop-mass' technique appears to cause a contusion within a single muscle of at least three degrees of severity. This previously unreported observation is of particular importance to other researchers wishing to investigate contusion injury in other animal models.

BACKGROUND: The South African Mental Health Care Act (the Act) No. 17 of 2002 stipulated that regional and district hospitals be designated to admit, observe and treat mental health care users (MHCUs) for 72 hours before they are transferred to a psychiatric hospital. METHODS: Medical managers in 49 'designated' hospitals in KwaZulu-Natal (KZN) were surveyed on infrastructure, staffing, administrative requirements and mental health care user case load pertaining to the Act for the month of July 2009. RESULTS: Thirty-six (73.4%) hospitals responded to the survey; 30 (83.3%) stated that the Act improved mental health care for MHCUs through the protection of their rights, provision of least restrictive care, and reduction of discrimination; 10 (27.8%) had a psychiatric unit and, of the remaining 26 hospitals, 11 (30.6%) had general ward beds dedicated for psychiatric admissions; 16 (44.4%) had some form of seclusion facility; and 24 (66.7%) provided an outpatient psychiatric service. Seventy-six per cent of admissions were involuntary or assisted. Thirteen of the 32 (40.6%) state psychiatrists in KZN were employed at 8 of these hospitals. Designated hospitals expressed dissatisfaction with the substantial administrative load required by the Act. The Review Board had not visited 29 (80.6%) hospitals in the preceding 6 months. CONCLUSION: Although 'designated' hospitals admit and treat assisted and involuntary MHCUs, they do so against a backdrop of inadequate infrastructure and staff, a high administrative load, and a low level of contact with Review Boards.