Innovating Hypertension Management Amongst Refugees in San Diego
4 min read
Refugees are a subset of the population that suffer displacement and other stressors, and once they reach their new home country, medical conditions including hypertension can go undetected and untreated. However, research into this very topic began in February 2021. The study entitled “Perceptions, Knowledge, and Attitudes Towards Hypertension Management among Refugees in San Diego” is being carried out by Dr. Tala Al-Rousan, a founding faculty member at the Herbert Wertheim School of Public Health at the University of California San Diego, in partnership with Dr. Job Godino who leads the Laura Rodriguez Research Institute at the Family Health Care Centers of San Diego.
Throughout the program, participants are using Withings BPM Connect, a smart blood pressure monitor, as well as the Withings Data Hub, a cellular gateway used to collect measurements. The study is funded by The National Heart, Lung, and Blood Institute of the US National Institutes of Health. It aims to contribute to a relatively small body of literature surrounding the unaddressed global challenge of uncontrolled blood pressure in displaced populations including refugees and asylum seekers. The problem of hypertension among displaced peoples is even more prevalent as the numbers of refugees continue to increase due to higher rates of violence, natural disasters, and health inequities.
A specific goal of the project is to examine the feasibility of self-administered blood pressure monitoring through supportive healthcare infrastructure. The study hopes to show preliminary data that refugee patients can and prefer to take leadership over their hypertension management from where they are residing in combination with receiving guidance on medication titration plans from their healthcare providers.
In combination with BPM Connect, Drs. Al-Rousan and Godino’s teams collect patient data using Withings remote patient monitoring (RPM) solution. Both device and RPM help solve several pain points that participants may face such as interrupted healthcare access, economic hardship, language barriers, and varying levels of health literacy and numeracy. Regarding interrupted access, going to the doctor can be difficult for participants as some may have employment that does not allow for brief leave from work; since the device can be used at home, less time needs to be budgeted. BPM Connect also uses one button to take measurements which reduces potential language and use factors. Finally, any question of whether participants can access the internet has been assuaged using Withings Data Hub, a cellular gateway that requires no installation from users and securely connects retrieved data to the Withings RPM solution without requiring a smartphone or Wi-Fi.
The study includes 80 Aramaic and Arabic-speaking refugees with diagnosed uncontrolled blood pressure. Participants were recruited in consultation with ethnic community-based organizations in San Diego that serve refugees including Al Majdal Center and others. Multicultural and multilingual investigators with expertise in refugee health, digital health, epidemiology, and chronic disease prevention are involved in the team.
The study asks participants to measure their blood pressure three times a day every other day for four weeks. Qualitative interviews are being conducted before and after the intervention period to understand the levels of acceptability of remote monitoring and whether participants feel more in control, empowered, aware, and engaged in better quality healthcare. Questions on the role of social networks in health education and medication adherence are also asked about in this study.
“This project is revolutionary in that it is the first of its kind to be addressing the unmet need of uncontrolled blood pressure, a silent killer to millions all over the world, in one of the most understudied and underserved populations which is the refugee population.” — Dr. Al-Rousan
An observation the team has noted in the program are the results of two randomized groups — one that receives in-person education about how to use BPM Connect and the other that receives the same education virtually. The virtual education group has not only received the intervention smoothly but actually preferred it over in-person instruction which may be explained by fears of contracting COVID, or simply convenience and saving on transportation and other costs. Additionally, the use of the BPM Connect has extended beyond the intended four-week intervention period.
The ongoing pandemic has highlighted health disparities that vulnerable populations face. Drs. Al-Rousan and Godino hope that this study will show how innovative digital health solutions fit within patients’ feelings of acceptance while displaying that taking healthcare to marginalized people’s homes enables these populations to relate to their health providers, engage in healthier behaviors, and better manage chronic diseases.
The study is now in the end phase and results will soon be published. For questions, please contact Dr. Tala Al-Rousan. To find out more about how institutions are using BPM Connect and other connected health devices with the Withings Data Hub, you can visit Withings.com.
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This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.
When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.
On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.
Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).
Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.
“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we're using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it's so painful patients can't sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”
Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C.
“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”
If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”
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[post_title] => Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
[post_excerpt] => Dr. Solomon Tesfaye is one of the world’s leading researchers in the field of diabetic peripheral neuropathies (DPN). His life has been a story of overcoming challenges with a mission to tackle one of the biggest problems facing people with diabetes - preventable amputations.
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Withings products not only help individuals and their clinicians better monitor and understand health, but they are contributing to a wide body of research. Withings is honored that researchers are increasingly turning to our products across an impressive number of therapeutic areas. Among them are diabetic neuropathy, retinopathy, sudomotor function, hypertension, sleep quality, sleep apnea, dementia, ECG intervals in children, arrhythmias, cardiovascular autonomic neuropathy (CAN), public health monitoring, and health technology adoption.
Here’s just a sampling of the diversity and reach of Withings products in medical research this year.
An October 2024 article in Frontiers in Neuroanatomy looks at the history and technical development of electrochemical skin conductance (ESC), as measured by Withings’ Sudoscan, and compares it to other measures of skin conductance such as galvanic skin response (GSR) and electrodermal activity (EDA). ESC was developed specifically to diagnose sudomotor function as opposed to GSR/EDA which is a continuous monitoring tool. EDA is increasingly incorporated into wearable technology. While both use skin/sweat conductance, it is important to differentiate EDA which can be used for physiological and psychological measures of stress from ESC which is used to evaluate sudomotor function and diagnose neuropathy. Withings has incorporated ESC in its smart scales which show a near perfect correlation with the Sudoscan clinical device. The Withings smart scales allow for easier and more frequent individual time series data as well as large scale data collection.
Public health surveillance has largely relied on self-reported surveys. This study applied mobile and wearable technologies to collect objective, real-time, continuous health data. Data from a variety of Withings products (Withings Sleep, Withings BPM Connect, Withings Thermo, and Withings Body+), were used to predict stress. Findings showed that a system, such as the Mobile Health Platform used here, could complement self-reported health data to better monitor and predict stress in a population.
This study compared the 1-lead ECG intervals available via the Withings ScanWatch with the standard 12-lead ECGs in children and adolescents. Smart watch intervals have previously been shown to be accurate for adults. The heart rate measure was found to be reliable for children, The automated QTc interval was less reliable but can be improved with manual measurements. It is worth noting that the study used pediatric subjects rather than adapting adult research, as is often the case.
This study of 67,254 adults showed that 30% of adults do not get the recommended 7-9 hours of sleep per night, and that even those who did average 7-9 hours, 40% of the nights fell outside the range. Only 15% of participants slept 7-9 hours for at least 5 nights per week. In addition to the findings of irregular sleep, the study highlights the usefulness of the at home Withings Sleep for large-scale and/or longitudinal sleep studies.
As we close out a year of significant knowledge advancements, we look forward to seeing what the global healthcare research community has in store for 2025.
If you are conducting research that might benefit from Withings technology, please contact us at contact-pro@withings.com.
Interested in partnering with us?
Contact Us
[post_title] => Withings 2024 Year in Review: Research Highlights
[post_excerpt] => 2024 was an exciting year for Withings. We’re honored that the global research community is increasingly turning to our solutions for studies across an impressive number of therapeutic areas. Among them are diabetic neuropathy, retinopathy, sudomotor function, hypertension, sleep quality, sleep apnea, dementia, ECG intervals in children, arrhythmias, cardiovascular autonomic neuropathy (CAN), public health monitoring, and health technology adoption.
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Several new, large-scale studies1, 2, 3, 4 from the Flinders Medical Research Institute (FHMRI) in Australia found studying sleep in real-world settings over multiple nights can greatly reduce the high 30% error rate of sleep apnea diagnosis from polysomnography (PSG), the traditional, single night, in hospital gold standard technique. Using Withings Sleep Analyzer, researchers were able to easily track multiple biomarkers for participants over time revealing large variability in sleep indicators from night to night.
Withings under-the-mattress sleep trackers have enabled researchers to study large groups over time. The FHMRI studies tracked 67,278 and 12,287 participants respectively over a total of 11 million nights, a feat not feasible with traditional polysomnography.
A key finding from the study of 12,000 users is the variability in the severity of Obstructive Sleep Apnea (OSA) from night to night. The variability of OSA, independent of severity, is associated with uncontrolled hypertension which is the leading cardiovascular risk factor. Sleep Analyzer also reveals other risks associated with hypertension, such as snoring, irregular waking and sleep hours, and duration of sleep.
Using the same hardware technology as Withings Sleep Analyzer, Sleep Rx is a noninvasive, at home device that users place under their mattresses to gather biomarkers such as heart rate, respiratory rate, snoring, sleep cycles, and the Withings Sleep Index, a measure of breathing events per hour, which can aid in the diagnosis of sleep apnea. Using this simple device for at least 14 nights gives a much clearer picture of sleep quality.
The multi-night Sleep Rx data can be used to predict the right patients at the right time for in hospital PSG. Better identification of patients who most need PSG will reduce overall spending on the costly tests and ease scheduling difficulties.
Sleep Rx offers an inexpensive, easy to use method to better target high risk cardiovascular patients, reduce the high error rate of sleep apnea diagnosis, and efficiently gather longitudinal, large-scale sleep data for a variety of chronic diseases. For more information about the Withings Sleep Rx, click here.
1 Lechat, Bastien et al. “Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea.” American journal of respiratory and critical care medicine vol. 205,5 (2022): 563-569. doi:10.1164/rccm.202107-1761OC
2 Lechat, Bastien et al. “High night-to-night variability in sleep apnea severity is associated with uncontrolled hypertension.” NPJ digital medicine vol. 6,1 57. 30 Mar. 2023, doi:10.1038/s41746-023-00801-2
3 Lechat, Bastien et al. “Regular snoring is associated with uncontrolled hypertension.” NPJ digital medicine vol. 7,1 38. 17 Feb. 2024, doi:10.1038/s41746-024-01026-7
4 Scott, Hannah et al. “Sleep Irregularity Is Associated With Hypertension: Findings From Over 2 Million Nights With a Large Global Population Sample.” Hypertension (Dallas, Tex. : 1979) vol. 80,5 (2023): 1117-1126. doi:10.1161/HYPERTENSIONAHA.122.20513
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[post_title] => Sleep Apnea Data from Multiple Nights is Key to Predicting Hypertension and Cardiovascular Risk
[post_excerpt] => New large-scale, longitudinal studies show that monitoring sleep for at least 14 nights at home with a connected sleep tracking mat, can reduce the 30% high error rate of sleep apnea diagnosis from the usual single-night, in hospital polysomnography (PSG) technique. This technology can identify which patients most need expensive, intrusive, and difficult to access PSG. Longitudinal data also detects variability of Obstructive Sleep Apnea from night to night which is associated with hypertension
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This article is based on our November 1, 2024 interview with Dr. Solomon Tesfaye.
When Solomon Tesfaye was a 16-year-old boy in Addis Ababa, Ethiopia, a military regime closed his school and forced the students into national service. Tesfaye, who had by then developed a true passion for learning, desperately hoped to continue his intellectual development and academic journey.
On the urging of his brother, he took a chance and applied for an international scholarship to the prestigious Sevenoaks School in Kent, England. Sevenoaks, a storied boarding school founded in 1432, may have seemed like an unlikely next home for Tesfaye. But they also decided to take a chance on him. Those bets ultimately paid off.
Dr. Tesfaye is now a globally recognized diabetes expert at the University of Sheffield whose research has played a significant role in understanding diabetic nerve damage, how to identify it earlier, and how to potentially treat it before the complications become debilitating. In September, Dr. Tesfaye was honored with a Lifetime Achievement Award at the 34th NeuroDiab annual meeting in recognition of his pioneering research in the field. Tesfaye credits his experience at Sevenoaks School as having kindled his interest in science and his enduring passion for grappling with difficult problems, like diabetic peripheral neuropathies (DPN).
Fast forward to today and Dr. Tesfaye is leading some of the most exciting work on early diagnosis of DPN and clinical strategies for altering its relentless progression. His team at University of Sheffield recently presented findings at The American Diabetes Association Scientific Sessions that found the use of point-of-care testing devices by clinicians (Withings’ Sudoscan in combination with DPNCheck) could significantly improve the detection of DPN over current standard of care methods and provide a rapid, reproducible, and quantitative assessment for busy clinicians.
“For diabetic retinopathy, we’ve been successful using technology to improve diagnosis and care,” said Tesfaye. “But for neuropathy, we're using these Stone Age implements. With a monofilament, even the best doctors cannot diagnose neuropathy the same two days in a row. Meanwhile, fifty percent (of patients) die within 5 years, it costs more than breast or colon cancer, and is devastating because it's so painful patients can't sleep. Sadly, advanced neuropathy is the strongest risk factor for diabetic foot ulceration that results in fifty percent mortality within 5 years, and costs more than breast, colon and prostate cancers, combined. Neuropathy also is devastating as it can also cause distressing foot and leg pain that interferes with sleep.”
Tesfaye is now immersed in a major new study with 160 participants – called OCEANIC – that seeks to determine whether early diagnosis, coupled with robust, early intervention can alter the course of DPN for the better. OCEANIC is using Withings Body Pro 2 smart scales with Electrochemical Skin Conductance (ESC) technology, wearable sensors, and activity trackers, to monitor and share patient progress on metrics including body fat, muscle mass, and ESC score, with the aim of reinforcing lifestyle changes. The study group will receive personalized diabetes education and exercise programs, and weight loss interventions including GLP-1s, to significantly reduce HbA1C.
“Our goal is to explore whether these intensive strategies to manage risk factors can halt or even reverse diabetes-related nerve damage when it is identified at an early stage,” said Dr. Tesfaye. “We want to do for neuropathy what early and routine screening has done for retinopathy – bringing better outcomes to millions of people with diabetes.”
If Solomon Tesfaye’s history is any guide, achieving clear answers to the big questions in the OCEANIC study will be but a waypoint on his journey. He credits a mentor, the late Professor John Ward, with encouraging him to tackle the most meaningful problems. “He told me not to worry about publishing too many studies, but rather focus on a few big questions that will fundamentally change people’s lives.”
Interested in partnering with us?
Contact Us
[post_title] => Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
[post_excerpt] => Dr. Solomon Tesfaye is one of the world’s leading researchers in the field of diabetic peripheral neuropathies (DPN). His life has been a story of overcoming challenges with a mission to tackle one of the biggest problems facing people with diabetes - preventable amputations.
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Article
Turning Challenges into Opportunities: Dr. Solomon Tesfaye and His Quest to Eradicate Preventable Amputations
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