Euthenics

From Wikipedia, the free encyclopedia

Euthenics /juːˈθɛnɪks/ is the study of the improvement of human functioning and well-being by improvement of living conditions. Affecting the "improvement" through altering external factors such as education and the controllable environment, including the prevention and removal of contagious disease and parasites, environmentalism, education regarding employment, home economics, sanitation, and housing.

 

Rose Field notes of the definition in a May 23, 1926 New York Times article, "the simplest being efficient living". A right to environment.

The Flynn effect has been often cited as an example of euthenics. Another example is the steady increase in body size in industrialized countries since the beginning of the 20th century.

Euthenics is not normally interpreted to have anything to do with changing the composition of the human gene pool by definition, although everything that affects society has some effect on who reproduces and who does not.

Origin of the term

Ellen Swallow Richards, the first female student and instructor at MIT.

The term was derived in the late 19th century from the Greek verb eutheneo, εὐθηνέω (eu, well; the, root of τίθημι tithemi, to cause).

(To be in a flourishing state, to abound in, to prosper.—Demosthenes. To be strong or vigorous.—Herodotus. To be vigorous in body.—Aristotle.)

Also from the Greek Euthenia, Εὐθηνία. Good state of the body: prosperity, good fortune, abundance.—Herodotus.

The opposite of Euthenia is Penia, Πενία ("deficiency" or "poverty") the personification of poverty and need.

History

Ellen H. Swallow Richards (1842–1911; Vassar Class of '70) was one of the first writers to use the term, in The Cost of Shelter (1905), with the meaning "the science of better living". It is unclear if (and probably unlikely that) any of the study programs of euthenics ever completely embraced Richards' multidisciplinary concept, though several nuances remain today, especially that of interdisciplinarity.

Vassar College Institute of Euthenics

Julia Clifford Lathrop as the first chief of the U.S. Children's Bureau.

After Richards' death in 1911, Julia Lathrop (1858–1932; VC '80)—one of Vassar's most distinguished alumnae—continued to promote the development of an interdisciplinary program in euthenics at the college. Lathrop soon teamed with alumna Minnie Cumnock Blodgett (1862–1931; VC '84), who with her husband, John Wood Blodgett, offered financial support to create a program of euthenics at Vassar College. Curriculum planning, suggested by Vassar president Henry Noble MacCracken in 1922, began in earnest by 1923, under the direction of Professor Annie Louise Macleod (Chemistry; First woman PhD, McGill University, 1910).

According to Vassar's chronology entry for March 17, 1924, "the faculty recognized euthenics as a satisfactory field for sequential study (major). A Division of Euthenics was authorized to offer a multidisciplinary program [radical at the time] focusing the techniques and disciplines of the arts, sciences and social sciences on the life experiences and relationships of women. Students in euthenics could take courses in horticulture, food chemistry, sociology and statistics, education, child study, economics, economic geography, physiology, hygiene, public health, psychology and domestic architecture and furniture. With the new division came the first major in child study at an American liberal arts college."

For example, a typical major in child study in euthenics includes introductory psychology, laboratory psychology, applied psychology, child study and social psychology in the Department of Psychology; the three courses offered in the Department of Child Study; beginning economics, programs of social reorganization and the family in Economics; and in the Department of Physiology, human physiology, child hygiene, principles of public health.

The Vassar Summer Institute of Euthenics accepted its first students in June 1926. Created to supplement the controversial euthenics major which began February 21, 1925, it was also located in the new Minnie Cumnock Blodgett Hall of Euthenics (York & Sawyer, architects; ground broke October 25, 1925). Some Vassar faculty members (perhaps emotionally upset with being displaced on campus to make way, or otherwise politically motivated) contentiously "believed the entire concept of euthenics was vague and counter-productive to women's progress."

Having overcome a lukewarm reception, Vassar College officially opened its Minnie Cumnock Blodgett Hall of Euthenics in 1929. Dr. Ruth Wheeler (Physiology and Nutrition – VC '99) took over as director of euthenics studies in 1924. Wheeler remained director until Mary Shattuck Fisher Langmuir (VC '20) succeeded her in 1944, until 1951.

The college continued for the 1934–35 academic year its successful cooperative housing experiment in three residence halls. Intended to help students meet their college costs by working in their residences. For example, in Main, students earned $40 a year by doing relatively light work such as cleaning their rooms.

In 1951, Katharine Blodgett Hadley (VC '20) donated $400,000, through the Rubicon Foundation, to Vassar to help fund operating deficits in the current and succeeding years and to improve faculty salaries.

"Discontinued for financial reasons, the Vassar Summer Institute for Family and Community Living, founded in 1926 as the Vassar Summer Institute of Euthenics, held its last session, July 2, 1958. This was the first and last session for the institute's new director, Dr. Mervin Freedman."

Elmira College

Elmira College is noted as the oldest college still in existence which (as a college for women) granted degrees to women which were the equivalent of those given to men (the first to do so was the now-defunct Mary Sharp College). Elmira College became coeducational in all of its programs in 1969.

A special article was written in the December 12, 1937 New York Times, quoting recent graduates of Elmira College, urging for courses in colleges for men on the care of children. Reporting that "preparation for the greatest of all professions, that of motherhood and child-training, is being given the students at Elmira College in the Nursery School which is Conducted as part of the Department of Euthenics."

Elmira College was one of the first of the liberal arts colleges to recognize the fact that women should have some special training, integrated with the so-called liberal studies, which would prepare them to carry on, with less effort and fewer mistakes, a successful family life. Courses in nutrition, household economics, clothing selection, principles of foods and meal planning, child psychology, and education in family relations are a part of the curriculum.

The Elmira College nursery school for fifteen children between the ages of two and five years was opened primarily as a laboratory for college students, but it had become so popular with parents in the community that there was always a long waiting list.

The New York Times article notes how the nursery had become one of the essential laboratories of the college, where recent mothers testified to the value of the training they received while in college. "Today," one graduate said, "when it is often necessary for young women to continue professional work outside the home after marriage, it is important that young fathers, who must share in the actual care and training of the children, should have some knowledge of correct methods."

Today

Many factors led to the movement never getting the funding it needed to remain relevant, including: vigorous debate about the exact meaning of euthenics, a strong antifeminism movement paralleling even stronger women's rights movements, confusion with the term eugenics, the economic impact of the Great Depression and two world wars. These factors also prevented the discipline from gaining the attention it needed to put together a lasting, vastly multidisciplinary curriculum. Therefore, it split off into separate disciplines. Child Study is one such curriculum.

Martin Heggestad of the Mann Library notes that "Starting around 1920, however, home economists tended to move into other fields, such as nutrition and textiles, that offered more career opportunities, while health issues were dealt with more in the hard sciences and in the professions of nursing and public health. Also, improvements in public sanitation (for example, the wider availability of sewage systems and of food inspection) led to a decline in infectious diseases and thus a decreasing need for the largely household-based measures taught by home economists." Thus, the end of euthenics as originally defined by Ellen Swallow Richards ensued.

Relationship with eugenics

According to Ellen Richards, in her book Euthenics: the science of controllable environment (1910):

The betterment of living conditions, through conscious endeavor, for the purpose of securing efficient human beings, is what the author means by Euthenics.
"Human vitality depends upon two primary conditions—heredity and hygiene—or conditions preceding birth and conditions during life."
Eugenics deals with race improvement through heredity.
Euthenics deals with race improvement through environment.
Eugenics is hygiene for the future generations.
Euthenics is hygiene for the present generation.
Eugenics must await careful investigation.
Euthenics has immediate opportunity.
Euthenics precedes eugenics, developing better men now, and thus inevitably creating a better race of men in the future. Euthenics is the term proposed for the preliminary science on which Eugenics must be based.

Debate, misconceptions and opposition

Lester Frank Ward

 

Abraham Flexner, c. 1895

 

Margaret Sanger, 1922

 

Charles Benedict Davenport, ca. 1929

Debate over misconceptions about the movement started almost from the beginning. In his comparison "Eugenics, Euthenics, And Eudemics", (American Journal of Sociology, Vol. 18, No. 6, May 1913), Lester F. Ward of Brown University opens the second section regarding euthenics lamenting:

Is there, then, nothing to do? Are we to accept that modem scientific fatalism known as laissez faire, which enjoins the folding of the arms? Are we to preach a gospel of inaction? I for one certainly am not content to do so, and I believe that nothing I have thus far said [about eugenics] is inconsistent with the most vigorous action, and that in the direction of the betterment of the human race. The end and aim of the eugenists cannot be reproached. The race is far from perfect. Its condition is deplorable. Its improvement is entirely feasible, and in the highest degree desirable. Nor do I refer merely to economic conditions, to the poverty and misery of the disinherited classes. The intellectual state of the world is deplorable, and its improvement is clearly within the reach of society itself. It is therefore a question of method rather than of principle that concerns us.

Ward later noted about the organic environment that:

Darwin has taught us that the chief barrier to the advance of any species of plants or animals is its competition with other plants and animals that contest the same ground. And therefore the fiercest opponents of any species are the members of the same species which demand the same elements of subsistence. Hence the chief form of relief in the organic world consists in the thinning-out of competitors. Any species of animals or plants left free to propagate at its normal rate would overrun the earth in a short time and leave no room for any other species. Any species that is sufficiently vigorous to resist its organic environment will crowd out all others and monopolize the earth. If nature permitted this there could be no variety, but only one monotonous aspect devoid of interest or beauty. Whatever we may think of the harsh method by which this is prevented, we cannot regret that it is prevented, and that we have a world of variety, interest, and aesthetic attractiveness.

Vassar historians note that "critics faulted the new program as a weakening of science and a slide into vocationalism. The influential educator and historian of education, Abraham Flexner—one of the founders of the Princeton Institute for Advanced Study—attacked the program, along with other “ad hoc” innovations like intercollegiate athletics and student governments, in Universities, American, English, German (1930)."

“

"Well, what is euthenics? Euthenics is the 'science of efficient living;' and the 'science' is artificially pieced together of bits of mental hygiene, child guidance, nutrition, speech development and correction, family problems, wealth consumption, food preparation, household technology, and horticulture.... The institute is actually justified in an official publication by the profound question of a girl student who is reported as asking, 'What is the connection of Shakespeare with having a baby?' The Vassar Institute of Euthenics bridges this gap!"

”

In the summer of 1926, Margaret Sanger created a stir when she gave a radio address, called "Racial Betterment", in the first Euthenics Institute, where she praised attempts to "close our gates to the so-called 'undesirables'" and proposed efforts to "discourage or cut down on the rapid multiplication of the unfit and undesirable at home", by government-subsidized voluntary sterilization. (from The Selected Papers of Margaret Sanger, vol. 1 (2003), Esther Katz, ed.)

Eugenicist, Charles Benedict Davenport, noted in his article "Euthenics and Eugenics," found reprinted in the Popular Science Monthly of January 1911, page 18, 20:

Thus the two schools of euthenics and eugenics stand opposed, each viewing the other unkindly. Against eugenics it is urged that it is a fatalistic doctrine and deprives life of the stimulus toward effort. Against euthenics the other side urges that it demands an endless amount of money to patch up conditions in the vain effort to get greater efficiency. Which of the two doctrines is true?

The thoughtful mind must concede that, as is so often the case where doctrines are opposed, each view is partial, incomplete and really false. The truth does not exactly lie between the doctrines; it comprehends them both. What a child becomes is always the resultant of two sets of forces acting from the moment the fertilized egg begins its development—one is the set of internal tendencies and the other is the set of external influences. What the result of an external influence—a particular environmental condition—shall be depends only in part upon the nature of the influence; it depends also upon the internal nature of the reacting protoplasm.

Incest, cousin marriage, the marriage of defectives and tuberculous persons, are, in wide circles, taboo. This fact affords the basis for the hope that, when the method of securing strong offspring, even from partially defective stock—and where is the strain without any defect?—is widely known, the teachings of science in respect even to marriage matings will be widely regarded and that in the generations to come the teachings and practice of euthenics will yield greater result because of the previous practice of the principles of eugenics.

In a New York Times op-ed dated October 24, 1926, entitled "Eugenics and euthenics", in response to an op-ed entitled "Bright Children Who Fail" which appeared the previous October 15, student of child psychology, Joseph A. Krisses observes:

“

From intensive study we realize the importance of eugenics—the right of birth, and also the subject of euthenics—the right to environment. Too little credit is given to environment when we speak of children having hereditary traits as "Like father, like son," or "Chip off the old block." Such phrases have their origin from the study of eugenics. No one has ever taken an Edwards baby and reared it in a Jukes environment.

”

Quotations

"Not through chance, but through increase of scientific knowledge; not through compulsion, but through democratic idealism consciously working through common interests, will be brought about the creation of right conditions, the control of the environment." (Ellen H. Swallow Richards)

"Right living conditions comprise pure food and a safe water supply, a clean and disease free atmosphere in which to live and work, proper shelter and adjustment of work, rest, and amusements." (Ellen H. Swallow Richards)

"Probably not more than twenty-five percent in any community are capable of doing a full days work such as they would be capable of doing if they were in perfect health" (Ellen H. Swallow Richards)

"Men ignore nature's laws in their personal lives. They crave a larger measure of goodness and happiness, and yet in their choice of dwelling places, in their building of houses to live in, in their selection of food and drink, in their clothing of their bodies, in their choice of occupations and amusements, in their methods and habits of work, they disregard natural laws and impose upon themselves conditions that make their ideals of goodness and happiness impossible of attainment." (George E. Dawson, The control of life through Environment)

"It is within the power of every living man to rid himself of every parasitic disease." (Louis Pasteur)

Flynn effect

From Wikipedia, the free encyclopedia

The Flynn effect is the substantial and long-sustained increase in both fluid and crystallized intelligence test scores that was measured in many parts of the world over the 20th century. When intelligence quotient (IQ) tests are initially standardized using a sample of test-takers, by convention the average of the test results is set to 100 and their standard deviation is set to 15 or 16 IQ points. When IQ tests are revised, they are again standardized using a new sample of test-takers, usually born more recently than the first. Again, the average result is set to 100. However, when the new test subjects take the older tests, in almost every case their average scores are significantly above 100.

Test score increases have been continuous and approximately linear from the earliest years of testing to the present. For the Raven's Progressive Matrices test, a study published in the year 2009 found that British children's average scores rose by 14 IQ points from 1942 to 2008. Similar gains have been observed in many other countries in which IQ testing has long been widely used, including other Western European countries, Japan, and South Korea.

There are numerous proposed explanations of the Flynn effect, as well as some skepticism about its implications. Similar improvements have been reported for other cognitions such as semantic and episodic memory. Research suggests that there is an ongoing reversed Flynn effect, i.e. a decline in IQ scores, in Norway, Denmark, Australia, Britain, the Netherlands, Sweden, Finland, France and German-speaking countries, a development which appears to have started in the 1990s.

Origin of term

The Flynn effect is named for James R. Flynn, who did much to document it and promote awareness of its implications. The term itself was coined by Richard Herrnstein and Charles Murray, authors of The Bell Curve. Although the general term for the phenomenon - referring to no researcher in particular - continues to be "secular rise in IQ scores", many textbooks on psychology and IQ testing have now followed the lead of Herrnstein and Murray in calling the phenomenon the Flynn effect.

Rise in IQ

IQ tests are updated periodically. For example, the Wechsler Intelligence Scale for Children (WISC), originally developed in 1949, was updated in 1974, in 1991, 2003 and again in 2014. The revised versions are standardized based on the performance of test-takers in standardization samples. A standard score of IQ 100 is defined as the median performance of the standardization sample. Thus one way to see changes in norms over time is to conduct a study in which the same test-takers take both an old and new version of the same test. Doing so confirms IQ gains over time. Some IQ tests, for example tests used for military draftees in NATO countries in Europe, report raw scores, and those also confirm a trend of rising scores over time. The average rate of increase seems to be about three IQ points per decade in the United States, as scaled by the Wechsler tests. The increasing test performance over time appears on every major test, in every age range, at every ability level, and in every modern industrialized country, although not necessarily at the same rate as in the United States. The increase was continuous and roughly linear from the earliest days of testing to the mid 1990s. Though the effect is most associated with IQ increases, a similar effect has been found with increases in attention and of semantic and episodic memory.

Ulric Neisser estimated that using the IQ values of 1997, the average IQ of the United States in 1932, according to the first Stanford–Binet Intelligence Scales standardization sample, was 80. Neisser states that "Hardly any of them would have scored 'very superior', but nearly one-quarter would have appeared to be 'deficient.'" He also wrote that "Test scores are certainly going up all over the world, but whether intelligence itself has risen remains controversial."

Trahan et al. (2014) found that the effect was about 2.93 points per decade, based on both Stanford–Binet and Wechsler tests; they also found no evidence the effect was diminishing. In contrast, Pietschnig & Voracek (2015) reported, in their meta-analysis of studies involving nearly 4 million participants, that the Flynn effect had decreased in recent decades. They also reported that the magnitude of the effect was different for different types of intelligence ("0.41, 0.30, 0.28, and 0.21 IQ points annually for fluid, spatial, full-scale, and crystallized IQ test performance, respectively"), and that the effect was stronger for adults than for children.

Raven (2000) found that, as Flynn suggested, data interpreted as showing a decrease in many abilities with increasing age must be re-interpreted as showing that there has been a dramatic increase of these abilities with date of birth. On many tests this occurs at all levels of ability.

Some studies have found the gains of the Flynn effect to be particularly concentrated at the lower end of the distribution. Teasdale and Owen (1989), for example, found the effect primarily reduced the number of low-end scores, resulting in an increased number of moderately high scores, with no increase in very high scores. In another study, two large samples of Spanish children were assessed with a 30-year gap. Comparison of the IQ distributions indicated that the mean IQ-scores on the test had increased by 9.7 points (the Flynn effect), the gains were concentrated in the lower half of the distribution and negligible in the top half, and the gains gradually decreased as the IQ of the individuals increased. Some studies have found a reverse Flynn effect with declining scores for those with high IQ.

In 1987, Flynn took the position that the very large increase indicates that IQ tests do not measure intelligence but only a minor sort of "abstract problem-solving ability" with little practical significance. He argued that if IQ gains do reflect intelligence increases, there would have been consequent changes of our society that have not been observed (a presumed non-occurrence of a "cultural renaissance"). Flynn no longer endorses this view of intelligence and has since elaborated and refined his view of what rising IQ scores mean.

Precursors to Flynn's publications

Earlier investigators had discovered rises in raw IQ test scores in some study populations, but had not published general investigations of that issue in particular. Historian Daniel C. Calhoun cited earlier psychology literature on IQ score trends in his book The Intelligence of a People (1973). R. L. Thorndike drew attention to rises in Stanford-Binet scores in a 1975 review of the history of intelligence testing.

Intelligence

There is debate about whether the rise in IQ scores also corresponds to a rise in general intelligence, or only a rise in special skills related to taking IQ tests. Because children attend school longer now and have become much more familiar with the testing of school-related material, one might expect the greatest gains to occur on such school content-related tests as vocabulary, arithmetic or general information. Just the opposite is the case: abilities such as these have experienced relatively small gains and even occasional decreases over the years. Meta-analytic findings indicate that Flynn effects occur for tests assessing both fluid and crystallized abilities. For example, Dutch conscripts gained 21 points during only 30 years, or 7 points per decade, between 1952 and 1982. But this rise in IQ test scores is not wholly explained by an increase in general intelligence. Studies have shown that while test scores have improved over time, the improvement is not fully correlated with latent factors related to intelligence. Rushton has shown that the gains in IQ over time (the Lynn-Flynn effect) are unrelated to g. Other researchers have shown that the IQ gains described by the Flynn effect are due in part to increasing intelligence, and in part to increases in test-specific skills. In parallel with the measured gains in IQ scores, secular declines have been found for "mental speed, digit span backwards, the use of difficult words, and color acuity, all of which are related to intelligence".

Proposed explanations

A 2017 survey of 75 experts in the field of intelligence research suggested four key causes of the Flynn effect: Better health, better nutrition, more and better education, and rising standards of living. Genetic changes were seen as not important. The experts' views agreed with an independently performed meta-analysis on published Flynn effect data, except that the latter found life history speed to be the most important factor.

The expert survey explained the possible end or decline in the Flynn effect by asymmetric fertility by means of genetic effects, migration, asymmetric fertility by means of socialization effects, declines in education, and the influence of media.

Schooling and test familiarity

Duration of average schooling has increased steadily. One problem with this explanation is that if in the US comparing older and more recent subjects with similar educational levels, then the IQ gains appear almost undiminished in each such group considered individually.

Many studies find that children who do not attend school score drastically lower on the tests than their regularly attending peers. During the 1960s, when some Virginia counties closed their public schools to avoid racial integration, compensatory private schooling was available only for Caucasian children. On average, the scores of African-American children who received no formal education during that period decreased at a rate of about six IQ points per year.

Another explanation is an increased familiarity of the general population with tests and testing. For example, children who take the very same IQ test a second time usually gain five or six points.  However, this seems to set an upper limit on the effects of test sophistication. One problem with this explanation and others related to schooling is that in the US, the groups with greater test familiarity show smaller IQ increases.

Early intervention programs have shown mixed results. Some preschool (ages 3–4) intervention programs like "Head Start" do not produce lasting changes of IQ, although they may confer other benefits. The "Abecedarian Early Intervention Project", an all-day program that provided various forms of environmental enrichment to children from infancy onward, showed IQ gains that did not diminish over time. The IQ difference between the groups, although only five points, was still present at age 12. Not all such projects have been successful. Also, such IQ gains can diminish until age 18.

Citing a high correlation between rising literacy rates and gains in IQ, David Marks has argued that the Flynn effect is caused by changes in literacy rates.

Generally more stimulating environment

Still another theory is that the general environment today is much more complex and stimulating. One of the most striking 20th century changes of the human intellectual environment has come from the increase of exposure to many types of visual media. From pictures on the wall to movies to television to video games to computers, each successive generation has been exposed to richer optical displays than the one before and may have become more adept at visual analysis. This would explain why visual tests like the Raven's have shown the greatest increases. An increase only of particular form(s) of intelligence would explain why the Flynn effect has not caused a "cultural renaissance too great to be overlooked."

In 2001, Dickens and Flynn presented a model for resolving several contradictory findings regarding IQ. They argue that the measure "heritability" includes both a direct effect of the genotype on IQ and also indirect effects such that the genotype changes the environment, thereby affecting IQ. That is, those with a greater IQ tend to seek stimulating environments that further increase IQ. These reciprocal effects result in gene environment correlation. The direct effect could initially have been very small, but feedback can create large differences of IQ. In their model, an environmental stimulus can have a very great effect on IQ, even for adults, but this effect also decays over time unless the stimulus continues (the model could be adapted to include possible factors, like nutrition during early childhood, that may cause permanent effects). The Flynn effect can be explained by a generally more stimulating environment for all people. The authors suggest that any program designed to increase IQ may produce long-term IQ gains if that program teaches children how to replicate the types of cognitively demanding experiences that produce IQ gains outside the program. To maximize lifetime IQ, the programs should also motivate them to continue searching for cognitively demanding experiences after they have left the program.

Flynn in his 2007 book What Is Intelligence? further expanded on this theory. Environmental changes resulting from modernization — such as more intellectually demanding work, greater use of technology and smaller families — have meant that a much larger proportion of people are more accustomed to manipulating abstract concepts such as hypotheses and categories than a century ago. Substantial portions of IQ tests deal with these abilities. Flynn gives, as an example, the question 'What do a dog and a rabbit have in common?' A modern respondent might say they are both mammals (an abstract, or a priori answer, which depends only on the meanings of the words 'dog' and 'rabbit' ), whereas someone a century ago might have said that humans catch rabbits with dogs (a concrete, or a posteriori answer, which depended on what happened to be the case at that time).

Nutrition

Improved nutrition is another possible explanation. Today's average adult from an industrialized nation is taller than a comparable adult of a century ago. That increase of stature, likely the result of general improvements of nutrition and health, has been at a rate of more than a centimeter per decade. Available data suggest that these gains have been accompanied by analogous increases of head size, and by an increase in the average size of the brain. This argument had been thought to suffer the difficulty that groups who tend to be of smaller overall body size (e.g. women, or people of Asian ancestry) do not have lower average IQs. Richard Lynn, however, claims that while people of East Asian origin may often have smaller bodies, they tend to have larger brains and higher IQs than average whites.

A 2005 study presented data supporting the nutrition hypothesis, which predicts that gains will occur predominantly at the low end of the IQ distribution, where nutritional deprivation is probably most severe. An alternative interpretation of skewed IQ gains could be that improved education has been particularly important for this group. Richard Lynn makes the case for nutrition, arguing that cultural factors cannot typically explain the Flynn effect because its gains are observed even at infant and preschool levels, with rates of IQ test score increase about equal to those of school students and adults. Lynn states that "This rules out improvements in education, greater test sophistication, etc. and most of the other factors that have been proposed to explain the Flynn effect. He proposes that the most probable factor has been improvements in pre-natal and early post-natal nutrition."

A century ago, nutritional deficiencies may have limited body and organ functionality, including skull volume. The first two years of life is a critical time for nutrition. The consequences of malnutrition can be irreversible and may include poor cognitive development, educability, and future economic productivity. On the other hand, Flynn has pointed to 20-point gains on Dutch military (Raven's type) IQ tests between 1952, 1962, 1972, and 1982. He observes that the Dutch 18-year-olds of 1962 had a major nutritional handicap. They were either in the womb, or were recently born, during the great Dutch famine of 1944 – when German troops monopolized food and 18,000 people died of starvation. Yet, concludes Flynn, "they do not show up even as a blip in the pattern of Dutch IQ gains. It is as if the famine had never occurred." It appears that the effects of diet are gradual, taking effect over decades (affecting mother as well as child) rather than a few months.

In support of the nutritional hypothesis, it is known that, in the United States, the average height before 1900 was about 10 cm (∼4 inches) shorter than it is today. Possibly related to the Flynn effect is a similar change of skull size and shape during the last 150 years. Though the idea that brain size is unrelated to race and intelligence was popularized in the 1980s, studies continue to show significant correlations. A Norwegian study found that height gains were strongly correlated with intelligence gains until the cessation of height gains in military conscript cohorts towards the end of the 1980s. Both height and skull size increases probably result from a combination of phenotypic plasticity and genetic selection over this period. With only five or six human generations in 150 years, time for natural selection has been very limited, suggesting that increased skeletal size resulting from changes in population phenotypes is more likely than recent genetic evolution.

It is well known that micronutrient deficiencies change the development of intelligence. For instance, one study has found that iodine deficiency caused a fall, on average, of 12 IQ points in China.

Scientists James Feyrer, Dimitra Politi, and David N. Weil have found in the U.S. that the proliferation of iodized salt increased IQ by 15 points in some areas. Journalist Max Nisen has stated that, with this type of salt becoming popular, that "the aggregate effect has been extremely positive."

Daley et al. (2003) found a significant Flynn effect among children in rural Kenya, and concluded that nutrition was one of the hypothesized explanations that best explained their results (the others were parental literacy and family structure).

Infectious diseases

Eppig, Fincher, and Thornhill (2009) argue that "From an energetics standpoint, a developing human will have difficulty building a brain and fighting off infectious diseases at the same time, as both are very metabolically costly tasks" and that "the Flynn effect may be caused in part by the decrease in the intensity of infectious diseases as nations develop." They suggest that improvements in gross domestic product (GDP), education, literacy, and nutrition may have an effect on IQ mainly through reducing the intensity of infectious diseases.

Eppig, Fincher, and Thornhill (2011) in a similar study instead looking at different US states found that states with a higher prevalence of infectious diseases had lower average IQ. The effect remained after controlling for the effects of wealth and educational variation.

Atheendar Venkataramani (2010) studied the effect of malaria on IQ in a sample of Mexicans. Exposure during the birth year to malaria eradication was associated with increases in IQ. It also increased the probability of employment in a skilled occupation. The author suggests that this may be one explanation for the Flynn effect and that this may be an important explanation for the link between national malaria burden and economic development. A literature review of 44 papers states that cognitive abilities and school performance were shown to be impaired in sub-groups of patients (with either cerebral malaria or uncomplicated malaria) when compared with healthy controls. Studies comparing cognitive functions before and after treatment for acute malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups.

Heterosis

Heterosis, or hybrid vigor associated with historical reductions of the levels of inbreeding, has been proposed by Michael Mingroni as an alternative explanation of the Flynn effect. However, James Flynn has pointed out that even if everyone mated with a sibling in 1900, subsequent increases in heterosis would not be a sufficient explanation of the observed IQ gains.

Possible end of progression

Jon Martin Sundet and colleagues (2004) examined scores on intelligence tests given to Norwegian conscripts between the 1950s and 2002. They found that the increase of scores of general intelligence stopped after the mid-1990s and declined in numerical reasoning sub-tests.

Teasdale and Owen (2005) examined the results of IQ tests given to Danish male conscripts. Between 1959 and 1979 the gains were 3 points per decade. Between 1979 and 1989 the increase approached 2 IQ points. Between 1989 and 1998 the gain was about 1.3 points. Between 1998 and 2004 IQ declined by about the same amount as it gained between 1989 and 1998. They speculate that "a contributing factor in this recent fall could be a simultaneous decline in proportions of students entering 3-year advanced-level school programs for 16–18-year-olds." The same authors in a more comprehensive 2008 study, again on Danish male conscripts, found that there was a 1.5-point increase between 1988 and 1998, but a 1.5-point decrease between 1998 and 2003/2004. A possible contributing factor to the more recent decline may be changes in the Danish educational system. Another may be the rising proportion of immigrants or their immediate descendants in Denmark. This is supported by data on Danish draftees where first or second generation immigrants with Danish nationality score below average.

In Australia, the IQ of 6–11 year olds as measured by the Colored Progressive Matrices has shown no increase from 1975–2003.

In the United Kingdom, a study by Flynn (2009) found that tests carried out in 1980 and again in 2008 show that the IQ score of an average 14-year-old dropped by more than two points over the period. For the upper half of the results the performance was even worse. Average IQ scores declined by six points. However, children aged between five and 10 saw their IQs increase by up to half a point a year over the three decades. Flynn argues that the abnormal drop in British teenage IQ could be due to youth culture having “stagnated” or even dumbed down. He also states that the youth culture is more oriented towards computer games than towards reading and holding conversations. Researcher Richard Gray, commenting on the study, also mentions the computer culture diminishing reading books as well as a tendency towards teaching to the test.

Lynn and Harvey argued in 2008 that the causes of the above are difficult to interpret since these countries had had significant recent immigration from countries with lower average national IQs. Nevertheless, they expect that similar patterns will occur, or have occurred, first in other developed nations and then in the developing world as there is a limit to how much environmental factors can improve intelligence. Furthermore, during the last century there is a negative correlation between fertility and intelligence although there is not yet any conclusive evidence of the association between the two. They estimate that there has been a dysgenic decline in the world's genotypic IQ (masked by the Flynn effect for the phenotype) of 0.86 IQ points per decade for the years 1950–2000.

Bratsberg & Rogeberg (2018) present evidence that the Flynn effect in Norway has reversed, and that both the original rise in mean IQ scores and their subsequent decline were caused by environmental factors.

IQ group differences

If the Flynn effect has ended in developed nations, then this may possibly allow national differences in IQ scores to diminish if the Flynn effect continues in nations with lower average national IQs.

Also, if the Flynn effect has ended for the majority in developed nations, it may still continue for minorities, especially for groups like immigrants where many may have received poor nutrition during early childhood or have had other disadvantages. A study in the Netherlands found that children of non-Western immigrants had improvements for g, educational achievements, and work proficiency compared to their parents, although there were still remaining differences compared to ethnic Dutch.

There is a controversy as to whether the US racial gap in IQ scores is diminishing. If that is the case then this may or may not be related to the Flynn effect. Flynn has commented that he never claimed that the Flynn effect has the same causes as the black-white gap, but that it shows that environmental factors can create IQ differences of a magnitude similar to the gap. Research that has examined whether g factor and IQ gains from the Flynn effect are related have found there is a negative correlation between the two, which may indicate that group differences and the Flynn effect are possibly due to differing causes.

The Flynn effect has also been part of the discussions regarding Spearman's hypothesis, which states that differences in the g factor are the major source of differences between blacks and whites observed in many studies of race and intelligence.

Telemedicine

From Wikipedia, the free encyclopedia

Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. It has been used to overcome distance barriers and to improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations.

Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging and health informatics data from one site to another.

Early forms of telemedicine achieved with telephone and radio have been supplemented with videotelephony, advanced diagnostic methods supported by distributed client/server applications, and additionally with telemedical devices to support in-home care.

Disambiguation

The definition of telemedicine is somewhat controversial. Some definitions (such as the definition given by the World Health Organization) include all aspects of healthcare including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments.

eHealth is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology.

Benefits and drawbacks

Telemedicine can be beneficial to patients in isolated communities and remote regions, who can receive care from doctors or specialists far away without the patient having to travel to visit them. Recent developments in mobile collaboration technology can allow healthcare professionals in multiple locations to share information and discuss patient issues as if they were in the same place. Remote patient monitoring through mobile technology can reduce the need for outpatient visits and enable remote prescription verification and drug administration oversight, potentially significantly reducing the overall cost of medical care. Telemedicine can also facilitate medical education by allowing workers to observe experts in their fields and share best practices more easily.

Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. This is particularly an issue where MRSA is a concern. Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, white coat syndrome may be avoided. Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration.

The downsides of telemedicine include the cost of telecommunication and data management equipment and of technical training for medical personnel who will employ it. Virtual medical treatment also entails potentially decreased human interaction between medical professionals and patients, an increased risk of error when medical services are delivered in the absence of a registered professional, and an increased risk that protected health information may be compromised through electronic storage and transmission. There is also a concern that telemedicine may actually decrease time efficiency due to the difficulties of assessing and treating patients through virtual interactions; for example, it has been estimated that a teledermatology consultation can take up to thirty minutes, whereas fifteen minutes is typical for a traditional consultation. Additionally, potentially poor quality of transmitted records, such as images or patient progress reports, and decreased access to relevant clinical information are quality assurance risks that can compromise the quality and continuity of patient care for the reporting doctor. Other obstacles to the implementation of telemedicine include unclear legal regulation for some telemedical practices and difficulty claiming reimbursement from insurers or government programs in some fields.

Another disadvantage of telemedicine is the inability to start treatment immediately. For example, a patient suffering from a bacterial infection might be given an antibiotic hypodermic injection in the clinic, and observed for any reaction, before that antibiotic is prescribed in pill form.

History

In the early 1900s, people living in remote areas of Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals, to communicate with the Royal Flying Doctor Service of Australia.

In 1967 one of the first telemedicine clinics was founded by Kenneth Bird at Massachusetts General Hospital. The clinic addressed the fundamental problem of delivering occupational and emergency health services to employees and travellers at Boston's Logan International Airport, located three congested miles from the hospital. Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit. The timing of Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts. Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings. The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989. A year later under the leadership of its President/CEO S Eric Wachtel, MedPhone introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.

Types

Categories

Telemedicine can be broken into three main categories: store-and-forward, remote patient monitoring and (real-time) interactive services.

Store and forward

Store-and-forward telemedicine involves acquiring medical data (like 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. Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.

Remote monitoring

Telehealth Blood Pressure Monitor

Remote monitoring, also known as self-monitoring or testing, enables medical professionals to monitor a patient remotely using various technological devices. This method is primarily used for managing chronic diseases or specific conditions, such as heart disease, diabetes mellitus, or asthma. These services can provide comparable health outcomes to traditional in-person patient encounters, supply greater satisfaction to patients, and may be cost-effective. Examples include home-based nocturnal dialysis and improved joint management.

Real-time interactive

Electronic consultations are possible through interactive telemedicine services which provide real-time interactions between patient and provider. Videoconferencing has been used in a wide range of clinical disciplines and settings for various purposes including management, diagnosis, counselling and monitoring of patients.

Emergency

U.S. Navy medical staff being trained in the use of handheld telemedical devices (2006).

Common daily emergency telemedicine is performed by SAMU Regulator Physicians in France, Spain, Chile and Brazil. Aircraft and maritime emergencies are also handled by SAMU centres in Paris, Lisbon and Toulouse.

A recent study identified three major barriers to adoption of telemedicine in emergency and critical care units. They include:

• regulatory challenges related to the difficulty and cost of obtaining licensure across multiple states, malpractice protection and privileges at multiple facilities
• Lack of acceptance and reimbursement by government payers and some commercial insurance carriers creating a major financial barrier, which places the investment burden squarely upon the hospital or healthcare system.
• Cultural barriers occurring from the lack of desire, or unwillingness, of some physicians to adapt clinical paradigms for telemedicine applications.

Telemedicine system. Federal Center of Neurosurgery in Tyumen, 2013

Telenursing

Telenursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.
Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.

Baby Eve with Georgia for the Breastfeeding Support Project

In Australia, during January 2014, Melbourne tech startup Small World Social collaborated with the Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers. The application, named Google Glass Breastfeeding app trial, allows mothers to nurse their baby while viewing instructions about common breastfeeding issues (latching on, posture etc.) or call a lactation consultant via a secure Google Hangout, who can view the issue through the mother's Google Glass camera. The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently.

Telepharmacy

Pharmacy personnel deliver medical prescriptions electronically; remote delivery of pharmaceutical care is an example of telemedicine.

Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.

The term can also refer to the use of videoconferencing in pharmacy for other purposes, such as providing education, training, and management services to pharmacists and pharmacy staff remotely.

Teleneuropsychology

Teleneuropsychology (Cullum et al., 2014) is the use of telehealth/videoconference technology for the remote administration of neuropsychological tests. Neuropsychological tests are used to evaluate the cognitive status of individuals with known or suspected brain disorders and provide a profile of cognitive strengths and weaknesses. Through a series of studies, there is growing support in the literature showing that remote videoconference-based administration of many standard neuropsychological tests results in test findings that are similar to traditional in-person evaluations, thereby establishing the basis for the reliability and validity of teleneuropsychological assessment.

Telerehabilitation

Telerehabilitation (or e-rehabilitation) is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient’s functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech-language pathology, audiology, occupational therapy, and physical therapy. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.

Most telerehabilitation is highly visual. As of 2014, the most commonly used mediums are webcams, videoconferencing, phone lines, videophones and webpages containing rich Internet applications. The visual nature of telerehabilitation technology limits the types of rehabilitation services that can be provided. It is most widely used for neuropsychological rehabilitation; fitting of rehabilitation equipment such as wheelchairs, braces or artificial limbs; and in speech-language pathology. Rich internet applications for neuropsychological rehabilitation (aka cognitive rehabilitation) of cognitive impairment (from many etiologies) were first introduced in 2001. This endeavor has expanded as a teletherapy application for cognitive skills enhancement programs for school children. Tele-audiology (hearing assessments) is a growing application. Currently, telerehabilitation in the practice of occupational therapy and physical therapy is limited, perhaps because these two disciplines are more "hands on".

Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.

In the United States, the National Institute on Disability and Rehabilitation Research's (NIDRR) supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh, the Rehabilitation Institute of Chicago, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Health Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense. Outside the United States, excellent research is conducted in Australia and Europe.

Only a few health insurers in the United States, and about half of Medicaid programs, reimburse for telerehabilitation services. If the research shows that teleassessments and teletherapy are equivalent to clinical encounters, it is more likely that insurers and Medicare will cover telerehabilitation services.

Teletrauma care

Telemedicine can be utilized to improve the efficiency and effectiveness of the delivery of care in a trauma environment. Examples include:

Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation, via the internet using mobile devices, to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient.

Telemedicine for intensive care unit (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people to include attending physicians, fellows, residents and other clinicians. This group usually moves from bed to bed in a unit discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift, but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view the settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows the remote viewers two-way communication with clinicians at the bedside.

Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, firsthand knowledge and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources.

Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.

Specialist care delivery

Telemedicine can facilitate specialty care delivered by primary care physicians according to a controlled study of the treatment of hepatitis C. Various specialties are contributing to telemedicine, in varying degrees.

Telecardiology

ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem Einthoven, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab. See above reference-General health care delivery. Remotely treating ventricular fibrillation Medphone Corporation, 1989

Teletransmission of ECG using methods indigenous to Asia

One of the oldest known telecardiology systems for teletransmissions of ECGs was established in Gwalior, India in 1975 at GR Medical college by Ajai Shanker, S. Makhija, P.K. Mantri using an indigenous technique for the first time in India.

This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.

This system was also used to monitor patients with pacemakers in remote areas. The central control unit at the ICU was able to correctly interpret arrhythmia. This technique helped medical aid reach in remote areas.

In addition, electronic stethoscopes can be used as recording devices, which is helpful for purposes of telecardiology. There are many examples of successful telecardiology services worldwide.

In Pakistan three pilot projects in telemedicine was initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi and Holy Family Rawalpindi. These 12 remote sites were connected and on average of 1,500 patients being treated per month per hub. The project was still running smoothly after two years.

Telepsychiatry

Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings. Most telepsychiatry is undertaken in real time (synchronous) although in recent years research at UC Davis has developed and validated the process of asynchronous telepsychiatry. Recent reviews of the literature by Hilty et al. in 2013, and by Yellowlees et al. in 2015 confirmed that telepsychiatry is as effective as in-person psychiatric consultations for diagnostic assessment, is at least as good for the treatment of disorders such as depression and post traumatic stress disorder, and may be better than in-person treatment in some groups of patients, notably children, veterans and individuals with agoraphobia.

As of 2011, the following are some of the model programs and projects which are deploying telepsychiatry in rural areas in the United States:

1. University of Colorado Health Sciences Center (UCHSC) supports two programs for American Indian and Alaskan Native populations

a. The Center for Native American Telehealth and Tele-education (CNATT) and

b. Telemental Health Treatment for American Indian Veterans with Post-traumatic Stress Disorder (PTSD)

1. Military Psychiatry, Walter Reed Army Medical Center.
2. In 2009, the South Carolina Department of Mental Health established a partnership with the University of South Carolina School of Medicine and the South Carolina Hospital Association to form a statewide telepsychiatry program that provides access to psychiatrists 16 hours a day, 7 days a week, to treat patients with mental health issues who present at rural emergency departments in the network.
3. Between 2007 and 2012, the University of Virginia Health System hosted a videoconferencing project that allowed child psychiatry fellows to conduct approximately 12,000 sessions with children and adolescents living in rural parts of the State.

There are a growing number of HIPAA compliant technologies for performing telepsychiatry. There is an independent comparison site of current technologies.

Links for several sites related to telemedicine, telepsychiatry policy, guidelines, and networking are available at the website for the American Psychiatric Association.

There has also been a recent trend towards Video CBT sites with the recent endorsement and support of CBT by the National Health Service (NHS) in the United Kingdom.

In April 2012, a Manchester-based Video CBT pilot project was launched to provide live video therapy sessions for those with depression, anxiety, and stress related conditions called InstantCBT The site supported at launch a variety of video platforms (including Skype, GChat, Yahoo, MSN as well as bespoke) and was aimed at lowering the waiting times for mental health patients. This is a Commercial, For-Profit business.

In the United States, the American Telemedicine Association and the Center of Telehealth and eHealth are the most respectable places to go for information about telemedicine.

The Health Insurance Portability and Accountability Act (HIPAA), is a United States Federal Law that applies to all modes of electronic information exchange such as video-conferencing mental health services. In the United States, Skype, Gchat, Yahoo, and MSN are not permitted to conduct video-conferencing services unless these companies sign a Business Associate Agreement stating that their employees are HIPAA trained. For this reason, most companies provide their own specialized videotelephony services. Violating HIPAA in the United States can result in penalties of hundreds of thousands of dollars.

The momentum of telemental health and telepsychiatry is growing. In June 2012 the U.S. Veterans Administration announced expansion of the successful telemental health pilot. Their target was for 200,000 cases in 2012.

A growing number of HIPAA compliant technologies are now available. There is an independent comparison site that provides a criteria-based comparison of telemental health technologies.

The SATHI Telemental Health Support project cited above is another example of successful Telemental health support. - Also see SCARF India.

Teleradiology

A CT exam displayed through teleradiology

Teleradiology is the ability to send radiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another. For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving-image review station. The most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.

The teleradiology process begins at the image sending station. The radiographic image and a modem or other connection are required for this first step. The image is scanned and then sent via the network connection to the receiving computer.

Today's high-speed broadband based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard personal computer (PC) and digital subscriber line (DSL) connection is enough to reach keosys central server. No particular software is necessary on the PC and the images can be reached from wherever in the world.

Teleradiology is the most popular use for telemedicine and accounts for at least 50% of all telemedicine usage.

Telepathology

Telepathology is the practice of pathology at a distance. It uses telecommunications technology to facilitate the transfer of image-rich pathology data between distant locations for the purposes of diagnosis, education, and research. Performance of telepathology requires that a pathologist selects the video images for analysis and the rendering diagnoses. The use of "television microscopy", the forerunner of telepathology, did not require that a pathologist have physical or virtual "hands-on" involvement is the selection of microscopic fields-of-view for analysis and diagnosis.

A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services. He, and his collaborators, published the first scientific paper on robotic telepathology. Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks. Weinstein is known to many as the "father of telepathology". In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989. This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.

Telepathology has been successfully used for many applications including the rendering histopathology tissue diagnoses, at a distance, for education, and for research. Although digital pathology imaging, including virtual microscopy, is the mode of choice for telepathology services in developed countries, analog telepathology imaging is still used for patient services in some developing countries.

Teledermatology

Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education. The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.

Teledentistry

Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine.

Teleaudiology

Tele-audiology is the utilization of telehealth to provide audiological services and may include the full scope of audiological practice. This term was first used by Dr Gregg Givens in 1999 in reference to a system being developed at East Carolina University in North Carolina, USA.

Teleophthalmology

Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients. In Mizoram, India, a hilly area with poor roads, between 2011 till 2015, Tele-ophthalmology has provided care to over 10000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6–12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally. There were huge cost savings in travel etc.

Licensure

U.S. licensing and regulatory issues

Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.

If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.

In 2008, the U.S. passed the Ryan Haight Act which required face-to-face or valid telemedicine consultations prior to receiving a prescription.

State medical licensing boards have sometimes opposed telemedicine; for example, in 2012 electronic consultations were illegal in Idaho, and an Idaho-licensed general practitioner was punished by the board for prescribing an antibiotic, triggering reviews of her licensure and board certifications across the country. Subsequently, in 2015 the state legislature legalized electronic consultations.

In 2015, Teladoc filed suit against the Texas Medical Board over a rule that required in-person consultations initially; the judge refused to dismiss the case, noting that antitrust laws apply to state medical boards.

Companies

In the United States, the major companies offering primary care for non-acute illnesses include Teladoc, American Well, and PlushCare. Companies such as Grand Rounds offer remote access to specialty care. Additionally, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations. For example, In 2015, UnitedHealthcare announced that it would cover a range of video visits from Doctor On Demand, American Well’s AmWell, and its own Optum’s NowClinic, which is a white-labeled American Well offering. In November 30, 2017, PlushCare launched in some U.S. states, the Pre-Exposure Prophylaxis (PrEP) therapy for prevention of HIV. In this PrEP initiative, PlushCare does not require an initial check-up and provides consistent online doctor visits, regular local laboratory testing and prescriptions filled at partner pharmacies.

Advanced and experimental services

Telesurgery

Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.

Remote surgery is essentially advanced telecommuting for surgeons, where the physical distance between the surgeon and the patient is immaterial. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.

Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.

Enabling technologies

Videotelephony

Videotelephony comprises the technologies for the reception and transmission of audio-video signals by users at different locations, for communication between people in real-time.

At the dawn of the technology, videotelephony also included image phones which would exchange still images between units every few seconds over conventional POTS-type telephone lines, essentially the same as slow scan TV systems.

Currently videotelephony is particularly useful to the deaf and speech-impaired who can use them with sign language and also with a video relay service, and well as to those with mobility issues or those who are located in distant places and are in need of telemedical or tele-educational services.

Developing countries

For developing countries, telemedicine and eHealth can be the only means of healthcare provision in remote areas. For example, the difficult financial situation in many African states and lack of trained health professionals has meant that the majority of the people in sub-Saharan Africa are badly disadvantaged in medical care, and in remote areas with low population density, direct healthcare provision is often very poor However, provision of telemedicine and eHealth from urban centres or from other countries is hampered by the lack of communications infrastructure, with no landline phone or broadband internet connection, little or no mobile connectivity, and often not even a reliable electricity supply.

The Satellite African eHEalth vaLidation (SAHEL) demonstration project has shown how satellite broadband technology can be used to establish telemedicine in such areas. SAHEL was started in 2010 in Kenya and Senegal, providing self-contained, solar-powered internet terminals to rural villages for use by community nurses for collaboration with distant health centres for training, diagnosis and advice on local health issues.

In 2014, the government of Luxembourg, along with satellite operator, SES and NGOs, Archemed, Fondation Follereau, Friendship Luxembourg, German Doctors and Médecins Sans Frontières, established SATMED, a multilayer eHealth platform to improve public health in remote areas of emerging and developing countries, using the Emergency.lu disaster relief satellite platform and the Astra 2G TV satellite. SATMED was first deployed in response to a report in 2014 by German Doctors of poor communications in Sierra Leone hampering the fight against Ebola, and SATMED equipment arrived in the Serabu clinic in Sierra Leone in December 2014. In June 2015 SATMED was deployed at Maternité Hospital in Ahozonnoude, Benin to provide remote consultation and monitoring, and is the only effective communication link between Ahozonnoude, the capital and a third hospital in Allada, since land routes are often inaccessible due to flooding during the rainy season.