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A Broad-Spectrum Health Delivery Model and Intelligent Mobile Information-Network to Strengthen Individual-Based Primary Care Medicine: Scientific Foundation and Architecture

Rodolfo J Stusser1* and Richard A Dickey2

1Clinical Biostatistics, American Academy of Family Physicians, USA

2Clinical Endocrinology, Past-President of American Academy of Clinical Endocrinologists, NC, USA

*Corresponding Author:
Rodolfo J Stusser
General Practitioner, Clinical Biostatistics
American Academy of Family Physicians, USA
Tel: 786-216-8310
E-mail:
[email protected]

Received date: February 12, 2016; Accepted date: April 08, 2016; Published date: April 15, 2016

Citation: Stusser RJ, Dickey RA. A Broad-Spectrum Health Delivery Model and Intelligent Mobile Information-Network to Strengthen Individual-Based Primary Care Medicine: Scientific Foundation and Architecture. J Healthc Commun. 2016, 1:2. DOI: 10.4172/2472-1654.100015

 
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Abstract

Background: Primary care (PC) medicine, while nurturing patient’sfew positive (+) health states and enhancer factors, has mostly healed many negative (-) health/ disease states and risk factors. In 2013, we designed a US research program for quality/cost improvement of healthcare measuring patient global health outcome using e-health record and socio-bio-sensed data.

Aim: To justify and engineer a US broad-spectrum health PC’s delivery/intelligent mobile information-network.

Methods: 1) Quasi-experimental evaluation of democratic-scientific-industrial revolutions’ effects on 193 nations and the US assessed by 106 life-health, theoretical-technological variables’ trends from 1750 to 2015, and 2) optimization via system analysis and categorization by analogy-making of PC medical model.

Results: The modernization has practically tripled human life expectancy, by spreading life-health advances and controlling nutritional-infectious and maternalinfant diseases/injuries. In 1957-2014, life expectancy increased slightly more slowly than in 1900-1956, despite the fact that quality, equality, and survival of high-lethality chronic diseases/injuries greatly improved, through much more preventive-therapeutic biomedical-biopharmaceutical advances and higher costs. This difference in the rate of increase of life expectancy seems linked to the persistently high-incidence of chronic diseases/injuries related to chronic disorders and risks in infants, children and teenagers. With an individual-based broad-spectrum health delivery PC system to measure, enhance, and safeguard his health reserve, upgraded with information sciences/technologies, we can evaluate/reduce objectively the health information overload of our young and adult individuals. Physician-nurse teams managing it can increase the individual health intelligence, helping process his entire life e-health record data, enriched with smart wearable through a smartphone-computer network, empowering selfhealth induction with prompt data-exchange of defragmented cultureconosociopsychoneuro-biophysiological (+ ± -) global health. It also must increase the homogeneity of lifestyle/biomedical trials' groups in global health index, profile, +prognostic/enhancer factors, and enable developing integral bottom-up population health indices.

Conclusion: Increasing individual health intelligence through primary care integral infomedicine should increase healthcare efficiency.

Keywords

Patient-physician always-on online communication and advice; Patient negative, positive and global health status; Primary care medicine health broad-spectrum delivery model; Life and health indices and scientific biomedical secular tendencies; Intelligent mobile healthcare information network; Patient health reserve self-enhancement and safeguard; Healthcare quality and cost improvement

Introduction

Historical premises

In the 5th-century BC, standard Euryphon’s Cnidus school of primary care (PC) and general medical (GM) science concentrated on disease classification, grouped by symptoms and syndromes to organize diagnosis and therapy. Meanwhile, Hippocrates’ Cos school of PC-GM art focused on 1) observation of individual and environment, recorded in case-histories and 2) reasoning for guidance in diagnosis, prognosis, prevention and therapy [1-7]. Individual health normalcy was an initial experience, while the healing powers of nature battled one’s sickness. The general physician (GP) nurtured and preserved the individual’s positive (+) health enhancer factors and states, protected him from negative (-) health risk factors, and alleviated his suffering and cured his diseases [8,9]. According to the goddess ‘Hygeia’, health was the natural order of things to which man is entitled if life is governed wisely. The function of PC-GM was to discover and teach the laws that will ensure health. The followers of the god ‘Asclepius’ believed that the GP’s key role is to be a healer, replacing Hygeia cult in the 3rd century BC. Since then, GPs mostly treat patient disease and reactively restore health by medicating or operating. However, treating disease is not the same thing as creating proactively health. Health is the expression of the way in which the individual responds and adapts to the challenges met in everyday life, and has been valued as 90% of one’s happiness [1].

In the 2nd-century AD, Galen, wrote, “Health is such a condition in which we neither suffer pain nor are hindered in the functions of daily life.” He preserved patient health by carefully directing attention to “air, cleanliness, exercise, food, drink, occupation, sleep, sexual life, and emotions.” The preservation and attainment of health is the moral responsibility of the individual [7-9]. Galen stated, “Given a congenitally sound constitution and a politically free situation, an individual could -with recurring effort and constant attention- attain health.” He championed human choice and free will for everything. “Humans alone have the capacity to modify their feelings by choosing responses, activities, and regimens, which will make moderation a reality as well as an ideal [1].” In the middle ages, the Hippocratic concept of individual medicine was replaced by that of community medicine. In the 1600s, Newton used the scientific method as an iterating cycle of Bacon’s empirical and Descartes’ rational steps in the pursuit of objectivity [2,3,10], guiding Sydenham to link the Hippocratic patient’s observation approach with the Euryphon focus on disease classification. Sauvages patho-nosology science still confusing symptoms with diseases, was not useful, emphasizing clinical phenomenology, evading the conflicting anatomic, physiologic, and etiologic speculative systems [11-13]. A similar nosology is still being used in diagnosing patient mental disorders, with poorly recordable, measurable, and reproducible factors regarding etio-pathogeneses [5,11-14].

In 1760, democratic, scientific and industrial revolutions began to increase freedoms, knowledge-technologies, and life-health standards in some western nations [15,16]. The French-style general hospital isolated patients from their PC environment for specialized critical clinical-surgical secondary level care, raising efficiency, while some ones evolved to German-style institutes for more specialized tertiary level care and research [2,10]. The birth of thousands of somatic diseases, hundreds of psychic and dozens of psychosomatic disorders, broke down the unified individual mind-body health concept [17,18]. Thus, the fragmented PC-GM could not progress scientific and technologically in the patient’s global and + health, as much as it did it in the hospital care of his somatic diseases [19-25].

Present premises

In 2013, we designed a 30 year US research program for quality and cost improvement of healthcare via measurement of patient global bioecono-psychosocial (+ ± -) health outcome using e-health record and sociobio-sensed data. Continued study and exchanges with experts have prompted us to clarify further the necessity for the creation of a patient global health clinical decision support system (CDSS), using health information technologies (HIT), to strengthen our Western/ US PC-GM [26]. With respect to the enhancement and preservation of the healthiest patient, we doubt the adequacy of the Hippocrates’ individual-based PC and Euryphon’s science GM models, reduced 2200 years ago to handle mainly patients’ somatic diseases and risks, and 200 years ago to porter the hospital technological critical care, and manage the uncritical PC. However, upgrading the original Hippocratic PC human health broad-spectrum and Euryphon’s GM science can permit us to create a patient global health index, classification, intelligence and advice mobile HIT/CDSS managed by our GPnurse team.

Objective

Our objective here is to justify more historical and logically the scientific need of a US broader model of PC’s health delivery and GM’s scientific research and engineer further our health intelligence mobile HIT/CDSS algorithm.

Methods

Study design and tasks

We made observational analyses of 194 nations (world population), in a ‘quasi-experimental’ evaluation of the intervention of the democratic-scientific-industrial revolution policies since 1760, assessing on. We assessed baseline and post-intervention outcomes values and trends by numerical comparisons between 1750 and 1900, 1957, 2015, using 106 variables of life-support, healthcare, biomedical and info-medical models, methods, knowledge and technologies in the following two tasks:

1. Quantitative cohort study of outcomes of global life and health population indices from 1750 to 2014, by percent of change of 90 indices between both years. It included a comparison of longitudinal outcomes by US trends 1900 to 1956 vs. 1957 to 2014, and of a cross-section contrast in 2014, of the US value per index vs. the best value of reference of the other 27 most developed nations, with non-probabilistic contrasts [27-31].

2. Qualitative longitudinal study of scientific results with 16 variables on global healthcare problems with scientific discoveries of etio-pathogenesis and preventive-therapeutic knowledge and technologies 1750 to 2015, by nation and year of origin, application in the US and world. It included a comparison of the percents of US vs. global achievements 1900 to 1956 vs. 1957 to 2015 periods, with non-probabilistic contrasts [32, 33].

We engineered our PC-GM delivery model on the bases of our conceptual premises [34-48] and empirical results of our first two tasks, integrating healthcare main components defragmented 1760 to 2015 in two more tasks.

3. Searching for new relations of principal components, levels and elements via system analysis and categorization by analogy-making, we optimized our preliminary CDSS PC-GM delivery model solution to amplify the patient- GP communication through HIT apps {e-health record (EHR), wireless-sensing wearables of the patient internal/ external milieu, intelligent mobile smartphone-computer networks}.

4. Developing further the main multi-algorithm-components, scale-levels and element-variables of our preliminary broad-spectrum health-metrics of the patient’s global health status and factors {index and classification of +health states, enhancer factors, besides the - health or disease states, and risk factors}.

5. Details of our preliminary HIT/CDSS and broad-spectrum health-metrics can be found in our paper of 2013 [26].

Limitations of the study

In the two first tasks, we were obliged to estimate for Table 1 some world/US populations’ life and health indices for the years 1750, 1900, and even 1957, absent in the Universities of Pennsylvania, Yale and Miami Libraries’ Databases and Web sources in 2010- 2016. We estimated these by analogy with Maddison and other indirect econometric methods for incomplete pre-modern historical series (even for the year 1 AD) [49-58]. We marked these estimates in the table, so the accurate analyses of some trends are limited. We think that is better to have than to lack now these first modest estimates by the expert method, which can be adjusted further iteratively with more information and other methods. For the Boxes 1-3 a selection bias of healthcare advances’ sources in English language, overestimating slightly the US percents of advances in 1957-2015, was verified comparing percent with the national institutions of 210 Nobel Prize laureates 1901 to 1956 and 1957 to 2015. We had heuristic limitations in the last two tasks, in operational system and mathematical research, which require research of other professionals.

Health & Living Standard Population Index World Development Level Trend (year, value & percent of change) US Development Level Trend (year, value & rank in relation to developed 1strank nation) 1stDevelopedNation (year, level value)
1750 2014 % 1900 1957 2014 2014
Politic-civil rights [index 7 worst-1 best score] (Freedom House) 14 not free 9 partly free -1,6 4 freest (2nd) 3 freest (1st) 2 freest (1st) Switzerland 2
Economic freedom [1–100 score] (Heritage Foundation) 10 repressed 60 mod. free +6 90 freest (2nd) 80 freest(1st) 76mosfree(12th) Switzerland 82
Global weighted liberty[1-100 score] (State World Liberty Index Project) <10* 57 +5,7 66 (2nd) * 75 (3rd) * 82 (6th) Ireland 83,3
Total adult>14y population literacy [%] (UNESCO-UNDP) <15 81,2 +40,6 95 (7th) 99 (5th) 100 (1st) Switzerland 100
Years of schooling [mean years] (UNESCO-UNDP) <3* 7,9 +2,6 6 (8th) * 9 (6th) 12,9 (1st) Germany 13,1
Expected years of schooling [number] (UNESCO-UNDP) >5* 12,2 +2,4 8 (7th) * 12 (5th) 16,5 (9th) Australia 22,1
GDP [1990 G-Khamis US$] (Maddison) [PPP US$ billion] (WB-UNDP) <498.0 97,140.4 +195,1  0,312.0 (1st) 1,808.0 (1st) 16,230.2 (1st) US 16,230.2
Population [billion inhabitants] (Maddison, UNFPA-UNDP) >0.790 7,643,2 +9,7 0,076 0,165 0,322 (1st) US 0,322
GDP percapita [1990 G-Khamis US$] (Maddison) [PPP US$] (WB-UNDP) <630 13,964 +22,2 4,091 (2nd) 10,920 (3rd) 51,340 (3rd) Norway 62,448
GDP share for health expenditures [%] (WHO, WB-UNDP) <0,5 * 9,9 +19,8 2 (3rd) * 5 (1st ) 17,1 (1st) US 17,1
Government health expenditures [%] (WHO, WB-UNDP) <10 * 62,8 +6,3 15 (1st) * 25 (1st) 53,1 (1st) US 53,1
GDP share for education expenditures [%] (EUROSTAT, WB-UNDP) <0,5 * 5 +10 3 (3rd) * 6 (2nd) 5,2 (16th) Denmark 8,7
GDP share for R&D expenditures [%] (EUROSTAT, WB-UNDP) <0,1 * 2 +20 2 (4th) * 2,3 (3rd) 2,8 (7th) Israel 3,9
GDP share military expenditures [%] (SIPRI, WB-UNDP) >10 * 2,4 -4.2 2,3 (5th) * 13 (3rd) 4,8 (6th) Israel 6,5
Kcal [mean daily intake x person] (Fogel, FAO) <1 700 2 900 +1,7 3000 (3rd) * 3300 (2nd) 3770(1st) US 3770
People not working due to chronic caloric malnutrition [%] (Fogel) >20 > 5 -4 2 (3rd) * 1 (1st) * 0,0 (1st ) US 0
Daily vegetable eating consumption>14 y prevalence [%] (OECD) >80 * 45 -1,7 40 (6th) * 55 (5th) 79 (7th) Australia 100
Daily fruit eating consumption >14 y prevalence [%] (OECD) >70 * 40 -1,7 30 (14th) * 45 (13th) 47 (26th) Australia 94
Moderate-to-vigorous daily physical activity at 11 & 15 y [%] (OECD) >50 * 25 -2 40 (7th) * 33 (4th)  27 (5th) Austria 40
Height at maturity 20-74 y [mean m] (Fogel/Costa, NCHS) <1,55 * <1,65 +1,1 1,58 (5th) * 1,62 (3rd) 1,70 (3rd) Holland1,75
Weight at maturity 20-74 y [mean kg] (Fogel/Costa, NCHS) <50 * <67 +1,3 60 (3rd) * 67 (2nd) 83 (1st) US 83
BMI at maturity 20-74 y [mean kg/m2] (Fogel/Costa, NCHS) <21 * <25 +1,2 24,9 (3rd) * 25,6(2nd) 29 (1st) US 29
Obesity measuredprevalence >14 y [%] (OECD-NCHS) <1 * 10 +10 6 (22nd) * 13 (23rd) 35 (28tht) Japan 3,7
Overweight+obesity measured prevalence0-14 y [%](OECD-NCHS) <5 * 15 +3 10 (16th) * 20 (18th) 33 (26th) Norway 15
Diabetes type I-II prevalence 20-79 y [%](OECD-NCHS) <1 * 3 +3 3 (18th) * 5 (20st) 9,2 (22nd) Iceland 3,2
Diabetes type I incidence children 0-14 y [%](OECD-NCHS) <2 * 8 +4 7 (15th) * 11 (17th) 23,7 (19th) Japan 2,4
T-cholesterol >200 mg/dLpreval>17 y [%] (REACH Registry-NCHS) <10 * 38 +4 50 (10th) * 35 (7th) 29 (5th) Finland 24
Arterial hypertension >140/90 mmHg preval>14 y [%] (OECD-NCHS) <5 * 10 +2 25 (4th) * 22 (2nd) 17 (1st ) US 17
Alzheimer-dementia prevalence elder >59 y [%] (OECD-NCHS) <1 * 2 +2 1 (15th) * 2 (10th) 6,2 (7th) Greece 5,2
Schizophrenia/Manic-depressive psychosis preval. [%] (Torrey & Miller) <0,1 * 0,4 +4 0,3 (8th) * 0,4 (4th) 0,5 (1st) US 0,5
Smoking daily prevalence 14 y+pop. [%] (WHO, OECD-NCHS) >10 * 22 2,2 33 (10th) * 45 (12th) 15 (3rd) Sweden 13,1
Daily smoking prevalence among >14 y [%] (OECD-NCHS) >20 * 15 -2 40 (6th) * 46 (5th) 13 (4th) Sweden 10
Alcohol consumption prevalence >14 y [l x head] (WHO, OECD-NCHS) <3 * 6,2 +2,1 10 (8th) *  12 (10th) 8,6 (9th) Israel 2,4
Insufficient physical activity prevalence adult >17 y [%] (WHO) <3 * 23 +7,6 25 (12th) * 40 (16th) 35 (14th) Greece 15,4
Insufficient physical activity prevalence adolescent 11-17 y[%] (WHO) <3 * 81 +27 83 (2nd) * 78 (3rd) 72,6 (2nd) Ireland 71,6
Low birth weight (<2 500 g) [%] (Fogel, WHO-UNICEF, OECD) >30 16 -1,9 13 (3rd) 10 (7th) 8 (21st) Iceland 3,7
Natality or birth (× 103 inhabitant) [rate] (Clark, WHO-UNFPA-NHSC) >50 19 -2,6 32 (13rd) 25 (12nd ) 13 (19th) Germany 8
Adolescent birth (× 103 girls 15-19 y) [rate] (Clark, UNICEF-NHSC) >300 47,4 -6,3 40 (18th) 35 (20th) 31 (27th) Switzerland 1,9
Preterm birth <37 week pregnancy (× 102 live-birth) [%] (Fogel, WHO) >33 * 11,1 -3 20 (18th) 16 (19th) 12 (22nd) Finland 5,5
Total fertility per woman [ratio] (Clark, UNFPA) >10 2,5 -4 3,3(14th) 3,5(16th) 2 (17th) Portugal 1,3
Use of contraceptive prevalence (women 15-49 y) [rate] (Clark, UNFPA) <10 64 +6,4 66 (10th) 70 (8th) 77 (6th) Norway 88
Induced abortion (× 102 live-births) [ratio] (Guttmacher Institute) >5 * 32 +6,4 5 (5th) * 10 (4th) 18 (6th) Portugal 0,2
Infant mortality <1 y (× 103 live-births) [rate](UNICEF-UNDP,OECD) >330 34 -9,7 135 (4th) 26 (8th) 5,9 (28th) Iceland 1,6
Neonatal mortality <28 days (× 103live-birth) rate] (UNICEF-WHO) >300 20 -15  61 (4th) 19 (8th) 4 (27th) Japan 1
Child mortality <5 y (× 103live-births) [rate] (UNICEF-UNDP) >360 46 -7,8 150 (9th) 32 (8th) 6,9 (28th) Luxembourg 2
Maternal mortality (× 105 live-births) [ratio] (UNFPA) >2 000 210 -9,5 500 (6th) 40 (5th) 28 (26th) Israel 2
Homicide mortality (× 105inhab.) [crude rate](OECD-UNOCD-NCHS) >50 * 6,2 -8,1  1,2 (14th) *  4,8 (24th) 4,7 (28th) Iceland 0,3
Suicide mortality (× 105inhab.) [standard rate](OECD-UNOCD-NCHS) >3 * 11,3 3,8 13,1 (10th) * 9,8 (8th) 12,3 (20th) Greece 3,8
Transport accident mort. (× 105 inhab.) [stand. rate](WHO-OECD-NCHS) >0,1 * 18 180 2 (4th) * 23 (28th) 12,5 (28th) UK 3,5
Diabetes mellitus mortality (× 105inh.) [stand. rate](WHO-OECD-NCHS) >15 * 21 1,4 20 (4th) 16 (8th) 21 (22nd) Japan 4
Ischemic heart dismortality (× 105 inhab.) [standard rate](OECD-NCHS) >44 * 104 2,4 137 (4th) 369 (7th) 128 (20th) Japan 35
Cerebrovascular dis mortality (× 105 inhab.) [stand. rate] (OECD-NCHS) >34 * 95 2,8 107 (4th) 110 (7th) 44 (5th) Switzerland 37
Respiratory dis mortality (× 105 inh.) [stand. rate] (WHO-OECD-NCHS) >240 * 88 -2,7 202 (4th) 36 (8th) 38 (25th) Switzerland 13
Cancer dis mortality (× 105 inhab.) [standard rate] (WHO-OECD-NCHS) >15 * 116 7,7 64 (4th) 149 (8th) 195 (12th) Finland 175
Prostatic cancer5y survival [%] (CONCORD 2-NCI/SEER) >8 * 50 +6,23 40 (1st) * 50 (1st) 99 (1st) US 99
Female breast cancer5y survival [%] (CONCORD 2-NCI/SEER) >5 * 45 +9 33 (1st) * 60 (1st) 90 (1st) US 90
Colorectal cancer 5y survival [%[ (CONCORD 2-NCI/SEER) >6 * 33 +5,5 25 (1st) * 37 (1st) 65 (1st ) US 65
Melanoma-skin5y survival [%[ (CONCORD 2-NCI/SEER) >9 * 46 +5,1 20 (1st) * 49 (1st ) 92 (1st) US 92
Hodgkin lymphoma 5y survival [%[ (CONCORD 2-NCI/SEER) >5 * 44 +8,8 15 (1st) * 35 (1st) 86 (1st) US 86
All Leukemias5y survival [%[ (CONCORD 2-NCI/SEER) >5 * 29 +5,8 10 (1st) * 25 (1st) 60 (1st) US 60
Childhood cancer5y survival [%] (CONCORD 2-NCI/SEER) >5 * 40 +8 15 (1st) * 30 (1st) 83 (1st) US 83
All cancer sites/types 5y survival [%] (CONCORD2 -NCI/SEER) >5 * 33 +6,6 20 (1st) * 35 (1st) 67 (1st) US 67
Male premature mortal. 15-59 y (x103inh.) [prob. dying] (WHO-HMD) >900 * 187 -4,8 228 (23rd) * 167 (21st ) 130 (28th) Iceland 67
Female premature mortal 15-59 y (x103inh.) [prob. dying] (WHO-HMD) >800 * 124 -6,5 126 (22nd) * 89 (22nd) 77 (28th) Iceland 34
Median age of the population [y] (Clark, UNDESA-UNDP) <14 * 30,2 2,2  27 (18th) *  30 (15th) 37,7 (20th) Japan 46,5
Gross ALE-B [y] (Clark, WHO-UNDP-HMD, Salomon et al) <26 72 +2,8 47 (5th) 68 (7th) 79,1 (27th) Japan 83,5
Standardized HALE-B [y] (WHO, Fogel, Salomon et al) <14 * 62 +4,4 34 (3rd) * 55 (7th) * 69 (27th) Japan 75
Gross ALE at age 60 [y] (Clark, WHO, HMD/Max Plank Inst.) <9 * 20,7 +2,3  14 (5th)  16 (7th) 23,2 (20th) Japan 26,1
Standardized HALE at age 60 [y] (WHO, Fogel, Salomon et al) <5 * 16 +3,2  6 (3rd) *  9 (5th) 18 (20th) Japan 22
Gross ALE at age 80 [y] (US Natl. Res Council, HMD/Max Plank Inst.) <1 * 3 +3 5 (3rd)  6 (5th) 9,7 (5th) France 10
Standardized ALE-B free of fatal injury [y] (Clark, Ohsfeld-Scheneider) <25 * 69 +2,8 48 (4th) * 68 (5th) 79 (1st) US 79
Good general health self-perceived by adults > 14 yr [%] (WHO-OECD) <25 * 50 +2 40 (1st) * 70 (1st) * 88 (3rd) New Zealand 90
Practicing university physicians (× 104 population) [rate] (WHO-OECD) <2 * 13,8 +6,9 17 (3rd) *  13 (7th) 24,5 (26th) Austria 48,3
Generalists as share of all practicing physicians [%] (WHO-OECD)* <100 * 50 -2 95 (28th) * 50 (28th) * 25 (2nd) US 25
Urban population access to drinking water [%] (UNICEF-WHO) <2 * 96 +48 90 (5th)* 95 (5th) 99 (27th) Switzerland 100
Rural population access to drinking water [%] (UNICEF-WHO) <2 * 82 +41 80 (5th)* 85 (5th) 98 (27nd) Switzerland 100
Urban population access to sanitation facilities [%] (UNICEF-WHO) <2 80 +40 90 (3rd) * 95 (3rd) 100 (1st) Switzerland 100
Rural population access to sanitation facilities [%] (UNICEF-WHO) <2 47 +23,5 80 (3rd) * 90 (3rd 100 (1st) Switzerland 100
Access top tech. emergency/inpatient critic care/rehab care [%]* (WHO) <10 * 75 +7,5 80 (5th)* 95 (1st) 100 (1st) US 100
Access top PC reproductive risk perinatal mother/infant care[%]*(WHO) <2 * 69 +34,5 75 (10th) * 95 (1st ) 98 (5th) Holland100
Access top PC comm. diagnosis, therapy, rehab. care [%] * (WHO) <2 * 55 +27,2 67 (15th) * 75 (10th) 95 (1st) Sweden 100
Access top PC comm. health prom, disease prev. care [%]*(WHO) <2 * 40 +20 55 (20th) * 67 (15th) 90 (10th) Norway 100
Access top PC comm. lifestyles/intensive outreach programs [%]*(WHO) <2 * 34 +17 55 (20th) * 67 (15th) 90 (10th) Switzerland 100
Net migration (× 103 people) [ratio] (UNDESA-UNDP) 0,0 * 0,0 0,0 3,5 (10th) * 2,0 (20th) 3,1 (22nd) Luxembourg 9,7
Stock of immigrants in population [%] (UNDESA-UNDP) <10 * 3,2 -3,1 14 (5th) * 6 (20th) 14,3 (22nd) Luxembourg 43,3
Urban population[%] (UNDP) >10 53,5 +5,4 40 (15th) 67 (10th) 83,1 (22nd) Belgium 97,6
Growing middle-class (reduction of 99% of low-class) [%]* (Sachs) <1 * 45 +45 25 (2nd) * 33 (1st) 50 (1st) US 50
Human development index [0-1] (UNPD) <0,150 * 0,711 +4,7 0,300(2nd) * 0,500(2nd) * 0,915 (8th) Norway 0,944
Mobile cellular subscriptions (× 100 people) [%] (WB-UNDP) - 96,2  -  -  - 98,4 (24th) Italy 154,3
Internet users in population [%] (WB-UNDP) - 40,5  -  -  - 87,4 (12nd) Iceland 98,2
BMI=Body Mass Index ALE=Average Life Expectancy HALE=Healthy ALE UN=United Nations UNDP=UN Development Program UNESCO=UN Education/Science/Cultural Organisation UNFPA=UN Population Fund WHO=World Health Organisation UNICEF=UN Children’s Fund HMD=Human Mortality Database FAO=UN Food/Agricultural Organisation UNDESA=UN Deparment Economic/Social Affairs UNODC=UN Office Drugs/Crime WB=World Bank EUROSTAT=European Commission Statistics OECD=Organisation of Economic Cooperation/ Development SIPRI=Stockholm International Peace Research Institute NCHS=US National Center Health Statistics CONCORD 2=Global Comparison of Population-Based Cancer Survival Study NCI/SEER=US National Cancer Institute/Surveillance, Epidemiology & End Results *Some are authors’ indicators, estimations & adjustments.Sources: [46, 49-116]

Table 1: Impact of the scientific revolution in the long-term trends of life and health in the world in 1760-2014 and in the US in 1900-1957-2014.

Results

Impact of the democratic-scientific-industrial revolutions in the life and the health of the world

Table 1 shows how, since 1760 modern human development in the United Kingdom (UK), France, US, Germany, and other nations, accelerated life and health growth, allowing liberation from global main disease’s risk factors: extreme oppression, inequality, hunger, poverty, ignorance [46] and dystrophy, distressing the poorest class, 99% of world population in 1750. Dirt, pestilence, wars and natural disasters, affected and prevailed in affluent and poorest classes. These 10 hazards caused most premature deaths, suffering and disabilities by nutritional, infectious and chronic diseases, and injuries, before the 26 years of average life expectancy at birth (ALE-B). The percents of change followed empirically Nobelist Fogel’s ‘human techno-physiological evolution/physio-capital enhancement theory. Rising freedoms fostered the growth of education, scientific-technologies, and productivity of agro-artisanal industries, and food output allowed increased daily intake of required nutrients per person, reducing the chronic caloric-protean malnutrition. Former beggars without enough energy (25% of labor force) began to work, increasing the standards of living and health of the affluent 1% and a growing middle class, but much more so of the declining poorest class [49,50].

Better nutrition improved the health and longevity, allowing future parents to reproduce with bodies that were more robust. Better education increased their awareness of and ability to assume responsibly for their lives, environment, and health. Parental health led to more physiological conceptions, pregnancies, and less intrauterine nutritional, traumatic, infectious and other ecological insults to the embryos-fetuses. Newborns were sturdier and breast-fed more often, protecting child health. New contraceptive and safer abortion methods decreased the gross -and adolescent- birthrates and mean fertilities. Hospital deliveries reduced neonatal, infant and maternal mortality rates (IMR, MMR). Cultureconosocio-psychoneuro-biophysiological health reserve increased with each new generation, resisted acute diseases and postponed the onset of chronic diseases, their complications and deaths, increasing overall/disease-free survival rates, and reducing adult mortality rates too. Gross and healthy ALE-B (HALE-B) trends grew rapidly 1900 to 2014, but their 1900 to 1956 fastest-growing trends, slightly slowed up to 2014, from 28-51 years to 71 years and 16-40 years to 62 years [56,58,61,65,76,77,80,91,92]. This slowdown concurred with a fast rise of the quality, equity, survival and cost of care rates on high incidence rates of most lethal and disabling chronic diseases and injuries, stagnated along with high incidence rates of chronic disorders and risks in infants, children and teenagers.

Impact of the democratic-scientific-industrial revolutions in the life and the health of the US

The US did well increasing its population’s access to all types of over 150 human rights, though very few civil ones still need attention. Thus, the US grew its middle class and equity, reduced its poor class and achieved top world years of schooling. In 1957- 2013, US top world gross domestic product (GDP) rose nine-fold [79]; share of GDP tripled for health (excluding 5% lost by patients unable to work and on welfare), halved for defense, and slightly rose for education and research. Health expenses threaten to reach nearly a third of GDP in 2040 [50]. Caloric intakes per person and body mass index are on average excessive, while safe drinking water is about to reach 100% in rural/urban areas. The US lost the top world human development index with its slowed rise of ALE-B, due to a decelerated rate of fall in IMR, because a braked fall of birth rates in adolescent pregnant, preterm, and percent of low birth weight newborns [105-111], and a slowed fall in adult 15-59 years mortality rates, mainly in males [93,112]. Though the US kept the world’s first rank on ALE-B standardized by fatal injuries, ALE over 74 years old [85,112], and self-perceived best health status in 1980-2012 [86], its ALE-B and HALE-B ranking 7th in 1957 worsened five-fold mostly in 1990-2014 to the 35th positions [59-65,76,77,91-93,100,112]. These anomalies seem related with high incidence rates of chronic cultureconosociopsychoneuro- biophysiological disorders, addictions, violence, HIV/AIDS, obesity and lifestyle factors, disturbing infant, child and teen health [48-50, 59-63,82-86,91-93,100-116], and US involvement in six wars overseas 1950-2014, while freedom, GDP, ALEs, and other life-health standards in Europe, Canada, Japan, Australia, Israel, and rest of the world improved. Access to the world’s highest standards and technologies of emergent/critical hospital care, community-based PC, diagnosis, therapy, rehabilitation, prevention, reproductive risk, peri-natal, infant medical facilities continue to increase in the US.

Progress of medicine and health care with sciences, industries and business in the world and US

Boxes 1-3 show how the biomedical sciences in two-dozen advanced nations, created new theories, models, methods, and technologies for health promotion and disease preventiontherapeutics, empowering individual and population health 1760 to 2015. Box 1 shows that scarcely 29% (10 of 35) of the main advances in etio-pathogenesis and protective measures of infectious, nutritional, cancerous, and genetic diseases were discovered by US institutions 1900 to 1956, while 86% (24/28) of the main advances including also metabolic, cardiovascular, mental, and other chronic diseases were found in the US 1957 to 2015. Box 2 displays how 1900 to 1956, 37% (26/70) of new clinical-surgical diagnosis, therapeutic, and rehabilitation means for infectious and chronic diseases were accomplished in the US, whereas Box 3 reveals that 75% (49/65) of all those advances 1957 to 2015 were discovered in the US. Notably, the US institutions 1901 to 1956, achieved 31% (22 of 70) of Nobel Prize laureates in physiology-medicine among 17 nations, while 1957 to 2015 accomplished 59% (83/140) among 13 nations [117-124].

Health care problem Medical and/or public health intervention, nation & year of discovery, later assimilated in the US or transferred from the US to the world Applied in US
(year)
Middle/long-term output in the US & global population health
World Preventive Scientific & Technological Discoveries Assimilated by the US & Influencing Population Health until the US Explosion of Discoveries
Scrotal cancer protection 1st occupational carcinogen ‘soot’ in chimney sweepers UK 1775 1775 Reduced incidence & mortality
Scurvy protection, treatment 1st controlled clinical trial, citric for sailors, UK 1747-87; birth of experimental nutrition 1787 Protected, controlled & dis eradication
Smallpox protection 1st generation vaccine UK 1770, 1796-98; birth of immunology 1800 Controlled outbreaks & dis eradication
Cholera protection Control sewage-polluted water sources, UK 1849-54; birth of hygiene & epidemiology 1855 Controlled outbreaks & dis eradication
Puerperal (sepsis) fever protection Antiseptic methods Austria 1847 & UK 1870s 1847-70 Reduced maternal/neonatal mortalities
Infectious & chronic dis etio-pathogeny Natural history of disease Germany 1859; birth of modern epidemiology & ecology 1859 Reduced incidence & mortality
Infectious diseases etio-pathogenesis Germ theory France 1860-64-77; birth of microbiology & preventive medicine 1860-62 Reduced puerperal sepsis incid/mortal
Safe milk of bacterial contamination Pasteurization; homogenization of milk, France 1862; developed infant artificial feeding 1862 Reduced infectious diarrhea inci/morta
Hereditary mechanism of  living beings Gene principles & laws, UK 1865; birth of agronomic & general genetics 1865 Explained inheritance mechanism
Safe  surgery of bacterial contamination Asepsis/antiseptic principles/phenol UK 1867; developed safe surgery 1867 Reduced sepsis mortal from 80 to 4%
Pneumonia etiology Isolated & grew pneumococcal bacteria France, US 1881 1881 Controlled, contagion/incidence fell
Cholera, Anthrax, Tuberculosis etiology Bacteria causing disease discovered Germany 1882-83; birth of  medical causality criteria 1882-83 Controlled outbreaks, incid/mort fell
Cholera, Anthrax & Rabies protection Antitoxin/2nd generation vaccines human/pets France 1879-82-5; developed immunology 1885 Controlled outbreaks, incid/mort fell 
Malaria etio-pathogenesis Plasmodium protozoa, France 1880; birth of parasitology 1880 Controlled, incidence/mortality fell
Newborn Tetanus protection Training midwives washing hands/antiseptic-umbilical cord package, Holland-Sweden 1800 1880s Controlled, disease eradication
Tetanus & Diphtheria antitoxins Single antitoxins, France, Germany 1883-1890 1883-90 Controlled, incidence/mortality fell
Quarantinable disease protect/detection Sanitation /quarantine act; disease laboratories; septic tanks for sewage treatment, US 1890s 1893 Controlled outbreaks, dis eradication
Bubonic plague etiology & protection Sanitation/quarantine/bacteria/vaccine France & Japan 1894-97; developed epidemiology 1894-97 Controlled outbreaks, dis eradication
Hereditary diseases etio-pathogenesis Mendel’s gene rediscovered Germany, Holland, Austria 1902; developed medical genetics 1900 Controlled, incidence/mortality fell
Yellow fever etiopathogeny–protection Cuba 1881; Cuba-US verified, sanitation-insecticide, 1900-01; birth of tropical medicine 1901 Control outbreaks, dis eradication
Typhoid fever protection Sanitation/bacteria/vaccine UK 1896-1902 1902 Controlled outbreaks, incid/mort fell
Tuberculosis screening Tuberculin sensitivity skin test France 1907 1907 Reduced contagion, incid/mortal fell
Whooping Cough semi protection Single vaccine France 1912-15 1915 Controlled outbreaks, incid/mort fell
Scurvy-Rickets-Beriberi-Pellagra protec Vitamins C, D 1922, B1 1931, B2 1937 Japan, UK, Holland; developed nutrition science 1920 Controlled carencial dis, inci/mort fell
Diphtheria protection Single vaccine France 1923-24 1924 Controlled outbreaks, incid/mort fell
Tetanus protection Single vaccine, France 1924 1924 Maternal/neonatal incid/mortal fell
Virus experimental study Tissue & cell culture technique UK 1885, US 1930 1930 Produced viral vaccines & protection
Yellow fever protection 1st  viral vaccine US 1935-6 1935-6 Controlled outbreaks, eradication
Whooping cough protection Single vaccine shown to be effective US 1939 1939 Controlled outbreaks, eradication
Influenza protection Single vaccine US 1940-45 1945 Controlled outbreaks, incid/mort fell
Mumps, Poliomyelitis, Measles & others Growth of  viruses in cell & tissue cultures US 1945, 1946, 1954; birth of modern virology 1946 Controlled outbreaks, incid/mort fell
Diphtheria-Tetanus-Pertussis protection Combined Duple vaccine diphtheria/tetanus (DT) & triple with pertussis (DTP) US 1947-48 1947-48 Controlled outbreaks, dis eradication
Lung & other cancer sites protection Smoking identified & confirmed as cause of lung cancer UK 1950-54 1950 Controlled, incidence/mortality fell
Chemical structure of cell nucleic acids DNA double-helix struct. model, UK, US 1953; birth of molecular biol/genetic-engineering 1953 Explained inheritance mechanism
Poliomyelitis protection  I Injected vaccines serotypes 1, 2 & 3 US 1953-5 1955 Controlled outbreaks, incid/mort fell
World Assimilated & Own US Preventive Scientific & Technological Discoveries Influencing Population Health After the US Explosion of Discoveries
Framingham heart long-term study Ongoing cardiovascular study of diet, exercise/other risks & common medication US 1948 1958 Controlled risks/incid, rose survival, 
Poliomyelitis protection  II Oral vaccines serotypes 1, 2 & 3 Russia 1961-62 1962 Controlled outbreaks, dis eradication
Measles protection Inactivated & live vaccines US, 1963 1963 Controlled outbreaks, dis eradication
Viral Hepatitis B detection Isolated virus US 1964; developed diagnosis/vaccine 1964 Controlled outbreaks, incid/mort fell
Rubella protection Vaccine US 1960-66 1960 Controlled outbreaks, dis eradication
Car-collision injury/death protection Child safety car seat US 1960-63 1963 Reduced incidence & mortality
Mumps protection Vaccine US 1967, 1986 1967 Controlled outbreaks, dis eradication
Measles, Mumps, Rubella protection Combined Duple measles/rubella vacc (MR) /Triple with mumps vacc (MMR) US 1971 1971 Controlled outbreaks, dis eradication
Meningococcal group C protection Mono-valent polysaccharide vaccine US 1969-74 1974 Controlled outbreaks, incid/mort fell
Pneumonia protection Pneumococcal polysaccharide vaccine US 1977, including Streptococcus pneumo US 1983 1977-83 Controlled, incidence/mortality fell 
Meningococcal group A, C, Y, W-135 Quadrivalent polysaccharide vaccine US, Canada, France 1974 1978 Controlled outbreaks, incid/mort fell
Etiopathogeny of cancer Oncogene in bladder, lung & colon cancers, US 1980 1980 Reduced cancer incidence & mortality
Etiopathogeny of AIDS Human immunodeficiency virus (HIV) France US 1983 1983 Reduced AIDS incidence & mortality
Post-Mumps Meningo-Enceph. protect. Vaccine US 1986 1986 Controlled outbreaks, eradication
Viral Hepatitis B /Hepatoma protection Vaccine plasma-based US, France 1976-81, recombinant vaccine US 1986 1976-86 Controlled outbreaks, incid/mort fell 
Varicella protection Vaccine US, 1974-88 1988 Controlled outbreaks, incid/mort fell
Meningococcal group B partial protect. Vaccine for some particular strains of Cuban serogroup B, Cuba 1988 Useless Lowest preventab rate in US & world
Hepatitis A protection Inactivated vaccine US 1989-92 1992-95 Controlled outbreaks, incid/mort fell
Hemoph. influenza B/Mening-Encprot. Vaccine Hib carbohydrate-protein conjugate US 1983-5, 1990 1983-90 Controlled outbreaks, incid/mort fell
Hemoph. influenza B/Mening-Encprot. Vaccine Hib synthetized antigen Canada-Cuba 1987, 1997, 2004 Not used Controlled outbreaks, incid/mort fell
Japanese encephalitis Virus inactivated vaccine Japan 1992 1992 Controlled outbreaks, incid/mort fell
Leading lethal causes smoking-related State tobacco/cigarette smoke-free laws in worksites, restaurants, bars US 2000 2000 Reduced heart/cancer/lung morb- mort
Shingles (herpes zoster) protection Vaccine US 2006 2006 Controlled outbreaks, incid/compl fell
Rotavirus protection Live, oral, tetravalent vaccine US 1998-2006 2006 Controlled outbreaks, incid/mort fell
Hum papilomavir./ cancer/c-v dis prot. Vaccine US-Australian 2006 effective against genital, throat, lung, other  cancers, & c-v dis. 2006 Controlled, incidence & mortality fell
Genome mapping f/early diagn./therapy Human genome mapping ‘the Book of Life’ completed, US 1990-2013 2013 Identif genes causing dis improve treat
Meningococcal serogroup B protection Vaccine (MenB-FHbp) Trumenba [bivalent, rLP2086] US, 2005-13-14 2014 Controlled outbreaks, incid/mort fell
Meningococcal serogroup B protection Vaccine (MenB-4C) Bexsero [quadrivalent, rDNA multicomponent adsorbed] US, 2011-15 2015 Controlled outbreaks, incid/mort fell
Sources: [2,10, 32-33, 117-124]

Box 1: Development of scientific theories, vaccines, and sanitation on the health of the US and the world in 1760-1956 and in 1957-2015.

Heath care problem Medical intervention, nation & year of discovery, later assimilated in the US or transferred from the US to the world Applied in US (year) Middle/long-term output in the US & global population health
World Therapeutic Scientific & Technological Discoveries Assimilated by the US & Influencing Population Health until the US Explosion of Discoveries
Cataracts modern surgery 1st European resection of cataracts of the eye France 1748 1750 Restored vision, laterw/external-lenses
Explore fundus & structures of the eye Ophthalmoscopy UK 1747 Germany 1751, developed ophthalmology 1751 Improved diagnosis internal eye dis
Pain & fever remedy Isolated salicylic acid in willow bark UK 1763 1763 Relieved pain & fever
Acute appendicitis 1st successful appendectomy, UK 1763 1765 Controlled/ cured, morti-lethality fell
Blood cells, lymph vessel & coagulation Discovered  white/red cells, & fibrinogen (factor I) UK 1770s; birth of hematology 1770 Blood/lymph/coagulation pathophysio
Edema & heart failure chemotherapy 1st purified digoxin UK 1785; developed cardiology 1785 Controlled, morti-lethality fell
Intra-body normal & abnormal noises 1st clinical stethoscope France, 1816; developed clinical-surgical & cardiology specialties 1816 Improved health-disease diagnostics
Description of the shaking  paralysis Parkinson disease UK 1817 1817 Allowed further diagnosis & therapy
Acute/chronic severe pain treatment Morphine Germany 1804-17; developed opioid analgesics 1817 Relieved intensive pain & suffering
Family planning male barrier means From gut to rubber condom US 1844; latex 1880-1930. Before coitus interrup/rhythm meth 1844 Natality, inf/mat mort/venereal dis fell
Malaria treatment Quinine sulphate France 1812-1850 1850 Controlled, morti-lethality fell
General anesthetics for surgical therapy Ether Germany 1730, US 1842, Chloroform US 1831, UK 1853; dev anesthesiology/surgery 1853 Controlled pain, morti-lethality fell.
Quick administration of medicines Hypodermic needle UK France 1853 1853 Accelerated action & effectiveness
Anatomy descriptive & surgical Anatomy textbook UK 1858 1858 Rose the human body knowledge
General anesthesia for surgical therapy Nitrous oxide synthesized (laughing gas), UK 1772-79; use as anesthetic US 1844, 1863 1863 Controlled pain, morti-lethality fell
Hyperthermia detection Portable & practical clinical thermometer UK 1867 1867 Reduced dis complications & lesions
Premature/very low birth weight 1st incubator France 1881; developed neonatal intensive care 1881 Controlled, newborn mortality fell
Premature/very low birth weight 1st early intra-gastric feeding US 1882, developed infant critical care units (ICCU) 1882 Controlled, newborn mortality fell
Family planning female barrier means Diaphragms made from gut Germany 1882; later from rubber Holland 1883 1882 Fertility/natality, inf/mat mortality fell
Family planning spermicidal means Vaginal suppository of cocoa butter & quinine sulfate UK 1885; later of hydroquinine 1885 Fertility/natality, inf/mat mortality fell
Hypothyroidism treatment Thyroid hormone replacement therapy UK 1890, thyroxin 1930; developed endocrinology 1890 Controlled, complications/mortal fell
1stintrabody norm/abno macro-imaging X/roentgen rays-radiography, Germany 1895; birth radiology; developed clinics & surgery 1895 Improved health-disease diagnostics
Pain, fever & arthritis chemotherapy Acetylsalicylic acid-aspirin France 1853 Germany 1897-9; dev analgesic/anti-inflammatory 1899 Controlled of pain, fever & arthritis
High mortality of premature newborns Incubators & breastfeeding for premature US 1893-1900; developed childcare nutrition 1900 Controlled, premature mortality fell
Family planning male sterilization Vasectomy UK 1775-1830, 1900 1900 Permanent anticonception, natality fell
Family planning female sterilization Fallopian tubes cut Germany 1834, 1900 1900 Permanent antifertilization, natal fell
Heart nor/abnor electric wave imaging Electrocardiogram(ECG) UK, France, Holland 1872-1903; develop electro-cardiology 1903 Sup heart health-disease diagnosis
Ill newborn nutrition treatment Introduced infant formula US 1907;  developed childcare nutrition 1907 Controlled, premature/ill neo mort fell
Safe blood transfusion treatment ABO blood groups France 1818, UK 1829, Austria, US 1900-7; dev hematology/surgeries 1907 Controlled hemor/hemoly dis/mort fell
1st antibacterial chemo Syphilis/others Arsphenamine (606), salvarsan Germany 1909-10;  developed infectology, dermatology 1910 Controlled, complications/mortal fell
1st surgical intraabdom minimal explor Laparoscopy animals Germany 1902, humans 1910; devel. clinic/surgical diagnosis/therapy 1910 Supported diagn/ther internal disease
Regional anesthesia for surgery Epidural anesthesia Spain, Italy 1921; developed surgery 1921 Controlled surgical pain, mortality fell
Diabetes mellitus treatment Insulin hormone replacement therapy Canada 1922; developed endocrinology 1922 Controlled, complication/mortality fell
Brain nor/abnor electric waves imaging EEG-topography UK, Poland, Russia, Germany 1875-1924; developed  physio- neurology 1924 Sup brain health-disease diagnosis
Regulation internal milieu balance Homeostasis concept France, US 1932; developed physiology of health &patho-physiology 1932 Sup health states internal mechanisms
2ndantib chemo Syphilis, puer/neon seps Prontosil& other sulphonamides Germany 1932-35; developed infectology 1935 Reduced complic, inf-mat mortal fell
Safe birth of newborn & mother Rise of births in hospitals with obstetricians & midwives UK, US 1936 1936 Birth complic/mat-neon mortality fell
Congenital/other heart dis X-ray diagn Angiocardiography, Cuba 1935; developed pediatric-cardiology & cardiovascular surgery 1936 Sup heart health-disease diagnosis
Acute psychosis attack therapy Insulin induced hypoglycemic shock Germany 1927; electroconvulsive shock Italy 1937 1937 Controlled attack, disability fell
Micro-biological ultra-structure study Electron microscope Germany 1931-33; developed microbiology & virology 1938 Rose knowledge of bioultra-structures
Cervix uterine pre-cancer imaging Pap vaginal cytological smear UK, Romania, US 1927-28-41; developed onco-gynecology 1941 Early screening/diagnosis, mortal fell
3rdantib chemo Syphilis, puer/neon seps Penicillin UK 1928-1941-43; birth of antibiotics; developed infectology 1941 Controlled/cured, mat/inf mort fell
Terminal chronic renal failure 1st Kidney dialysis machine (artificial kidney) Holland 1943-44; developed uro-nephrology 1944 Controlled, rose survival, mortal fell
Tuberculosis (TB)/penicillin resist bact Streptomycin, US 1943-1944 1944 Controlled, cure TB/bacterial sepsis
Rhesus disease diagnosis/protection Rhesus( Rh) blood factor UK 1940 & Coombs test 1945; dev. hematology/immunology 1945 Sup health-disease diagnosis, m-m fell
Heart/Coronary disease diagnosis/R&D 1st cardiac catheterization in animal UK 1710 & in human Germany, US 1929, 1945 1945 Controlled, complic& mortality fell
Kern icterus by Rhesus disease therapy Exchange  transfusions Canada, 1925 US 1944-46;  developed hematology, immunology 1946 Controlled hemolytic dis & mortal fell
Hansen disease chemotherapy Dapsone France, UK 1946 1946 Controlled, mortality/incidence fell
1st single chemo in adult Lymphoma Nitrogen mustard single chemotherapy US 1946-47 1946 Controlled, rose dis multisites survival
General & special surgeries General anesthesia + curare-muscle relaxants for controlled-ventilation Canada 1942-46 1946 Diff surgery procedurcompl./mort fell
Meningitis/lung/total TB single chemoth 1st  randomized controlled trial (RCT) with Streptomycin UK 1946 1946 Controlled, morbid-mortality fell
Cardiac arrest/malign arrhythmia ther Defibrillator reanimation of cardiac arrest, ventricular tachycardia & fibrillation US 1946-47 1947 Controlled, heart/other dis mort fell
Solid cancers & metastasis treatment US Linear accelerator & Canadian Cobalt therapy 1947- 1949 1947 Controlled, cured some sites of cancer
Cholera & other bacteria treatment Tetracycline antibiotic, US 1947 1947 Cured cholera & other infections
Typhoid Fever chemotherapy Antibiotic chloromycetin US 1947-48 1948 Controlled, cured, inciden/mortal fell
Cerebral & lung embolism protection Long-action anti-coagulant Warfarin US 1948 1948 Incidence & mortality fell
1st single chemo child Acute L Leukemia Anti-folatesaminopterin& methotrexate produced temporary remission of cancer US 1948 1948 Increase cancer survival
Dehydration/acid-baseimbalan therapy Hydro-electrolytic assessment Ionogram US 1930-49 1949 Mortality by multiple diseases fell
Arthritis, inflamm, allergic, collagen dis Corticosteroid therapy cortisone US 1949 1949 Controlled, rose survival, mortal fell
Heart arrhythmia outpatient detection Holter portable device to monitor 24 hours or more of cardiac electrical rhythms US 1949 1949 Improved diagnosis & treatment
Solid tumors & cysts Diagnostic ultrasound US 1949-1950 1950 Rose diagnosis precision
Tuberculosis effective combined chemo Streptomycin/PAS/isonic; single & combined chemotherapy UK, US 1943-1950 1950 Cured dis. & mortal-lethality fell
Copenhagen polio epidemic Child & adult intensive care Denmark, 1952, developed the intensive care units & specialty 1952 Controlled, disability & mortality fell
Schizophrenia chemotherapy Antipsychotic drug Chlorpromazine France 1952 1952 Controlled, complic/disability fell
Open-heart surgery for heart diseases Artificial heart-lung machine US 1953-1955 1953 Controlled, rose survival, mortal fell
Epilepsy treatment Potassium bromide UK 1860, Phenobarbital Germany 1902-12, diphenylhydantoin 1908-38 1953 Controlled seizures, disease, disability
Newborn vitality & health Apgar measurement scale US 1953 1953 Complications & mortality fell
Microsurgery Operating microscope Germany 1954; develop micro-surgery 1954 Rose accuracy, survival; mortality fell
Cardiac fibrillation & arrest treatment Cardio-pulmonary resuscitation (CPR) US 1956 1956 Controlled, morti-lethality fell
Chemoleukemiabonemarrow aplasia 1st bone marrow transplant involving stem cell therapy, US 1956; opened regenerative med 1956 Rose survival &morti-lethality fell
Sources:[2,10, 32-33, 117-124]

Box 2: Development of scientific theories, medicines, and procedures on the health of the US and the world in 1760-1956.

Heath care problem Medical intervention, nation & year of discovery, later assimilated in the US or transferred from the US to the world Applied in US (year) Middle/long-term output in the US & global population health
World Assimilated & Own US Therapeutic Scientific & Technological Discoveries Influencing Population Health After the US Explosion of Discoveries
2ndintrabody nor/abnor macro-imaging Gamma camera scintigraphy w radioactive isotopes US 1957; developed nuclear medicine 1957 Rose function diagn/physiopharma
Fetal arrhythmia early detection Doppler fetal heartbeat monitor US 1958 1958 Improved diagnosis of fetal suffering
Radiation bone marrow aplasia therap Bone marrow transplant France 1959; developed transplantation in leukemia & lymphoma 1959 Rose survival multiple diseases
2ndintrabody nor/abnor minimal explor Laparoscopy with endoscope, US 1959; develop internal disease clinics-surgery 1959 Rose diagnosis precision & treatment
Ulcer/glaucoma/inflamth/brain tis imag Laser device-emission of electromagnetic radiation US 1957-1960; developed surgery 1960 Rose resection capab, &ultradefimag
Ill newborn nutrition Total parenteral via a central vein US 1960  1960 Neonatal mortality fell
Family planning hormon/infertility dis Combined contraceptive pill of estrogen/progestin (Enovid) US 1957-60; emergency pill 1960 Fertility fell, cured function infertility
Parkinson disease Levodopa chemotherapy, US 1961 1961 Controlled, disability fell
Degenerative osteoarthritis Hip replacement, UK 1961 1961 Reduced disability
Childhood cancer (Acute L Leukemia) Combined chemotherapy VAMP, US 1962-71; developed chemotherapy clinical oncology 1962 Quasi-cured some cancers & relapses
Open obstruction within the body Enlarge narrow opening balloon catheter, US 1963 1963 Created coronary/other angioplasties
Deadly chronic renal failure  Kidney transplantation, US 1954, 1963 1963 Reduced disability & mortality
Heart blocks & arrhythmias Implantable heart pacemaker, US, Sweden, France 1960-63 1963 Reduced disability & mortality
Fetal growth, c-v struct./function metric Doppler ultrasound, US 1964 1964 Perinatal complication & mortality fell
Prevention of Strokes Anti-hypertensive chlorothiazide US 1930s &propanolol 1950s UK 1964 1964 Reduced incidence & mortality
Rhesus disease immune-prophylaxis  Immunoglobulin (IgG) anti-D, US 1964 1964 Reduced neonatal incidence/mortality
Neonatal cardio-respiratory monitoring Vital signs & blood gases, US 1965 1965 Neonatal complication & mortality fell
Hemophilia A & B treatment Clotting factors VIII & IX, US 1965 1965 Controlled dis, mortality fell
Coronary artery disease CABG therapy Bypass surgery internal mammary art US 1960, Russia 1964; saphenous vein graft US 1967 1967 Reduced pain, disability & mortality
Terminal chronic heart failure Heart transplant, South Africa 1967 1967 Reduced disability & mortality
Down’s syndrome Prenatal diagnosis, US 1969 1969 Reduced incidence
High risk deliveries Rise of Caesarean segmental section, US 1970 1970 Neonatal & maternal mortality fell
Reanimation of the ill newborn Neonatal intensive care unit ICU with mechanical ventilation & CPAP, US 1961-70 1970 Reduced complication & mortality
Depression, Anxiety, etc. Cognitive therapy, US 1960-70; developed cognitive behavioral therapy 1970 Reduced mental suffering & mortality
Safer semi-surgical abortion Intra-uterine vacuum aspiration, China, 1958, Canada UK 1967 cannula US 1970 1970 Reduced time, compl& maternal mort
3rd intrabody norm/abno macro-imaging 1st Positron emission tomography (PET) scanner short action radiopharmaceuticals US 1972 1972 Rose disfunctiondiagn/physiopharma
Preterm lung immaturity Corticosteroids induce maturity, US 1972 1972 Reduced neonatal mortality
4th intrabody norm/abno macro-imaging 1st Magnetic resonance imaging (NMRI) US-UK 1972-77; developed clinics & surgeries 1977 Rose struct/functio diagnosis-accuracy
Coronary artery disease PCI treatment 1st femoral angioplasty/stent US 1964, coronary percutaneous inter. (PCI), Switzerland 1977 1977 Reduced chest surgery & mortality
Infertility 1st test-tube baby, UK, US 1978 1978 Reduce frustration of infertility
Coronary artery disease treatment Coronary angioplasty, US 1979 1979 Reduced pain, disability & mortality
Very low birth weight < 1000 g Special basal formulas, US 1980 1980 Rose nutrition/reduced neonatal mort
Ill preterm infants Reuse of breast milk fortified, US 1980 1980 Rose nutrition/reduced neonatal mort
Embryonic stem (ES) cells transplant ES cells of mouse derivation & culture UK 1981; developed regenerative medicine 1981 Facilitated human ES cells culture
Cataracts implant surgery Intraocular artificial lens permanent implant UK 1948-50, 1981 1981 Support surgery restoring vision 
Type I diabetes automatic treatment Portable glucometer & infusion external pump US 1963, 1st implanted pump France 1981 1981 Regulated blo glucose insulin demand
Peptic ulcer chemotherapy Helicobacter pylori cause, UK 1984 1984 Controlled, eradication of dis
Acute myocardial infarction Thrombolytic (clot-busting) therapy, US 1987 1987 Reduced disability & mortality
Dyslipidemia treatment Lipid-lowering & anti-arteriosclerosis statins, US 1987 1987 Heart infarction & stroke mortality fell
Coronary/Carotid Artery disease therap Intra coronary & carotid vascular stents, US 1988 1988 Heart infarction & stroke mortality fell
Cataract minimum access surgery Laser cataract surgery, US 1988 1988 Reduced complications
Safe medical abortion Mifepristone, abortion pill, with misoprostol & prophylactic antibiotics, France 1988 1988 Perinatal/mat mort high-risk pregn fell
Respiratory distress syndrome Surfactant replacement therapy, US 1980-89 1989 Reduced neonatal mortality
Minim-access-surgery gallbladder/other Laparoscopic surgery of hernia, appendix, etc., US 1990 1990 Less pain, small scars/short recovery
E-health, medicine, education, R&D Email US 1965-1976 & World Wide Web, Switzerland 1980-1991    1991 Rose diffusion of health advances
Artificial muscle Electroactive polymer, US 1992 1992 Reduced disabilities
Severe combined immunodeficiency syn Gene therapy in defective cells extracted & transfusing them back, US 1990 1993 Restored/developed normal immunity
HIV/AIDS anti-viral treatment Triple anti-viral therapy, US 1996 1996 HIVsero + incidence/AIDS mortal fell
Open-angle glaucoma therapy Latanaprost (analogue of prostaglandin F 2alpha), Sweden 1982-1994 1996 Reduced progression & surgeries
Erectile dysfunction treatment Sildenafil & others, UK 1996-98, developed male sexology 1998  Reduced impotence & suffering
Wounded or damaged hands Hand transplantation, France 1998 1998 Increased static & functionality
Replace diseased/damaged tissue/organ Embryonic stem cell therapy growing new bladder, US 1999; devel regenerative medicine 1999 Reduced disability of organs
Distant tele- surgical support Tele-surgery Lindbergh operation, France, US 2001 2001 Increased surgery productivity
Deadly chronic hepatic failure Artificial Liver US 2001 2001 Reduced disability & mortality
3rd voluntary family planning means Contraceptive pills (four full periods of a year or no periods indefinitely) US 2003 2003 Fertility/natality, inf/mat mortality fell
Repair diseases & damaged tissues Stem cells cloning, US 2006; developed regenerative medicine 2006 Potential therapy repair heart, eye, etc
HIV/AIDS antiviral therapy adherence One pill cocktail of triple/quadruple anti-viral drugs US 2006 2006 Simplified schedule; rose adherence
Limbs prosthesis Bionic i-LIMBs, hand & fingers, UK 2007 2007 Reduced disabilities
Visual prosthesis Bionic eye, US 2007 2007 Reduced disabilities
Healthy/ill genome’s diagnosis/therapy Human normal & varied genome & mapping for early gen diagnosis & therapy, US 2007 2007 Diag genetic risks for timely gene ther
Non-blind very damaged face Partial & total face transplant France, Spain 2005-10 2008 Restored a better face to the patient
Infant/adult cancer early diagn/therapy Targeted cancer therapies with small molecules & monoclonal antibodies, US 1975-2010 2010 Individual ther mol. targets pat cancers
Paraplegic disability Bionic suite to re-walk, Israel 2011 2012 Restore ability to walk 2 miles daily
Retinitis pigmentosa leading blindness Implanted artificial retina + a pair of glasses attached to a video unit, US 2011 2013 Rest see image/contrast b/light & dark.
Advanced lung cancer immunotherapy Necitumumab, Nivolumab&Pembrolizumab monoclonal antibodies, US 2013-2015  2015 Rose 3month survival in refractory dis
Sources:[2,10, 32-33, 117-124]

Box 3: Developmentof scientific theories, medicines, and procedures on the health of the US and the world in 1957-2015.

In 1747, Lind began scientific controlled preventive trials. In 1761, based on Vesalius, Harvey and others’ post-mortem pathoanatomic and pre-mortem patho-physiologic findings, disease was no longer considered as only the clinical manifestations experienced by the patient and GP. From 1800 to 1820, Bichat, Broussais, Pinel, and Cabanis assisted the birth of ‘internal medicine’ [1,5,11-13], disease now considered as the organ and tissue anatomic ‘lesion’ or physiologic ‘disturbance’ caused by ‘modifiers’. Louis started controlled therapeutic trials. Based on Darwin’s theory of evolution through adaptation, Bernard developed the Hippocratic dictum that health is universal sympathy. He argued that life balance and fitness depend of constant multiple interplays between the external and internal milieu of the patient. Virchow stated, “Disease is the altered vital state of larger or smaller number of cells or cell-territories; not life under abnormal conditions, not the disturbance as such, engenders a disease, rather disease begins with the insufficiency of the regulatory apparatuses [1,5,11-13].” A more accurate classification of diseases increased the probabilities of exact diagnosis, therapy and cure. Hundreds of somatic diseases, based on thousands of patho-morphophysiological biophysico-chemical ‘inner-body macro/micro-parameters’ were found earlier than an isolated from dozens of psychic and psychosomatic disorders, grounded on hundreds of not well-recordable, measurable and reproducible ‘outer-cultureconosocial and inner-psychoneurological parameters’. In 1855-1885, Snow, Hirsch, Koch and Pasteur’s contributions on germs’ transmission began ‘Medicine’s first golden era of hygiene-epidemiology, microbiology-immunology, and physiology-cell biology’ [124]. The patient’s history and exam, correlated with lab findings, completed the clinical method, with the pathologist arbiter of the true diagnosis, therapy and pathogenesis [2,10].

In the eve of the 1900s, the GP rescued a PC-GM short-range health examination, pursuing more somatic than psychic/psychosomatic diseases [125-128]. Cannon developed Bernard ‘homeostasis’, as the condition of actively sustained equilibrium prevailing in the organism by neuroendocrine regulatory mechanisms. Biophysicochemical labs appeared for diabetes, cancer, cardiovascular, and other diseases’ applied and basic research, beginning a boom of discoveries of theories and technologies’ inventions and innovations, starting ‘Medicine’s second golden era of biophysical imaging-radiation, chemotherapy, biochemical genetic-molecular and micro, endoscopic, transplantation surgery’. These advances sowed the seeds of ‘evidence-based medicine’, diverting attention from individual living processes, and causing a self-imposed segregation from the cultureconosocio-psychological health dimensions. This truncated clinical method focusing mainly on diseases and risks, restored the patient’s physiological equilibrium, excluding +health states, enhancer factors, cultureconosociopsychoneuro- biophysiological harmony, and global quantity and quality of health [1,2,5,17-26]. Staging classification in cancer advised according to prognostic evolutionary factors the spectrum and strength of the therapies. In 1946, Hill began randomized controlled trials (RCTs), and cross-section/cohort controlled surveys, empowering with probability errors and epidemiologic criteria the proof of cause-effect relationships judged by a biostatistician. Small and middle-size RCTs need stratification by bad or - prognostic factors of patients’ population/sample before random allocation of intervention to trial and control groups, or after in the outcome analysis, rising groups homogeneity to detect intervention effects with statistical testing. In the 1980s, began ‘Medicine’s third golden era of personalized, precision, telemedicine, robotic-surgery, tele-education / research, with genetic, biotechnology, computer, internet, and mobile HIT apps’ [2,10].

Optimizing the individual-based PC-GM delivery and science models with our HIT/CDSS

Our broad PC-GM HIT/CDSS fused Hippocrates’ PC delivery and Euryphon’s GM science models with Snow’s transmission theory (1855), Pasteur’s germ theory (1862), Flexner’s biomedical model (1913), Watson and Crick’s biomolecular theory (1953), Backer’s patient health equation, Engel’s biopsychosocial model (1977), Antonovski’s salutogenesis concept (1979), McWhinney’s patientcentered method (1983), Foss and Rothenberg’s info-medical model (1987), Hollnagel and Malterud’s health resource/risk balance (1995), Archimedes’ simulation for control of diabetes risks (2002), and Collins and Varmus’s personalized/precision medicine for cancer and diabetes (2015) [2,26,129-135]. Since the 1800s, the PC-GM had no differentiated technological research field, and stayed only with a partial-health integrated care [136,137]. The discovery of new + health enhancer factors and states, interacting with - health risks and diseases, to materialize the patient global health index and classification, are GP-nurse teams’ new differentiated and integrated high-technological research fields. It is time to re-evaluate the best 60 year tools created by GP-nurse teams with psychologists, sociologists and mathematicians on patient’s health-metrics [26]. These teams must measure patient global (+ ± -) health status, as engineers and scientists use to do with every object of study [26]. The patient needs this automated health assessment, intelligence and advice HIT/CDSS to re-build its individuality and re-engage him in his own PC. It shall be always ready to work when he consults the GP-nurse team, between visits and virtual exchanges, wanting to know how his health is and what to do to his freedom to choose. Practice-based research networks must strengthen the HIT/ CDSS function and integrate it in family PC programs [26,138]. It shall actively ‘transmit’ + health potentiating factors and states throughout the patient’s life, fostering and preserving his health reserve free from potential subclinical diseases, and decreasing the hazards and costs of hospital care [5].

The US PC-GM shall be potentiated with our HIT/CDSS, if we individualize +health enhancement and -health safeguard, and search for the healthiest social milieu, life-styles, as well as immune-defenses, genes, and biomolecules. This must accelerate the enhancement of the patient cultureconosociopsychoneuro- biophysiological (+ ± -) health reserve, slowing its deterioration. The private-charity-public sectors ought to develop research programs on patient’s +health causes, enhancer factors and states. It would facilitate support of richer global health status decisions on PC-GM interventions by the patient, growth of GP-nurse team, and a better managerial evaluation. Our HIT/CDSS shall work in parallel and on personalized+and global health reserve enhancement, too abstractedly done by public health programs now. It shall complement novel community-based PC delivery models, i.e., medical home, retail clinics protocol-based for conditions handled by nursing software, and digitized models focusing risks and diseases monitoring and intervention. Potentiating tele-health providers, smartphone-based apps, networks, and consumer-oriented devices, a HIT/CDSS shall help enrich a personal ‘always-on’ PC-GM [139,140].

Toward a patient multi-level-variable global health index and classification algorithm

Figure 1 depicts an algorithm for our global health measures of 2013 [26]. We defined a comprehensive + and -health matrix with symptoms, signs, milieu, and lab variables, as well as a research path to build an integral health semiology, nosology, algorithms and equations, more ambitious than simply mirroring opposite taxonomies to the current ones of thousands of symptoms and diseases. These tools shall offer shortest numerical and categorical answers to the GP and the patient’s question about his degree of health. This query usually involves a GP synthetic judgment of dozens of present and past patient self-perceived symptoms, feelings, and biosocial milieu variables referred, plus dozens of objective signs, factors, lab, and milieu parameters observed. Our HIT/ CDSS shall give more exact and standardized answers than the ones the GP can process mentally in an ordinal scale of gross qualities as: excellent, good, regular, bad, and worst health. Our model of multiple organization levels of patient’s global health is for best assisting the reasoning of the GP and patient by using thousands, rather than dozens of interacting variables at the memory, using linear and non-linear functions and equations. Not viable for the GP’s brain, such ‘homeodynamic’ model [131] needs automated mathematical software acting on an expanded patient lifelong EHR database, running in a secure smartphone-computer network. It shall be fed by biosocial sensors (in watch, belt, glasses with camera, shoes, blood monitors and other wearables) indicating trends and fluctuations in personalized cultureconosocio-psychoneurobiophysiological parameters. It must work according to patient’s life-cycle stage, gender, environment and time, assisting him and the GP-nurse team in managing the complex healthcare of his individuality [26].

healthcare-communications-global-health-index

Figure 1: Patient global health index (GHI) and classification (GHC) rules of inference to optimize health reserve potential growth.

Discussion

Impacts of freedoms, scientific-technologies, industries, and businesses on health

From 1855 to 2015, the US and Western developed nations’ main axes of modernization have allowed achieve the ‘Greatest Enhancement of Health and other Living Standards on Earth’. However, 1957 to 2015 trends of quality, equity, survival, and cost of hospital care rates grew exponentially, while high-lethal chronic diseases/injuries’ mortality and incidence rates, and cultureconosocio-psychoneuro-biophysiological distresses and risks’ incidence rates declined logarithmically in the best health systems [85-87,93,95-99, 102-104]. This seems due to the forgotten value and power of the individualized health information [131,132]. This is increasingly being used by digitally savvy ‘millennials’, adults, and even ‘boomers’, through the explosion of social networks, online websites and HIT biosensing apps, overloading self-individual PC [141] with nonwell evaluated health promotion information, in relation to the well-focused disease prevention-therapeutics means with besttested biomedical-biopharmaceutical technologies. With our individual-based broad-spectrum health delivery PC system to measure, enhance, and safeguard his health reserve, upgraded with information sciences/technologies, we can evaluate/reduce objectively the redundant health information overload, and the possibility of ‘cyberchondria’ [141], in our young and adult individuals.

We read frequently, “The US healthcare system is broken and must be fixed [142]”. Nobelist Fogel suggested increasing access to the best standard and technology community-based health promotion, lifestyle change, preventive PC, and intensive outreach programs [49, 50]. Thus, the US shall re-boost a part of the slowed rising trends of ALEs and HALEs. The problem is that the current PC-GM model is of the disease era in the 1800s [143], when personal hygiene was subsumed by public hygiene and preventive medicine of groups, and abandoned the study of the healthy individual, life processes, lifestyles, and hygiene. Later, mental hygiene became applied psychology and preventive psychiatry, as bodily hygiene became applied physiology and preventive medicine [144]. The 200 year successful diseasetherapy oriented hospital care [36,40,85,97,98] needs harmonization with a long-range view of health-centered individual-based PC-GM to increase patient quantity and quality of health reserve, even in the ‘absence’ of subclinical diseases and risks [26]. Although much suffering is relieved and many diseases are regressed or stabilized, yet many risks of diseases and injuries are neither well-known nor well-controlled yet.

We think that what not only the US but all other world healthcare systems have broken is the concept of individual cultureconosocio-psychoneuro-biophysiological (+ ± -) health reserve. Its upgraded reintegration could accelerate the + health outcomes and broaden the PC clinical history, method and delivery model scopes to the original Hippocratic ones. The GP left behind the logical PC-GM path to enhance the patient + health enhancement factors and states, because as disease and other failures of adaptation are obvious and often dramatic, whereas health and fitness are considered the ‘normal’ state and therefore unnoticed [1], it is not surprising that he tended to be very busy and focused in the restoration and protection of the patient’s biophysiological health. While this happened, public health specialists absorbed these +health promotion tasks, but at the abstract level of diverse populations of patients. The US patient needs personalized health information by a HIT/CDSS built with Euryphon’s GM science, to enable him to administer in a wiser and healthier way, the amazing freedom, knowledge, and wealth that he owns.

HIT/CDSS improvement of population healthmetrics and randomized clinical trials efficiency

The HIT/CDSS software for the US patient global health index values calculation and profile identification could be programmed by a multidisciplinary research team with GPs, nurses and other professionals [26], supported by the National Collaborative for Improving Primary Care through Industrial and Systems Engineering, Patient-Centered Outcomes Research Institute, and Primary Care Extension Program [138]. It could run experimentally in supercomputers of the National Institutes of Health Center for HIT and Centers for Disease Control/Prevention. The software shall receive big data from the patient’s EHR and sensors through secure GP-patient smartphones-computer network, upon a standardized personalized health data matrix created by the GPnurse research team. The software response in near real-time, to each patient enquiry or virtual consultation to the GP-nurse team, could give also an instantaneous bottom-up more real health aggregate index and profile results to the city, county, state, CDC, and US Department of Health [145].

Some have criticized the effectiveness of general health checks, screening, and lifestyle counseling in reducing chronic disease and injury mortality and even incidence [146-149]. Our patient global health index, profile and +health enhancers, can help perfect the PC health promotion RCTs, causal-healthgenic surveys, preventive and even therapeutic RCTs, mainly immunologic and genetic, and etio-pathogenic case-control/exposed-control surveys [150]. New good or +prognostic and health enhancer factors discovered could help balance and reduce better the bias allowed by randomized designs and analyses of RCT trials and surveys, contributing to higher homogeneity of baseline and outcome test and control groups through a broader prognostic stratification. This will allow more valid research conclusions about new intervention effects, new individual causal factors of +health, and healthy lifestyles. Thus, our research program also offers new means for the enhancement and safeguard of the patient health reserve.

Conclusion and Implications

We have argued the necessity of an individual health broadspectrum HIT/CDSS, fusing the upgraded Hippocrates’ PC delivery and Euryphon’s GM science models with the models of the past 160 years. Giving personalized mobile integral health intelligence to the individual, empowering self-health induction with prompt data-exchange shall amplify healthcare communication with the GP-nurse team and potentiate healthier outcomes. This can make possible, very necessary medical work before the patient is distressed, suffers, or is disabled.

A more aware patient can better solve -health weaknesses, build up +health strengths, and balance his cultureconosociopsychoneuro- biophysiological (- ± +) ‘health reserve’, enriching and guarding it supported by the GP-nurse team. Besides personalized/precise biomedical, pharmaceutical, genetic, and biomolecular means to reduce - health, we shall also research and use more the individualized healthy-lifestyle info tools to increase + and global health.

We have advanced our HIT/CDSS algorithm architecture to reopen the patient health scope of the non-critical PC-GM delivery model, and process his ‘entire life data’ resulting in automatic multi-level and variable global health results by mathematical software that shall be created. Measuring individual global health reserve with more information sciences/technologies, we can help evaluate/reduce objectively the health information overload of our ‘millennials’, adults, and even ‘boomers’.

It needs communities with rapid and secure access to Internet, EHR, wearable-sensors and smartphone-computers’ networks. Responses in near real-time to patient/GP enquiries and comments on enhancement and safeguard of patient global health output, could offer also automatically bottom-up more real health aggregate index and profile outcomes to local, state and US health departments. Patient global health index, profile, good or +prognostic and enhancer factors and states, besides debilitating - prognostic, risk factors and diseases, are crucial to all RCTs and surveys’ results validity. Searching for and testing new healthier-lifestyles is essential.

Our proposal is, through this research program, to encourage the progression of pleasant and optimal comprehensive wellness feelings, hyper-abilities, healthiest, and happiest states in each patient, as well as the regression or stabilization of even subclinical diseases and risk factors. Health economics benefits, always sought and valued, must result from this approach. Its effectiveness at improving quality of patient global healthcare and lowering its costs, would allow our nation’s wealth to be shared with other necessary priorities.

Acknowledgement

We are very grateful for the encouragement of medical historian Guenter B Risse of the UCSF/UWS to bring our PCGM HIT/CDSS of 2013 into routine patient-GP interaction; and for the kind suggestions of Past Presidents of WONCA, Chris van Weel of the Universities of Nijmegen/Australia, and Richard G Roberts of the University of Wisconsin, and James W. Mold, Chair, Committee on Advancing the Science of Family Medicine of the University of Oklahoma, and NAPCRG, to be cautious avoiding disruption of the successful patient- GP relationships. In addition, this paper reflects valuable teachings on multivariate analyses of visiting neurophysiologist Thalia Harmony of the UNAM-Querétaro in 1976-1977 and biostatistician John Fertig of Columbia University in 1976 and 1979. Finally, we are thankful with the help of the reviewers of this paper to be able to reach this improved version.

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