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Zeitschrift Fur Gerontologie Und... Nov 2022The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly... (Review)
Review
The clinical presentation of infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) is very heterogeneous and the risk of a severe course clearly increases with age. Therefore, older adults are an important target group for vaccinations. Several vaccines are currently licensed in Europe for older adults, namely two mRNA vaccines, two adenoviral vector vaccines and a protein-based vaccine. The immunogenicity and clinical efficacy of these vaccines in the first approval trials were equal or only slightly reduced for older adults compared to younger age groups; however, the concentration of neutralizing antibodies and protection against infection greatly declined over time and the latter is substantially reduced for virus variants, particularly for the Omicron variant. Nevertheless, protection against severe disease and hospitalization is maintained at a high level for longer time periods, and after three vaccine doses (2 + 1 schedule) also for the Omicron variant. Additional booster vaccinations are currently recommended for patients with risk factors, especially older adults. With respect to the currently valid recommendations for different age and risk groups, the publications and notifications of the national vaccine advisory bodies should be referred to.All currently available vaccines target the original virus strain. New vaccines, which are adapted to virus variants are currently being developed and tested, and it is highly likely that they will be used in the near future; however, viral evolution is ongoing and a continuous development of adapted vaccines will probably be necessary.
Topics: Humans; Aged; COVID-19; SARS-CoV-2; Vaccination; Antibodies, Neutralizing
PubMed: 36112215
DOI: 10.1007/s00391-022-02102-x -
ACR Open Rheumatology Nov 2022Many patients with rheumatoid arthritis (RA) have difficulty finding clinicians to treat them because of workforce shortages. We developed an app to address this problem...
Development and Testing of an Electronic Health Record-Integrated Patient-Reported Outcome Application and Intervention to Improve Efficiency of Rheumatoid Arthritis Care.
OBJECTIVE
Many patients with rheumatoid arthritis (RA) have difficulty finding clinicians to treat them because of workforce shortages. We developed an app to address this problem by improving care efficiency. The app collects patient-reported outcomes (PROs) and can be used to inform visit timing, potentially reducing the volume of low-value visits. We describe the development process, intervention design, and planned study for testing the app.
METHODS
We employed user-centered design, interviewing patients and clinicians, to develop the app. To improve visit efficiency, symptom tracking logic alerts clinicians to PRO trends: worsening PROs generate alerts suggesting an earlier visit, and stable or improving PROs generate notifications that scheduled visits could be delayed. An interrupted time-series analysis with a nonrandomized control population will allow assessment of the impact of the app on visit frequency.
RESULTS
Patient interviews identified several of the following needs for effective app and intervention design: the importance of a simple user interface facilitating rapid answering of PROs, the availability of condensed summary information with links to more in-depth answers to common questions regarding RA, and the need for clinicians to discuss the PRO data during visits with patients. Clinician interviews identified the following user needs: PRO data must be easy to view and use during the clinical workflow, and there should be reduced interval visits when PROs are trending worse. Some clinicians believed visits could be delayed for patients with stable PROs, whereas others raised concerns.
CONCLUSION
PRO apps may improve care efficiency in rheumatology. Formal evaluation of an integrated PRO RA app is forthcoming.
PubMed: 36099161
DOI: 10.1002/acr2.11498 -
Frontiers in Global Women's Health 2022In Ethiopia, postnatal care (PNC) service utilization was low although many interventions had been implemented. Previous studies showed community-/caregiver-related...
BACKGROUND
In Ethiopia, postnatal care (PNC) service utilization was low although many interventions had been implemented. Previous studies showed community-/caregiver-related barriers to PNC service utilization, but limited evidence was available on the health facilities and health care provider-related barriers. Therefore, the study was aimed at exploring both community and health care provider-related barriers to PNC service utilization.
METHODS
A descriptive qualitative study was conducted at Debre Libanos District, Ethiopia, from 11 March to 7 April 2019. A purposive sampling technique was used to recruit study participants among recently delivered women (<2 months), health care providers, and community members. A total of five in-depth interviews, 12 key informant interviews, and four FGDs were conducted. Data were audio-recorded, transcribed verbatim, and translated, and inductive thematic analysis was used to analyze the data using the atlas ti.7.1 software.
RESULTS
A total of 51 participants were involved in the study. The findings were organized into two major themes: (1) Community/caregiver-related barriers to PNC service utilization: lack of awareness about PNC, its importance, and schedules; lack of awareness about postnatal danger signs, sociocultural and religious beliefs, topographical and transportation problems, non-functionality of the health developmental armies (HDA); (2) health facility and health care provider-related barriers to PNC service utilization: poor supportive supervision and monitoring, lack of health extension workers' (HEW) commitment, lack of an organized system to notify delivery to HEW, shortage of HEWs, the residence of the HEWs, closure of health posts (HP) on working hours, and non-functionality of HPs.
CONCLUSIONS
The study findings underscore the need to develop different strategies and take actions. Therefore, the health centers and district health offices should have to assign the required number of HEWs at HPs, regularly supervise and monitor HEWs, and develop an organized system to facilitate early notification of delivery to HEWs. The HEWs should have to live near the HP, re-organize HDAs, create awareness of maternal and newborn danger signs, and conduct social and behavioral change communications to increase the health-seeking behavior of community members for utilizing PNC services.
PubMed: 36090597
DOI: 10.3389/fgwh.2022.986662 -
BMC Psychiatry Aug 2022Fear of missing out (FoMO) can increase loneliness and smartphone addiction and decrease academic performance in university students. Most studies investigated the...
BACKGROUND
Fear of missing out (FoMO) can increase loneliness and smartphone addiction and decrease academic performance in university students. Most studies investigated the relationship between FoMO and smartphone addiction in developed countries, and no studies were found to examine this association in Iran. The mediating role of loneliness and academic performance in the relationship between FoMO and smartphone addiction is unclear. This study investigated the relationship between FoMO and smartphone addiction and the mediating role of loneliness and academic performance in this relationship in Iranian university students.
METHODS
In this cross-sectional study, 447 students from Urmia University of Medical Sciences were investigated. Data were collected using demographic questionnaires, Przybylski's FoMO scale, Pham and Taylor's academic performance questionnaire, Russell's loneliness scale, and Kwon's smartphone addiction scale. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2.
RESULTS
FoMO had a positive and direct association with smartphone addiction (β = 0.315, t-value = 5.152, p < 0.01). FoMO also had a positive and direct association with students' loneliness (β = 0.432, t-value = 9.059, p < 0.01) and a negative and direct association with students' academic performance (β = -0.2602, t-value = 4.201, p < 0.01). FoMO indirectly associated with smartphone addiction through students' loneliness (β = 0.311, t-value = 5.075, p < 0.01), but academic performance was not mediator of smartphone addiction (β = 0.110, t-value = 1.807, p > 0.05). FoMO also indirectly correlated with academic performance through students' loneliness (β =-0.368, t-value = 6.377, p < 0.01).
CONCLUSIONS
FoMO can be positively associated with students' smartphone addiction, and loneliness is an important mediator of this association. Since smartphone addiction could harm students' academic performance, thus, healthcare administrators should reduce students' loneliness and improve their academic performance by adopting practical strategies to help students to manage their time and control their smartphone use. Holding self-management skills classes, keeping students on schedule, turning off smartphone notifications, encouraging students to engage in sports, and participating in group and family activities will help manage FoMO and loneliness.
Topics: Cross-Sectional Studies; Fear; Humans; Internet Addiction Disorder; Iran; Loneliness; Smartphone; Students; Universities
PubMed: 35962328
DOI: 10.1186/s12888-022-04186-6 -
JMIR Research Protocols Aug 2022It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home...
BACKGROUND
It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms.
OBJECTIVE
The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM), and lung function in terms of forced expiratory volume in 1 second (FEV%); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control.
METHODS
We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM, and FEV%, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility.
RESULTS
This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023.
CONCLUSIONS
Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines.
TRIAL REGISTRATION
ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/39887.
PubMed: 35916686
DOI: 10.2196/39887 -
Acta Informatica Medica : AIM : Journal... Mar 2022An assessment of the level of adherence of patients diagnosed with hypertension to therapy has not been conducted in Central Asia yet. It includes the lack the...
BACKGROUND
An assessment of the level of adherence of patients diagnosed with hypertension to therapy has not been conducted in Central Asia yet. It includes the lack the information on the impact of digital technologies on hypertension management.
OBJECTIVE
The study aimed at the evaluation of the effect of using a mobile application on adherence to therapy in patients with diagnosed arterial hypertension.
METHODS
A multi-centre randomized controlled study was conducted on 517 patients with diagnosed arterial hypertension (in the out-patient clinic, Almaty, Kazakhstan). Patients were randomly assigned to intervention (IG) and control (CG) groups. IG patients used a mobile application, which allowed creating an individual schedule for taking medications, including visual and audio notifications. The assessment of adherence to antihypertensive treatment was carried out using the Lebanese Medication Adherence Scale-14 (LMAS-14), consisting of 14 items. Data were collected before therapy (T1), 3 months (T2), 6 months (T3) and 12 months (T4) followed the first dose. Adherence was assessed on 101 patients in the CG group and 165 respondents in the IG group.
RESULTS
In the period T1 in both groups CG and IG, a moderate adherence to treatment was recorded with indices equal to 35.9 ± 1.2 and 35.9 ± 1.3, respectively (p ≤ 0.05). A decrease in adherence in the CG group was determined after 3 months (35.9 ± 1.2) (p ≤ 0.05) and six months later (36.5 ± 3.2) in comparison with relatively high adherence among respondents in the IG group in periods T2 (39.5 ± 1.2) and T3 (40.5 ± 1.2) (p ≤ 0.001). After 12 months (T4) on the adherence scale in patients who used the mobile application "MyTherapy" (IG), despite a slight decrease in scores, the results were relatively higher (40.3 ± 1.3) compared with the CG group (33.6 ± 1.9) (p ≤ 0.001).
CONCLUSION
The analysis of adherence of patients with primary health care in Almaty (Kazakhstan) with chronic arterial hypertension showed the effectiveness of using the 'MyTherapy' mobile application in increasing patient adherence. The obtained data on the positive effect of the use of digital technologies require further research to assess the possibility of wider implementation in healthcare.
PubMed: 35800910
DOI: 10.5455/aim.2022.30.18-24 -
BMC Health Services Research Jun 2022Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up...
BACKGROUND
Caesarean sections account for roughly one third of all surgical procedures performed in low-income countries. Due to lack of standardised post-discharge follow-up protocols and practices, most of available data are extracted from clinical charts during hospitalization and are thus sub-optimal for answering post-discharge outcomes questions. This study aims to determine enablers and barriers to returning to the hospital after discharge among women who have undergone a c-section at a rural district hospital in Rwanda.
METHODS
Women aged ≥ 18 years who underwent c-section at Kirehe District Hospital in rural Rwanda in the period March to October 2017 were prospectively followed. A structured questionnaire was administered to participants and clinical data were extracted from medical files between March and October 2017. At discharge, consenting women were given an appointment to return for follow-up on postoperative day 10 (POD 10) (± 3 days) and provided a voucher to cover transport and compensation for participation to be redeemed on their return. Study participants received a reminder call on the eve of their scheduled appointment. We used a backward stepwise logistic regression, at an α = 0.05 significance level, to identify enablers and barriers associated with post-discharge follow-up return.
RESULTS
Of 586 study participants, the majority (62.6%) were between 21-30 years old and 86.4% had a phone contact number. Of those eligible, 90.4% returned for follow-up. The predictors of return were counselling by a female data collector (OR = 9.85, 95%CI:1.43-37.59) and receiving a reminder call (OR = 16.47, 95%CI:7.07-38.38). Having no insurance reduced the odds of returning to follow-up (OR = 0.03, 95%CI:0.03-0.23), and those who spent more than 10.6 Euro for transport to and from the hospital were less likely to return to follow-up (OR = 0.14, 95%CI:0.04- 0.50).
CONCLUSION
mHealh interventions using calls or notifications can increase the post-discharge follow-up uptake. The reminder calls to patients and discharge counselling by a gender-matching provider had a positive effect on return to care. Further interventions are needed targeting the uninsured and patients facing transportation hardship. Additionally, association between counselling of women patients by a female data collector and greater return to follow-up needs further exploration to optimize counselling procedures.
Topics: Adult; Aftercare; Cesarean Section; Female; Follow-Up Studies; Hospitals, District; Humans; Patient Discharge; Pregnancy; Prospective Studies; Rwanda; Young Adult
PubMed: 35655212
DOI: 10.1186/s12913-022-08137-5 -
JMIR Formative Research May 2022Young African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-,...
BACKGROUND
Young African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women's CoOp (WC) is an HIV risk-reduction intervention that is proven to be efficacious in various face-to-face formats.
OBJECTIVE
This study aims to adapt the delivery method of an evidence-based intervention, the WC, from an in-person format to a self-guided mobile health (mHealth) format while ensuring that core elements are maintained for intervention comparability and fidelity.
METHODS
Several adaptation phases were conducted by using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability testing and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study.
RESULTS
The team converted the seven elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, cue card presentations of the materials delivered by the intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal-setting activities. In these cases, the subject matter experts and app developers worked together to find comparable analogs to be used within the app. Once developed, tested, and finalized, the mHealth WC app was deployed into local health departments as part of a randomized trial.
CONCLUSIONS
This systematic adaptation process created an accurate mHealth equivalent of an existing, in-person behavioral health intervention. Although participants' reception of the app during the formative developmental phase was overall positive, maintaining fidelity to the in-person delivery compromised the natural capabilities of a mobile app, such as further gamification, different types of interactivity, and integrated notifications and messaging, which could be helpful for participants' adherence to the intervention schedule. Given the development and implementation of the app, the next step is to examine the impact of the app and its efficacy in HIV and substance use risk-reduction.
PubMed: 35532978
DOI: 10.2196/34041 -
Musculoskeletal Care Sep 2022Determine (a) frequency of digital health use to obtain/record clinical information (pre-COVID-19); (b) willingness to use digital technologies among physical therapists...
OBJECTIVES
Determine (a) frequency of digital health use to obtain/record clinical information (pre-COVID-19); (b) willingness to use digital technologies among physical therapists and patients with musculoskeletal conditions.
METHODS
102 physical therapists, and 103 patients were recruited in Australia. An electronic survey ascertained (a) demographic/clinical characteristics, (b) frequency of methods to obtain and record clinical information; (c) willingness to use digital technologies to support musculoskeletal care.
RESULTS
Physical therapists mostly used non-digital methods to obtain subjective (e.g., face-to-face questioning, n = 98; 96.1%) and objective information (e.g., visual estimation, n = 95; 93.1%). The top three digital health technologies most frequently used by therapists: photo-based image capture (n = 19; 18.6%), accessing information logged/tracked by patients into a mobile app (n = 14; 13.7%), and electronic systems to capture subjective information that the patient fills in (n = 13; 12.7%). The top three technologies used by patients: activity trackers (n = 27; 26.2%), logging/tracking health information on mobile apps or websites (n = 12; 11.7%), and entering information on a computer (n = 12; 7.8%). Physical therapists were most willing to use technologies for: receiving diagnostic imaging results (n = 99; 97.1%), scheduling appointments (n = 92; 90.2%) and capturing diagnostic results (n = 92; 90.2%). Patients were most willing to use technologies for receiving notifications about health test results (n = 91; 88.4%), looking up health information (n = 83; 80.6%) and receiving personalised alerts/reminders (n = 80; 77.7%).
CONCLUSIONS
Physical therapists and patients infrequently use digital health technologies to support musculoskeletal care, but expressed some willingness to consider using them for select functions.
Topics: COVID-19; Digital Technology; Humans; Mobile Applications; Physical Therapists; Physical Therapy Modalities
PubMed: 35278266
DOI: 10.1002/msc.1627 -
Australian and New Zealand Journal of... Jun 2022This paper examines factors that enabled successful integration of testing for sexually transmissible infections into routine care in Aboriginal Community Controlled...
OBJECTIVES
This paper examines factors that enabled successful integration of testing for sexually transmissible infections into routine care in Aboriginal Community Controlled Health Services.
METHODS
This paper reports analysis of qualitative interview data recorded with 19 purposively sampled key informants in New South Wales, Australia, representing six Aboriginal Community Controlled Health Services and five government health bodies supporting those services. The analysis explicitly adopted a strengths-based approach.
RESULTS
Participants reported a strong belief that routine screening overcomes shame and increases engagement with sexual health screening. Incorporating sexual health screening into general medical consultations increases the capture of asymptomatic cases. The Medicare Benefits Schedule 715 Adult Health Check was highlighted as an ideal lever for effective integration into routine care.
CONCLUSION
Integration of testing for sexually transmissible infections into routine care is widely perceived as best practice by senior stakeholders in Aboriginal healthcare in NSW. Findings support continued work to optimise the MBS 715 as a lever to increase testing.
IMPLICATIONS FOR PUBLIC HEALTH
Identifying accessible strategies to increase testing for sexually transmissible infections in Aboriginal Community Controlled Health Services can reduce disparities in notifications affecting Aboriginal young people.
Topics: Adolescent; Humans; Health Services, Indigenous; National Health Programs; Primary Health Care; Sexual Health; Sexually Transmitted Diseases; Australian Aboriginal and Torres Strait Islander Peoples
PubMed: 35238454
DOI: 10.1111/1753-6405.13208