Goal setting among older adults starting mobile health cardiac rehabilitation in the RESILIENT trial.

BACKGROUND: There is growing recognition that healthcare should align with individuals' health priorities; however, these priorities remain undefined, especially among older adults. The Rehabilitation Using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting (RESILIENT) trial, designed to test the efficacy of mobile health cardiac rehabilitation (mHealth-CR) in an older cohort, also measures the attainment of participant-defined health outcome goals as a prespecified secondary endpoint. This study aimed to characterize the health priorities of older adults with ischemic heart disease (IHD) using goal attainment scaling-a technique for measuring individualized goal achievement-in a sample of 100 RESILIENT participants. METHODS: The ongoing RESILIENT trial randomizes patients aged ≥65 years with IHD (defined as hospitalization for acute coronary syndrome and/or coronary revascularization), to receive mHealth-CR or usual care. For the current study, we qualitatively coded baseline goal attainment scales from randomly selected batches of 20 participants to identify participants' cardiac rehabilitation outcome goals and their perceptions of barriers and action plans for goal attainment. We used a deductive framework (i.e., 4 value categories from Patient Priorities Care) and inductive approaches to code and analyze interviews until thematic saturation. RESULTS: This sample of 100 older adults set diverse health outcome goals. Most (54.6%) prioritized physical activity, fewer (17.1%) identified symptom management, fewer still (13.7%) prioritized health metrics, mostly comprised of weight loss goals (10.3%), and the fewest (<4%) were related to clinical metrics such as reducing cholesterol or preventing hospital readmission. Participants anticipated extrinsic (access to places to exercise, time) and intrinsic (non-cardiac pain, motivation) barriers. Action plans detailed strategies for exercise, motivation, accountability, and overcoming time constraints. CONCLUSIONS: Using goal attainment scaling, we elicited specific and measurable goals among older adults with IHD beginning cardiac rehabilitation. Priorities were predominantly functional, diverging from clinical metrics emphasized by clinicians and healthcare systems.

COVID-19 Imperils Access to Health and Human Services in El Paso, Texas and New York City: Perspectives from Hispanic Parents.

Low-income Hispanic communities are disproportionately impacted by the COVID-19 pandemic through exacerbated financial vulnerabilities and health challenges. The aim of this study is to assess and compare the self-reported impact and challenges caused by COVID-19 in Mexican-origin parents in New York City (NYC), NY and El Paso, TX. Data is based on routine follow-up calls used to assess uptake of the HPV vaccine and COVID-19 concerns conducted between March and August 2020. Three salient themes emerged: (1) financial insecurities; (2) emotional distress associated with COVID-19; and (3) limited access to health and human services. This study revealed increased financial insecurities and emotional distress, and disruptions to health and human services to low-income Mexican-born parents during the pandemic.

Fly Stampede 2.0: A Next Generation Optomotor Assay for Walking Behavior in Drosophila Melanogaster.

Optomotor behavior represents a stereotyped locomotor response to visual motion that is found in both vertebrate and invertebrate models. The Fly Stampede assay was developed to study an optomotor response in freely walking populations of Drosophila. Here we share optimized assay designs and software for production of a modified stampede assay that can be used for genetic screens, and improved tracking outputs for understanding behavioral parameters of visual-motion responses and arousal state of individual animals. Arousal state influences behavioral performance in the stampede assay. As proof of principle experiments we show parametric modulation of visual stimuli and startle stimuli in both wildtype and mutant flies for the type I family dopamine receptor Dop1R1 (DopR). DopR mutants are hyperactive and perform poorly in the stampede assay, suggesting a potential role in visual perception and/or arousal. The stampede assay creates an efficient platform for rapid screening of mutant animals or circuit manipulations for investigating attentional processes in Drosophila.