TASK-3, two-pore potassium channels, contribute to circadian rhythms in the electrical properties of the suprachiasmatic nucleus and play a role in driving stable behavioural photic entrainment.

Stable and entrainable physiological circadian rhythms are crucial for overall health and well-being. The suprachiasmatic nucleus (SCN), the primary circadian pacemaker in mammals, consists of diverse neuron types that collectively generate a circadian profile of electrical activity. However, the mechanisms underlying the regulation of endogenous neuronal excitability in the SCN remain unclear. Two-pore domain potassium channels (K2P), including TASK-3, are known to play a significant role in maintaining SCN diurnal homeostasis by inhibiting neuronal activity at night. In this study, we investigated the role of TASK-3 in SCN circadian neuronal regulation and behavioural photoentrainment using a TASK-3 global knockout mouse model. Our findings demonstrate the importance of TASK-3 in maintaining SCN hyperpolarization during the night and establishing SCN sensitivity to glutamate. Specifically, we observed that TASK-3 knockout mice lacked diurnal variation in resting membrane potential and exhibited altered glutamate sensitivity both in vivo and in vitro. Interestingly, despite these changes, the mice lacking TASK-3 were still able to maintain relatively normal circadian behaviour.

Chronic pain education delivered with a virtual reality headset in outpatient physical therapy clinics: a multi-site exploratory trial.

OBJECTIVE: Chronic pain is multidimensional, requiring expanded interventions for optimal management. Pain education, mindfulness training, and virtual reality (VR) are showing promise, but barriers remain for implementation by clinicians. The purpose of this study was to explore the experiences with a pain education and mindfulness intervention for patients with chronic low back pain and their treating clinicians. METHODS: This was a prospectively designed exploratory trial registered at ClinicalTrials.gov: NCT04777877. Patients were identified by study staff and consented. Baseline and follow-up questionnaires and surveys were collected with quantitative and qualitative data. Patients viewed five videos explaining key pain concepts and guided imagery nature videos using a VR headset. RESULTS: Twenty patients consented, and 15 patients completed the intervention. Patients and clinicians rated their experiences with the program as excellent; however, concerns were raised related to logistical challenges around use of the VR headset in busy clinic settings. Percentage changes in patient pain knowledge occurred in the desired direction in 8 out of 9 key concepts. CONCLUSIONS: Delivering educational and mindfulness content with a VR headset to patients with chronic low back pain was feasible and acceptable to patients and clinicians. Concerns remain regarding the increased time burden with use of this technology in a busy clinic setting weighed against potential benefits. Alternative delivery methods are needed to reduce logistical challenges and increase patient access to content outside of the clinic setting.

Differences in addiction and recovery gains according to gender - gender barriers and specific differences in overall strengths growth.

BACKGROUND: There is growing evidence on the importance of a gendered understanding of recovery. Gender differences have been reported in relation to the nature and extent of substance use, pathways to and through substance use disorder and recovery capital acquisition and maintenance. There is little existing research on factors associated with recovery capital growth by gender. METHODS: The current paper uses the European Life in Recovery database to assess specific domains of the Strengths and Barriers Recovery Scale (SABRS) that best predict growth of recovery capital amongst people in recovery from drug addiction. The 1313 participants were drawn from the REC-PATH study and recruited by the Recovery Users Network (RUN) from across Europe. Bivariate and multivariate analyses were performed to identify relationships between specific SABRS items and gender, as well as differences in the dimensions of the SABRS scale most likely to predict recovery capital growth by gender. RESULTS: Between their time in active addiction and in recovery, females show greater growth in strengths, despite females reporting fewer recovery strengths during active addiction than males, and males have greater reductions in barriers to recovery compared to females. Multivariate analyses show that strengths specifically related to prosocial meaningful activities are found to be highly significant for growth of recovery capital amongst males, whereas strengths related to both prosocial meaningful activities and general health management seem particularly relevant for growth of recovery capital amongst females. CONCLUSIONS: We conclude that this further demonstration of gender differences in recovery pathways should suggest gender-specific approaches adopted in recovery community organisations to address these different needs.

The Strengths and Barriers Recovery Scale (SABRS): Relationships Matter in Building Strengths and Overcoming Barriers.

There is a well-established relationship between isolation and both morbidity and mortality in the context of addiction recovery, yet the protective effects of intimate and familial relationships have not been adequately assessed. The current paper uses the European Life In Recovery database to assess the association between relationship status and living with dependent children on recovery capital of people in recovery from drug addiction, operationalised by the Strengths And Barriers Recovery Scale (SABRS). The study participants were drawn from the REC-PATH study and supplemented by a second sample recruited by the Recovered Users Network (RUN) across various European countries, resulting in a combined sample of 1,313 individuals completing the survey, primarily online. The results show that, in recovery, those who are married or co-habiting reported significantly greater recovery strengths and fewer barriers to recovery, and reported greater gains in recovery capital across their recovery journeys. Similar associations are found for participants who have dependent children living with them. There is also some indication that this association is stronger for female than for male participants. Finally, having more people that one can rely on and a greater proportion of people in recovery in the social network are both linked to greater recovery capital and greater self-reported growth in recovery capital. We conclude that this study provides further evidence in favour of a "social cure" in recovery, in which close familial ties are associated with stronger recovery resources.

The use of virtual reality for Peri-procedural pain and anxiety at an outpatient spine clinic injection visit: an exploratory controlled randomized trial.

Chronic pain is a major public health problem. There is a need to develop novel treatment strategies to address this growing issue. Virtual reality is emerging as an alternative approach to help people suffering from chronic pain. The purpose of this work was to explore the feasibility, acceptability, and impact of a brief virtual reality relaxation video on peri-procedural pain and anxiety in chronic low back pain patients receiving spinal injections. The intervention was delivered in the context of a busy fluoroscopy injection clinic. Upon arrival to the clinic, consented patients were randomized into one of three groups: (1) Audiovisual monitor-flat screen (AV) (2) Virtual Reality headset (VR) and (3) Control-no intervention. The main questions we set out to answer were: (1) Is it feasible to deliver the intervention in the context of clinical care? (2) Was the intervention acceptable to patients? and (3) Did the intervention impact pain and anxiety surrounding the injection procedure? Viewing a brief relaxation nature video in AV or VR format was not associated with statistically lower pain scores following an injection procedure compared to controls. However, the intervention was associated with lower anxiety scores recorded prior to the injection compared to controls. Importantly, the virtual reality intervention was acceptable and feasible to integrate into a clinic setting, however, to maximize effectiveness, the content delivered to this population should be targeted and delivered over a longer duration. In addition, alternative outcomes and settings beyond peri-procedural pain surrounding an injection should be explored.

Fear of Missing Out, Mental Wellbeing, and Social Connectedness: A Seven-Day Social Media Abstinence Trial.

Smartphones aid the constant accessibility of social media (SM) applications, and these devices and platforms have become a key part of our everyday lives and needs. Previous research has focused on the psychological impact of social media use (SMU) and SM abstinence has only received limited attention. Therefore, employing a combination of an experimental within-subjects mixed methodology using surveys to obtain both quantitative and qualitative data, this study aimed to compare psychosocial factors of fear of missing out (FoMO), mental wellbeing (MWB), and social connectedness (SC) before and after seven days of SM abstinence. Results revealed that participants (N = 61) experienced a significant increase in MWB and SC, and a significant decrease in FoMO and smartphone use following SM abstinence. There was a significant positive relationship between MWB and SC change scores and a significant negative relationship between SC and FoMO change scores. There were no significant differences in levels of SMU before abstinence or across genders in FoMO, MWB, and SC change scores. Thematic analysis revealed coping, habit, and boredom as motivations for SMU, and notification distractions presenting a challenge for successful abstinence from SM. Participants indicated that abstinence resulted in the perceived need to fill their time with non-SM applications. Finally, thematic analysis revealed mixed experiences of perceived connectivity in the absence of SMU. Findings present implications for the importance of unplugging from SM for temporary periods because scrolling through SM to fill time is a key motivator of SMU, and notifications encourage SMU and trigger FoMO.

The Rehabilitation Enhancing Aging Through Connected Health Prehabilitation Trial.

OBJECTIVE: To evaluate the proof of concept of an innovative model of physical therapy Rehabilitation Enhancing Aging through Connected Health (REACH) and evaluated its feasibility and effect on physical function and health care utilization. DESIGN: Quasi-experimental 12-month clinical trial. SETTING: Two outpatient rehabilitation centers. PARTICIPANTS: Community-dwelling older primary care patients with a treatment arm undergoing the intervention (n=75; mean age=77±5.9y; 54% women) and propensity matched controls derived from a longitudinal cohort study (n=430; mean age=71±7.0y; 68% women) using identical recruitment criteria (N=505). INTERVENTION: Combined outpatient and home PT augmented with a commercially available app and computer tablet. MEASUREMENTS: Primary outcomes included a feasibility questionnaire, exercise adherence, self-reported function, and the Short Physical Performance Battery (SPPB). Secondary outcomes included the rates of emergency department (ED) visits and hospitalizations. RESULTS: Among REACH participants, we observed a 9% dropout rate. After accounting for dropouts, with propensity matching, n=68 treatments and n=100 controls were analyzed. Over the 12-month study duration, 85% of participants adhered to the exercise program an average of 2 times a week and evaluated the treatment experience favorably. In comparison to controls, after 1 year of treatment and within multivariable regression models, REACH participants did not manifest a significant difference in patient reported function (group x time effect 1.67 units, P=.10) but did manifest significant differences in SPPB (group x time effect 0.69 units, P=.03) and gait speed (group x time effect .08m/s, P=.02). In comparison to controls, after 1 year, the rate of ED visits (group x time treatment rate=0.27, P<.004) were significantly reduced, but a significant reduction in hospitalizations was not observed. CONCLUSION: The REACH intervention is feasible and has proof of concept in preventing functional decline and favorably affecting health care utilization. Evaluation on a larger scale is warranted.

The rehabilitation enhancing aging through connected health (REACH) study: study protocol for a quasi-experimental clinical trial.

BACKGROUND: Mobility limitations among older adults increase the risk for disability and healthcare utilization. Rehabilitative care is identified as the most efficacious treatment for maintaining physical function. However, there is insufficient evidence identifying a healthcare model that targets prevention of mobility decline among older adults. The objective of this study is to evaluate the preliminary effectiveness of a physical therapy program, augmented with mobile tele-health technology, on mobility function and healthcare utilization among older adults. METHODS: This is a quasi-experimental 12-month clinical trial conducted within a metropolitan-based healthcare system in the northeastern United States. It is in parallel with an existing longitudinal cohort study evaluating mobility decline among community-dwelling older adult primary care patients over one year. Seventy-five older adults (≥ 65-95 years) are being recruited using identical inclusion/exclusion criteria to the cohort study. Three aims will be evaluated: the effect of our program on 1) physical function, 2) healthcare utilization, and 3) healthcare costs. Changes in patient-reported function over 1 year in those receiving the intervention (aim 1) will be compared to propensity score matched controls (N = 150) from the cohort study. For aims 2 and 3, propensity scores, derived from logistic regression model that includes demographic and diagnostic information available through claims and enrollment information, will be used to match treatment and control patients in a ratio of 1:2 or 1:3 from a Medicare Claims Registry derived from the same geographic region. The intervention consists of a one-year physical therapy program that is divided between a combination of outpatient and home visits (6-10 total visits) and is augmented on a computerized tablet using of a commercially available application to deliver a progressive home-based exercise program emphasizing lower-extremity function and a walking program. DISCUSSION: Incorporating mobile health into current healthcare models of rehabilitative care has the potential to decrease hospital visits and provide a longer duration of care. If the hypotheses are supported and demonstrate improved mobility and reduced healthcare utilization, this innovative care model would be applicable for optimizing the maintenance of functional independence among community-dwelling older adults. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT02580409 (Date of registration October 14, 2015).

Reliability, Validity, and Minimal Detectable Change of Four-Step Stair Climb Power Test in Community-Dwelling Older Adults.

BACKGROUND: Stair climb power is an important clinical measure of lower-extremity power. The stair climb power test (SCPT) was validated by requiring individuals to climb a full flight of stairs. A 4-step SCPT (4SCPT) would be more clinically feasible and easier to perform, yet its reliability and validity are unknown. OBJECTIVE: To evaluate reliability, validity, and minimal detectable change of 4SCPT among community-dwelling older adults. DESIGN: This study is a cross-sectional analysis of baseline data from a clinical trial. METHODS: Fifty older adults ≥65 years of age, at risk for mobility decline, consented to participate in this ancillary study. Test-retest reliability was derived from 2 measurements within each participant measured by a single assessor. Pearson correlation analyses among leg power measures (4SCPT, SCPT, single leg press power at 40% and 70% of the 1-repetition maximum [SLP40, SLP70]) were performed. Separate multivariate linear regressions were conducted evaluating the associations between each leg power measure and 2 mobility outcomes, the Short Physical Performance Battery (SPPB) and habitual gait speed (HGS). Minimal detectable change was based on a 90% confidence interval (MDC 90 ). RESULTS: The 4SCPT had excellent test-retest reliability (ICC(2,1) = 0.951), and strong correlation with SCPT, SLP40, and SLP70 ( r = 0.85-0.96). The 4SCPT explained a greater amount of variance in the SPPB (R 2 = 0.31) than other leg power measurements (R 2 = 0.23-0.25). The 4SCPT (R 2 = 0.41) and SCPT (R 2 = 0.42) described equivalent amounts of variance in HGS, and greater than that with SLP40 (R 2 = 0.28) and SLP70 (R 2 = 0.30). The MDC 90 for 4SCPT was 44.0 watts. LIMITATIONS: This was a cross-sectional analysis within a small, nonrepresentative sample. Interrater reliability was not evaluated. CONCLUSIONS: The 4SCPT shows scientific promise as a valid and reliable leg power measurement among community-dwelling older adults.

Evaluation of an Outpatient Rehabilitative Program to Address Mobility Limitations Among Older Adults.

Live Long Walk Strong is a clinical demonstration program for community-dwelling older patients. It was designed to be consistent with current fall prevention guidelines and reimbursed under the Medicare model. Patients were screened within primary care and referred to a physiatrist followed by systematic assessment and treatment within an outpatient rehabilitative care setting. The treatment included behavioral modification, fall prevention education, community/home exercise integration, and exercise targeting strength, power, flexibility, balance, and endurance. Treatment duration and frequency varied with each patient based on baseline presentation, clinical judgment, and patient preference. Program feasibility and preliminary effectiveness were evaluated by assessing participation and changes in physical performance, respectively. There were 266 patients referred to the program, and 147 were willing to participate. Of these, 116 patients completed all scheduled visits (10.8 ± 3.9 visits). The noncompleters (n = 31) had a higher rate of falls in the previous 6 months and lower baseline Short Physical Performance Battery composite score. At the completion of care, the adjusted mean change in Short Physical Performance Battery was 1.66 units, surpassing a large clinically meaningful threshold (1 unit). The Live Long Walk Strong program appears to be feasible to implement and demonstrates preliminary effectiveness in enhancing mobility among older adults.

The prevalence of anxiety and associated factors in a multiracial sample of older adults.

OBJECTIVE: Few multiracial epidemiological community-based studies of anxiety have been conducted with older adults. This study examined the prevalence of subsyndromal and syndromal anxiety and associated factors among older persons living in an urban area. METHODS: Persons aged 55 years and over (214 Caucasian and 860 black) living in Brooklyn, New York, between 1996 and 1999 were interviewed in randomly selected block groups. The researchers used an adaptation of George's social antecedent model to examine the association of 18 variables with anxiety. Syndromal anxiety was defined as a score of 50 or higher on the Anxiety Status Inventory Scale (ASIS). Subsyndromal anxiety was defined as an ASIS score under 50 and a positive response on three or more ASIS items, including at least one worry item. The sample was weighted by race and gender on the basis of 1990 census totals. RESULTS: The prevalence of syndromal and subsyndromal anxiety was 2.3 and 13.3 percent, respectively. With binary logistic regression analysis, persons rated as having syndromal anxiety differed from nonanxious individuals on ten of the 18 variables and persons with subsyndromal anxiety differed on seven. The anxiety groups differed from each other on three variables. In the past year, 23 and 12 percent of persons with syndromal and subsyndromal anxiety, respectively, reported seeking mental health assistance. CONCLUSIONS: About 14 percent of older adults have anxiety, and much of it is untreated. Anxious and nonanxious individuals have substantial differences in psychosocial and health-related variables. Older adults who have subsyndromal anxiety can be viewed as distinct from nonanxious older individuals.

The prevalence of phobia and its associated factors in a multiracial aging urban population.

OBJECTIVE: There have been few multiracial epidemiologic community-based studies of phobia in older adults. The aim of this study was to determine the prevalence of phobia and associated factors among older persons living in a northeastern urban area. METHODS: Using 1990 census data for Brooklyn, NY, the authors attempted to interview all persons age 55+ in randomly selected block groups. The final sample consisted of 214 whites and 860 blacks. The authors used an adaptation of George's Social Antecedent Model for examining the association of 18 individual variables and one interactive variable with the presence of a phobia. The dependent variable was derived from the Guy's/Age Concern community survey. The sample was weighted by race and gender. To control for design effects, the authors used SUDAAN for the data analysis. RESULTS: A total of 8.9% of the sample met criteria for a current phobia and 10.2% met phobia criteria at some time during their life. Using logistic regression analysis, the authors found six variables-higher personal income, more depressive symptoms, poorer physical health, use of prayer as a coping strategy, use of spiritualists or their products, and not having been raised by both parents-to be significantly associated with a current phobia. CONCLUSION: The prevalence rate of phobia was comparable to rates for older adults in the urban areas of the Epidemiologic Catchment Area study suggesting that prevalence has remained stable over the past two decades. Consistent with earlier studies, there were significant associations among phobia, depressive symptoms, and physical illness. Many of the demographic and social variables, including race, that had been reported previously to be associated with phobias in younger samples were not significant in this study.

Racial differences in syndromal and subsyndromal depression in an older urban population.

OBJECTIVE: The authors explored racial differences in the prevalence of depression and its associated factors among older persons. METHODS: Using 1990 census data for Brooklyn, New York, the authors attempted to interview all cognitively intact persons age 55 years and older in randomly selected block groups. The sample was weighted by ethnicity and gender. The authors adapted George's Social Antecedent Model of Depression to allow examination of 20 independent variables and the nominal dependent variable consisting of three levels of depression. The data were analyzed with SUDAAN. RESULTS: Syndromal depression was found among 8 percent of blacks and 10 percent of whites. Subsyndromal depression was found among 13 percent of blacks and 28 percent of whites. No racial differences were found in rates of syndromal depression, but significant racial differences were found in rates of subsyndromal depression and of any type of depression. Nonlinear effects on both types of depression were found, and higher levels of stress had a greater impact on whites than on blacks. The racial difference in subsyndromal depression was explained by its lower prevalence among French-speaking African Caribbeans. Many racial differences were found in the variables associated with syndromal and subsyndromal depression. CONCLUSIONS: Race had an independent effect on the rate of subsyndromal depression and an interactive effect with stress on the rate of both syndromal and subsyndromal depression. For each racial group, different elements may play a role in the etiology, maintenance, and relief of depression. The findings underscore the importance of recognizing within-group and between-group racial differences in depression.

Comparison of users and non-users of mental health services among depressed, older, urban African Americans.

OBJECTIVE: The authors sought to determine differences between depressed older black residents in an urban community who do and do not use formal mental health services. METHODS: The Treatment Group (TG) consisted of 106 black patients age >or=55 with a diagnosis of depression who were recruited from outpatient psychiatric programs in Brooklyn, NY. The Untreated Community Group (UCG) consisted of 101 cognitively intact black subjects age >or=55 from randomly selected block groups in Brooklyn who met symptom criteria for major or minor depression and had no previous history of psychiatric treatment. RESULTS: In logistic regression analysis, TG persons were significantly more likely than the UCG persons to be female, younger, born in the United States, to have impaired daily functioning, have a family history of mental illness, and believe that environmental factors and religious activities could influence mental illness. TG persons were significantly less likely to have social network members who provided advice, to use spiritualists or their products, to have vision or hearing impairments, and to have depressive symptoms. Although most UCG persons visited their doctor at least three times annually, only 11% reported using these physicians for help with mental health problems. CONCLUSIONS: A combination of demographic and attitudinal factors, family psychiatric history, social supports, and functional impairments were associated with the use of mental health services. Despite reluctance of persons in the UCG to use primary-care physicians for mental health reasons, the latter remain the most feasible intervention point within the existing service system.

Racial differences in paranoid ideation and psychoses in an older urban population.

OBJECTIVE: This study examined whether there are racial differences in the prevalence of paranoid ideation and psychotic symptoms in persons age >/=55 in an urban community. METHOD: Using 1990 census data for Brooklyn, N.Y., the authors attempted to interview all cognitively intact persons age >/=55 in randomly selected blocks. The final group consisted of 206 whites and 821 blacks. The authors used George's Social Antecedent Model for analyzing 21 independent and three dependent variables: paranoid ideation, psychotic symptoms, and psychotic symptoms/paranoid ideation. The group was weighted by race and gender. To control for intrablock clustering effects without replacement sampling, the authors used SUDAAN for data analysis. RESULTS: A significant difference in psychotic symptoms or paranoid ideation was found between blacks and whites (24% versus 10%) that was attenuated but not eliminated with logistic regression analyses. Blacks with psychotic symptoms or paranoid ideation, especially Caribbeans, had significantly lower receipt of mental health services and lower perceived service needs. With logistic regression, psychotic symptoms and paranoid ideation were associated with four variables among blacks and whites, although only one was significant in both groups. CONCLUSIONS: Racial differences in psychotic symptoms and paranoid ideation persist even after control for various clinical, social, and attitudinal effects. Among blacks, response to stressors may be expressed through increased paranoid ideation and psychotic symptoms. Stronger beliefs in spiritualism increase this expression in both races. The high prevalence of psychotic symptoms or paranoid ideation among this aging urban population, especially blacks, highlights a potential public health issue.