Reducing Loneliness and Social Isolation of Older Adults Through Voice Assistants: Literature Review and Bibliometric Analysis.

BACKGROUND: Loneliness and social isolation are major public health concerns for older adults, with severe mental and physical health consequences. New technologies may have a great impact in providing support to the daily lives of older adults and addressing the many challenges they face. In this scenario, technologies based on voice assistants (VAs) are of great interest and potential benefit in reducing loneliness and social isolation in this population, because they could overcome existing barriers with other digital technologies through easier and more natural human-computer interaction. OBJECTIVE: This study aims to investigate the use of VAs to reduce loneliness and social isolation of older adults by performing a systematic literature review and a bibliometric cluster mapping analysis. METHODS: We searched PubMed, Embase, and Scopus databases for articles that were published in the last 6 years, related to the following main topics: voice interface, VA, older adults, isolation, and loneliness. A total of 40 articles were found, of which 16 (40%) were included in this review. The included articles were then assessed through a qualitative scoring method and summarized. Finally, a bibliometric analysis was conducted using VOSviewer software (Leiden University's Centre for Science and Technology Studies). RESULTS: Of the 16 articles included in the review, only 2 (13%) were considered of poor methodological quality, whereas 9 (56%) were of medium quality and 5 (31%) were of high quality. Finally, through bibliometric analysis, 221 keywords were extracted, of which 36 (16%) were selected. The most important keywords, by number of occurrences and by total link strength; results of the analysis with the Association Strength normalization method; and default values were then presented. The final bibliometric network consisted of 36 selected keywords, which were grouped into 3 clusters related to 3 main topics (ie, VA use for social isolation among older adults, the significance of age in the context of loneliness, and the impact of sex factors on well-being). For most of the selected articles, the effect of VA on social isolation and loneliness of older adults was a minor theme. However, more investigations were done on user experience, obtaining preliminary positive results. CONCLUSIONS: Most articles on the use of VAs by older adults to reduce social isolation and loneliness focus on usability, acceptability, or user experience. Nevertheless, studies directly addressing the impact that using a VA has on the social isolation and loneliness of older adults find positive and promising results and provide important information for future research, interventions, and policy development in the field of geriatric care and technology.

Exhaustive Description of the System Architecture and Prototype Implementation of an IoT-Based eHealth Biometric Monitoring System for Elders in Independent Living.

In this paper, we present an exhaustive description of an extensible e-Health Internet-connected embedded system, which allows the measurement of three biometric parameters: pulse rate, oxygen saturation and temperature, via several wired and wireless sensors residing to the realm of Noncommunicable Diseases (NCDs) and cognitive assessment through Choice Reaction Time (CRT) analysis. The hardware used is based on ATMEGA AVR + MySignals Hardware printed circuit board (Hardware PCB), but with multiple upgrades (including porting from ATMEGA328P to ATMEGA2560). Multiple software improvements were made (by writing high-level device drivers, text-mode and graphic-mode display driver) for increasing functionality, portability, speed, and latency. A top-level embedded application was developed and benchmarked. A custom wireless AT command firmware was developed, based on ESP8266 firmware to allow AP-mode configuration and single-command JavaScript Object Notation (JSON) data-packet pushing towards the cloud platform. All software is available in a git repository, including the measurement results. The proposed eHealth system provides with specific NCDs and cognitive views fostering the potential to exploit correlations between physiological and cognitive data and to generate predictive analysis in the field of eldercare.

Clinical, economic, and humanistic burden of asthma in Canada: a systematic review.

BACKGROUND: Asthma, one of the most common chronic respiratory diseases, affects about 3 million Canadians. The objective of this study is to provide a comprehensive evaluation of the published literature that reports on the clinical, economic, and humanistic burden of asthma in Canada. METHODS: A search of the PubMed, EMBASE, and EMCare databases was conducted to identify original research published between 2000 and 2011 on the burden of asthma in Canada. Controlled vocabulary with "asthma" as the main search concept was used. Searches were limited to articles written in English, involving human subjects and restricted to Canada. Articles were selected for inclusion based on predefined criteria like appropriate study design, disease state, and outcome measures. Key data elements, including year and type of research, number of study subjects, characteristics of study population, outcomes evaluated, results, and overall conclusions of the study, were abstracted and tabulated. RESULTS: Thirty-three of the 570 articles identified by the clinical and economic burden literature searches and 14 of the 309 articles identified by the humanistic burden literature searches met the requirements for inclusion in this review. The included studies highlighted the significant clinical burden of asthma and show high rates of healthcare resource utilization among asthma patients (hospitalizations, ED, physician visits, and prescription medication use). The economic burden is also high, with direct costs ranging from an average annual cost of $366 to $647 per patient and a total annual population-level cost ranging from ~ $46 million in British Columbia to ~ $141 million in Ontario. Indirect costs due to time loss from work, productivity loss, and functional impairment increase the overall burden. Although there is limited research on the humanistic burden of asthma, studies show a high (31%-50%) prevalence of psychological distress and diminished QoL among asthma patients relative to subjects without asthma. CONCLUSIONS: As new therapies for asthma become available, economic evaluations and assessment of clinical and humanistic burden will become increasingly important. This report provides a comprehensive resource for health technology assessment that will assist decision making on asthma treatment selection and management guidelines in Canada.

Applications for oral research in microgravity - lessons learned from burning mouth syndrome and ageing studies.

The negative consequences of microgravity for the human body are central aspects of space travel that raise health problems. Altered functions of the same systems and treatment options are common points of spaceflight physiology, age-related diseases, and oral medicine. This work emphasizes the convergence of knowledge between pathophysiological changes brought on by aging, physiological reactions to microgravity exposure, and non-pharmacological and non-invasive treatment methods that can be used in spaceflight. Sarcopenia, peripheral nerves alterations, neuromotor plaque in the masticatory muscles, lingual, labial, and buccal weakness, nociplastic pain in oral mucosal diseases, and microgravity, as well as soft tissue changes and pathologies related to chewing and swallowing, corticomotor neuroplasticity of tongue, and swallowing biomechanics, are of particular interest to us. Neurologic disease and other pathologies such as recovery from post-stroke dysphagia, nociplastic pain in glossodynia, sleep bruxism, and obstructive sleep apnea have been studied and, in some cases, successfully treated with non-invasive direct and transcranial magnetic stimulation (TMS) methods in recent decades. An interdisciplinary team from medical specialties, engineering, and biophysics propose an exploratory study based on the parallelism of ageing and space physiology, along with experiment scenarios considering TMS and non-invasive direct methods.

Striated Muscle Evaluation Based on Velocity and Amortization Ratio of Mechanical Impulse Propagation in Simulated Microgravity Environment.

Long-duration space flight missions impose extreme physiological stress and/or changes, such as musculoskeletal function degradation, on the crew due to the microgravity exposure. A great deal of research studies have been conducted in order to understand these physiological stress influences and to provide countermeasures to minimize the observed negative effects of weightlessness exposure on musculoskeletal function. Among others, studies and experiments have been conducted in DI analogue Earth-based facilities in order to reproduce the weightlessness negative effects on the human body. This paper presents a complex muscular analysis of mechanical wave propagation in striated muscle, using MusTone, a device developed in-house at the Institute of Space Science, Romania. The data were collected during a 21-day DI campaign in order to investigate muscle fibers' behavior in longitudinal direction, after applying a mechanical impulse, taking into account two particular parameters, namely propagation velocity and amortization ratio. The parameters were determined based on the wave-propagation data collected from five points (one impact point, two distal direction points, and two proximal direction points) along the muscle fiber. By statistically analyzing propagation velocity and amortization ratio parameters, the study revealed that muscle deconditioning is time dependent, the amortization ratio is more significant in the distal direction, and the lower fibers are affected the most.

A Technology-Based Intervention to Support Older Adults in Living Independently: Protocol for a Cross-National Feasibility Pilot.

Innovative technologies can support older adults with or without disabilities, allowing them to live independently in their environment whilst monitoring their health and safety conditions and thereby reducing the significant burden on caregivers, whether family or professional. This paper discusses the design of a study protocol to evaluate the acceptance, usability, and efficiency of the SAVE system, a custom-developed information technology-based elderly care system. The study will involve older adults (aged 65 or older), professional and lay caregivers, and care service decision-makers representing all types of users in a care service scenario. The SAVE environmental sensors, smartwatches, smartphones, and Web service application will be evaluated in people's homes situated in Romania, Italy, and Hungary with a total of 165 users of the three types (cares, elderly, and admin). The study design follows the mixed method approach, using standardized tests and questionnaires with open-ended questions and logging all the data for evaluation. The trial is registered to the platform ClinicalTrials.gov with the registration number NCT05626556. This protocol not only guides the participating countries but can be a feasibility protocol suitable for evaluating the usability and quality of similar systems.

SARS-CoV-2 Infection in Seven Childbearing Women at the Moment of Delivery, a Romanian Experience.

COVID-19 pandemic outbreak had officially started on 11 March 2020 according to the World Health Organization. In Romania the first case of COVID-19 was documented on 26th of February. Ploiesti Obstetrics and Gynecology Hospital is one of the biggest mono-specialty units from Romania that was designated to deal with COVID-19 infected pregnant women. We retrospectively analyzed seven pregnant women infected with SARS-CoV-2 who gave birth during the 1st July and 30thNovember 2020. The median age of pregnancy was 39 weeks. Three of the childbearing women presented rupture membranes at hospital admission and four gave birth by cesarean section (C-section). The women infected with SARS-CoV-2 had a good evolution, vertical transmission of the virus did not occur, measures to prevent mother-to-child transmission were applied. Apgar score was 9 for all new-born babies and they all tested negative for SARS-CoV-2. There were no maternal deaths. One new born baby was preterm but didn't present low birth weight or low Apgar score. Applying cesarean section as a method of birth did not influence vertical transmission. There is no evidence if it is necessary to anticipate the time of birth. We believe it is recommended to individualize each case according to the experience of the obstetrician and the severity of the maternal infection.

Can Ultrasound Analysis of the Yolk Sac be a Predictor of Pregnancy Outcome?

The Yolk sac is the first source of transfer between the mother and the embryo, with a nutritional and gas exchange function, vital for the development of the embryo, to which we can add primitive hematopoiesis, the production of stem cells and germ cells. Although normal-term pregnancies with abnormal aspects of the yolk sac have been described, the smaller or larger size of the yolk sac is associated with pregnancy loss. Our study aimed to determine whether the yolk sac size change, determined by measuring diameter (2D ultrasonography) or volume (3D ultrasonography), is independently associated with adverse pregnancy outcomes. The results of the study did not show a statistical significance between 2D and 3D measurements with adverse pregnancy outcomes, noting only an abrupt increase in the diameter and volume of the yolk sac preceding pregnancy loss. However, the evaluation of the yolk sac remains an important element in the ultrasound evaluation of pregnancy in the first trimester.

Aspects of oral morphology as decision factors in mini-implant supported overdenture.

AIM: Evaluation of some morphological oral aspects perceived as decision factors in complete edentulism treatment by mini-implants overdenture. PATIENTS, MATERIAL AND METHODS: An observational study was conducted on a sample of 24 patients (average age of 61 years), through clinical and imagistic methods. The variables taken into consideration were: age, gender, alveolar mucosa status, bone offer, mini-implants characteristics, insertion torque and loading type. RESULTS: 117 mini-implants were applied, 59% to the lower jaw and 41% to the upper jaw. On average, there were inserted 5.33 implants to maxilla and 4.6 to mandible. Fifty-seven percent of implants were applied in the interforaminal area. The implants used had 10 mm (28.2%) and 13 mm (71.8%). In only 41% patients, the ridge width was higher than 5 mm (value necessary for conventional implant application). Diameters of implant used were: 1.8 mm (2.56%), 2.1 mm (25.64%) and 2.4 mm (71.8%). Smaller diameters were used in mandible. Only in 16.67% of patients was possible the transmucosal insertion. Bone density was D2 and D3 for men, and D3 and D4 for women. Immediate loading was achieved in 20.5% patients. CONCLUSIONS: Mini-implant supported overdenture can be an alternative to conventional denture and conventional implant overdenture. Its advantages derives from implants' characteristics (smaller diameter, variable length, O-ring retention system), which adapts better to the particular edentulous conditions. Insertion technique implies less surgical trauma. Choosing implants' size, number, topography, and the loading method have a great variety, depending on anatomical feature (bone offer, mucosa and relationship with the nearby anatomical structures), functional features and patients' wishes.

The Implications of the First Trimester 2d and Volumetric Ultrasound in Pregnancy Outcome.

BACKGROUND: The purpose is to investigate the role of the first trimester ultrasound markers: cown rump lengh (CRL), gestational sac volume (GSV), embryonic volume (EV) and yolk sac volume (YSV) as parameters for outcome. METHODS: Observational clinical study that was carried out in the Obstetrics and Gynecology Clinic. The study included a number of 81 unselected patients evaluated from the first trimester. Patients were evaluated in the first trimester by transvaginal ultrasound and followed up during pregnancy. Correlations between the GSV, EV, YSV and CRL was made for assessing outcome. RESULTS: Our study results show that patients with abnormal early ultrasound parameters had a higher incidence of pregnancy complications. CONCLUSIONS: An early pregnancy evaluation can be a helpful tool in predicting outcome.

A Romanian experience of syphilis in pregnancy and childbirth.

OBJECTIVE: to establish the incidence of syphilis in a group of childbearing women and their newborn babies in Romania and to identify the major risk factors of materno-fetal transmission in order for midwives to develop strategies to help prevent congenital syphilis. MATERIAL AND METHODS: a descriptive study of a group of 982 childbearing women who gave birth during a three-month period at an Obstetrics and Gynaecology Hospital in Romania. The women completed a questionnaire, which consisted of three sections: general data, general knowledge of syphilis and birth and pregnancy data. After admission to hospital, the women were investigated for syphilis using serological tests. RESULTS: there was a syphilis frequency of 0.91649% (n = 9) among the surveyed women. Among the nine infected women, two were not aware that they had a syphilis infection when initially admitted to hospital. The maternal profile with the highest risk of being diagnosed with syphilis was a young woman who had not had adequate prenatal care, who had elementary sex education and who lacked knowledge of personal health and hygiene. A significant percentage of the respondents, namely 11.9% (n = 117), were aged 15 to 20. CONCLUSIONS: in certain population groups, syphilis is still an important health care problem, especially in vulnerable individuals, such as childbearing women and newborns babies. More attention needs to be paid to primary prevention; the number of cases of congenital syphilis could be reduced by more involvement of midwifes and family doctors in antenatal care.

[Postoperative early enteral nutrition in a patient with polytrauma and late duodenal perforation]. / Nutritie enterala postoperatorie precoce la un politraumatism cu perforatie duodenala tardiva.

We present the case of a 51 years old multiple injured female patient who was transferred from another hospital. She suffered a car accident and at admission, the diagnosis was anterior flail chest with fractured sternum, blunt abdominal trauma with IIIrd grade kidney laceration, multiple extremities fractures, ISS = 50. We performed emergency nephrectomy, surgical fixation of the flail chest and bilateral pleurostomy. Postoperatively the evolution was difficult, she was intubated and mechanically ventilated. We started early enteral nutrition (EEN), at 24 hours with 20 ml/hour Fresubin (Fresenius-Kabi, Bad Hamburg, Germany) and then with 40 ml/hour. In the fourth postoperative day, CT scan identified no supplementary lesions. In the seventh postoperative day, jaundice became apparent and the CT exam identified gas in the retroperitoneum. At surgery, we identified a IInd degree D2 rupture. We practiced duodenal suture, pyloric exclusion, latero-lateral gastro-entero-anastomosis. We passed a naso-gastro-entero-duodenal tube into D2 for active suction and we performed a fine needle catheter jejunostomy. Difficult postoperative evolution, intubated, febrile, with hemodynamic instability. EEN on the jejunostomy at 20-40-60 ml/hour. 10 days after the reoperation, the general condition ameliorated. Enteral nutrition was continued for 22 days after reoperation. The patient was discharged after 44 days. The particularities of this case are the complexity of the traumatic lesions: anterior costal flail chest, left kidney rupture, late duodenal perforation, multiple extremities fractures (APACHE II score = 34). The treatment involved internal pneumatic stabilization and surgical fixation of the flail chest, duodenal suture with pyloric exclusion and fine needle catheter jejunostomy, left nephrectomy. We consider that the use of EEN was of real help in this case and we recommend it in all polytraumatised patients and in all the cases where it can be used.

Burden of Ocular Surface Disease in Patients With Glaucoma From Australia.

PURPOSE: In the Australian general population, the economic burden of ocular surface disease (OSD) severity and other dry eye-related diagnosis have been conducted; however, the glaucoma population has not been evaluated. We assessed the current OSD economic burden in Australian glaucoma patients. DESIGN: A cross-sectional, case-comparison study that quantified OSD signs and symptoms was conducted. METHODS: Patients with and without glaucoma from an Australian eye hospital participated. Patient-/physician-reported OSD assessment and literature-based cost-of-burden estimates were used to estimate burden of illness from the health care system (direct costs) and societal (indirect costs) perspectives. Ocular surface disease prevalence and costs were estimated. RESULTS: Significant OSD, defined as the presence of 2 or more signs plus 1 or more symptoms reported "often" or "always," was experienced by 39% of patients with glaucoma and 18% of a control group (P < 0.001); both populations had similar prevalence of mild OSD. Significant OSD cost estimates were Australian dollars (AU$) 1061.25 (direct costs) and AU$14078.40 (indirect costs); average (direct and indirect) was AU$6185.79 per patient per year. Based on 39% prevalence rate for significant OSD, estimated total cost to Australian society was AU$330.5 million per annum. CONCLUSIONS: The use of standard OSD definition across research would allow for comparisons between studies and for improved OSD prevalence estimates. In Australia, 39% of patients with glaucoma were found to have significant (moderate/severe) OSD, and the associated economic burden was AU$330.5 million per annum. Additional research evaluating quality of life and assessing actual direct/indirect OSD costs in the Australian population is warranted.

Patients' satisfaction with conventional dentures and mini implant anchored overdentures.

UNLABELLED: The aim of this study was to assess complete edentulous patient satisfactionwith two treatment alternatives--conventional dentures and mini implant anchored overdentures. MATERIALS AND METHODS: Study sample comprised 36 patients--18 treated with newly made conventional prosthesis and 18 with mini implants anchored overdentures, with a ball attachment system (from IMTEC Corporation). RESULTS: Patients treated with mini implant anchored overdenture presented a higher satisfaction regarding chewing ability (all of them reported satisfactory mastication, 50% accusing occasionally discontent) compared with the conventional denture group (28% reported impaired masticatory function and 39% occasionally discontent). Denture's retention was better in the mini implant overdenture sample (only 17% reported occasional problems, none of them feel the need to use denture adhesives), compared to the conventional treatment alternative (28% were dissatisfied about this issue). Both treatment alternatives were seen as being highly satisfactory regarding the aesthetic restoration of facial appearance and for performing phonation. Still, in the complete denture group 22% of patients claimed difficulties in articulating certain phonemes. The main reasons why patients refused implant treatment were its higher cost and fear of surgery. CONCLUSIONS: Patients treated with mini implant anchored overdentures were more satisfied than those treated conventionally, due to the increased retention and stability of dentures, mastication efficiency and improved comfort, these having probably a positive effect on the quality of life.

The burden of illness in patients with moderate to severe chronic obstructive pulmonary disease in Canada.

INTRODUCTION: No recent Canadian studies with physician- and spirometry-confirmed diagnosis of chronic obstructive pulmonary disease (COPD) that assessed the burden of COPD have been published. OBJECTIVE: To assess the costs associated with maintenance therapy and treatment for acute exacerbations of COPD (AECOPD) over a one-year period. METHODS: Respirologists, internists and family practitioners from across Canada enrolled patients with an established diagnosis of moderate to severe COPD (Global initiative for chonic Obstructive Lung Disease stages 2 and 3) confirmed by postbronchodilator spirometry. Patient information and health care resources related to COPD maintenance and physician-documented AECOPD over the previous year were obtained by chart review and patient survey. RESULTS: A total of 285 patients (59.3% male; mean age 70.4 years; mean pack years smoked 45.6; mean duration of COPD 8.2 years; mean postbronchodilator forced expiratory volume in 1 s 58.0% predicted) were enrolled at 23 sites across Canada. The average annual COPD-related cost per patient was $4,147. Across all 285 patients, maintenance costs were $2,475 per patient, of which medications accounted for 71%. AECOPD treatment costs were $1,673 per patient, of which hospitalizations accounted for 82%. Ninety-eight patients (34%) experienced a total of 157 AECOPD. Treatment of these AECOPD included medications and outpatient care, 19 emergency room visits and 40 hospitalizations (mean length of stay 8.9 days). The mean cost per AECOPD was $3,036. DISCUSSION: The current costs associated with moderate and severe COPD are considerable and will increase in the future. Appropriate use of medications and strategies to prevent hospitalizations for AECOPD may reduce COPD-related costs because these were the major cost drivers.

Role of obesity on the risk for total hip or knee arthroplasty.

We asked whether there was an association between obesity levels and subsequent THA or TKA using data from 54,406 THA and TKA patients entered into the Canadian Joint Replacement Registry. We compared these patients with a sample of the Canadian population using the Canadian Community Health Survey of 2006. We analyzed information from the Canadian Joint Replacement Registry to quantify the relative risk for THA or TKA in Canada for specific body mass index categories. In reference to the acceptable weight category of body mass index less than 25 kg/m2, the risk for TKA and THA was 3.20- and 1.92-fold higher, respectively, for overweight individuals (body mass index 25-29.9 kg/m2); 8.53- (TKA) and 3.42-fold (THA) higher for those in the obese Class I (body mass index 30-34.9 kg/m2) category; 18.73- (TKA) and 5.24-fold (THA) higher for those identified in obese Class II (body mass index 35-39.9 kg/m2); and 32.73- (TKA) and 8.56-fold (THA) higher for people in obese Class III group (body mass index > 40 kg/m2). Thus, our data support an association between obesity and subsequent THA and TKA.