Patients' and caregivers' perceptions of the quality of hospital-at-home service: A scoping review.

AIM: This scoping review aims to provide an overview of patients and caregivers perceptions of hospital-at-home (HaH) services. BACKGROUND: HaH services provide patients with hospital-level care at home and are central to integrated healthcare systems. Despite favourable data from individual studies in the literature, in-depth analysis from patient and caregivers perspectives is lacking. This understanding is essential for the dissemination and scaling of HaH services. DESIGN: The scoping review was performed using the PRISMA-ScR checklist and PAGER framework for the findings report and research recommendations. METHOD: Literature from PubMed, Web of Science, Ovid, CINAHL, Cochrane and Mednar databases were searched. Relevant studies published between 1st January 2005 and 31st December 2022 were identified. The conceptual model of the development of patient perceptions of quality was used for data extraction and tabulation. RESULTS: The review included 24 articles. Expectation attributions were identified as needs, types of service, hospitalisation experiences, family care preferences, social-demographics and coping skills. From patient's and caregiver's perspectives, HaH was safe, effective and viewed positively. Perceived concerns/barriers and enablers/facilitators were associated with individual, caregiver and system factors, but demonstrated an overall satisfaction in the HaH service. CONCLUSION: HaH provides an excellent service according to patients' and caregivers' perceptions. However, gaps in care were identified such as prioritising patient-centred care, along with improved multidisciplinary continuity of care and future studies should incorporate these into their research of HaH. RELEVANCE TO CLINICAL PRACTICE: Patients' and caregivers' HaH needs should be embedded in the design, development and implementation of HaH services. PATIENT AND PUBLIC CONTRIBUTION: Not applicable for the study design of this scoping review.

ADGRA1 negatively regulates energy expenditure and thermogenesis through both sympathetic nervous system and hypothalamus-pituitary-thyroid axis in male mice.

Adhesion G protein-coupled receptor A1 (ADGRA1, also known as GPR123) belongs to the G protein-coupled receptors (GPCRs) family and is well conserved in the vertebrate lineage. However, the structure of ADGRA1 is unique and its physiological function remains unknown. Previous studies have shown that Adgra1 is predominantly expressed in the central nervous system (CNS), indicating its important role in the transduction of neural signals. The aim of this study is to investigate the central function of Adgra1 in vivo and clarify its physiological significance by establishing an Adgra1-deficient mouse (Adgra1-/-) model. The results show that Adgra1-/- male mice exhibit decreased body weight with normal food intake and locomotion, shrinkage of body mass, increased lipolysis, and hypermetabolic activity. Meanwhile, mutant male mice present elevated core temperature coupled with resistance to hypothermia upon cold stimulus. Further studies show that tyrosine hydroxylase (TH) and ß3-adrenergic receptor (ß3-AR), indicators of sympathetic nerve excitability, are activated as well as their downstream molecules including uncoupling protein 1 (UCP1), coactivator 1 alpha (PGC1-α) in brown adipose tissue (BAT), and hormone-sensitive lipase (HSL) in white adipose tissue (WAT). In addition, mutant male mice have higher levels of serum T3, T4, accompanied by increased mRNAs of hypothalamus-pituitary-thyroid axis. Finally, Adgra1-/- male mice present abnormal activation of PI3K/AKT/GSK3ß and MEK/ERK pathways in hypothalamus. Overexpression of ADGRA1 in Neuro2A cell line appears to suppress these two signaling pathways. In contrast, Adgra1-/- female mice show comparable body weight along with normal metabolic process to their sex-matched controls. Collectively, ADGRA1 is a negative regulator of sympathetic nervous system (SNS) and hypothalamus-pituitary-thyroid axis by regulating PI3K/AKT/GSK3ß and MEK/ERK pathways in hypothalamus of male mice, suggesting an important role of ADGRA1 in maintaining metabolic homeostasis including energy expenditure and thermogenic balance.

Associating modifiable lifestyle factors with multimorbidity in community dwelling individuals from mainland China.

AIMS: Lifestyle factors have been well-established as essential targets for fighting individual chronic diseases, but little research has concentrated on multimorbidity from the perspective of multiple lifestyle factors in the Chinese population. Thus, this study aimed to explore the associations of lifestyle factors with the occurrence of multimorbidity. METHODS AND RESULTS: Cross-sectional data retrieved from the China Health and Retirement Longitudinal Study were used for analysis. Multimorbidity was calculated on a simple count of self-reported chronic conditions. Lifestyle factors included sleep duration, physical activity, alcohol intake, smoking status, and body mass index. Logistic regression analysis was used to examine the independent and accumulating effects of lifestyle factors on multimorbidity. Latent class analysis was performed to explore the lifestyle patterns. Six thousand, five hundred, and ninety-one valid subjects were included for analysis. Overall, the community dweller's median number of chronic conditions was 1 (range 1-11) and median number of high-risk lifestyle factors was 2 (range 0-5). All lifestyle factors were associated with the occurrence of multimorbidity but varied between genders. We also identified that participants who accumulated more unhealthy lifestyle factors having a higher likelihood of multimorbidity. 'Physical activity and weight', 'smoke and drink', and 'sleep and weight' dominated high-risk lifestyles were the most common lifestyle patterns. CONCLUSION: This study revealed the associations of unhealthy lifestyle factors and their accumulating effect with multimorbidity in Chinese community dwellers. Three common lifestyle patterns indicated that a holistic approach focused on engaging and changing multiple modifiable lifestyle behaviours within an individual might be more effective in managing multimorbidity.

Tea Consumption and Cognitive Impairment: A Cross-Sectional Study among Chinese Elderly.

BACKGROUND: Laboratorial and epidemiological researches suggested that tea exhibited potential neuroprotective effect which may prevent cognitive impairment, but there were few data among the elderly aged 60 years and above in China. OBJECTIVE: The objective was to explore the relationship between characteristics of tea consumption and cognitive impairment. DESIGN: We analyzed the baseline data from Zhejiang Major Public Health Surveillance Program (ZPHS) which was conducted in 2014. Totally 9,375 residents aged 60 years and above were recruited in this study. Face-to-face interview based on a self-developed questionnaire was performed for each participant. Detailed tea consumption habits were included in the questionnaire. Cognitive impairment screening was performed by using Mini-Mental State Examination (MMSE). Education-specific cut-off points for Chinese were applied to determine the status of cognitive impairment. Logistic regression analysis was used to calculate odds ratios (ORs) of cognitive impairment associated with tea consumption. RESULTS: The means (SD) of MMSE scores for the subjects who did not consume tea and consumed <2 cups/d, 2-4 cups/d, ≥4 cups/d were 23.3 (SD = 5.61), 23.8 (SD = 5.60), 24.5 (SD = 5.63) and 25.0 (SD = 5.08), respectively. An inverse correlation was found between tea consumption (of all types) and prevalence of cognitive impairment. Volume of tea consumption was significantly associated with cognitive impairment: compared with non-consumption participants, those who consumed < 2 cups/d, 2-4 cups/d, and ≥4 cups/d were observed ORs of 0.77 (95% CI: 0.56, 1.07), 0.62 (95% CI: 0.47, 0.81), and 0.49 (95% CI: 0.36, 0.66), respectively. Compared with non-consumption, black tea presented a positive correlation with cognitive function after controlling for potential confounders (OR = 0.52, 95% CI: 0.28, 0.95), while green tea showed no significant difference (OR = 1.04, 95% CI: 0.72, 1.51). Participants who consumed weak tea, moderate tea or strong tea more often were observed a better cognitive status when compared with those who did not have tea, with an OR of 0.51 (95% CI: 0.28, 0.92), 0.32 (95% CI: 0.19, 0.56) and 0.42 (95% CI: 0.22, 0.78) after adjusting for the potential confounders. But there was no statistically significant difference between any two of these ORs. CONCLUSION: Black tea consumption was association with better cognitive performance among the elderly aged 60 years and above in China, while green tea presented no correlation. The positive association of cognitive status with tea consumption was not limited to particular type of concentration.