Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study.

BACKGROUND: Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. OBJECTIVE: This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. METHODS: We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. RESULTS: Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. CONCLUSIONS: The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.

Additive effect of transcranial direct current stimulation (tDCS) in combination with multicomponent training on elderly physical function capacity: a randomized, triple blind, controlled trial.

PURPOSE: To evaluate the additive effect of Transcranial Direct Current Stimulation (tDCS) associated with multi-component training (MT) on the functional capacity (FC) of older adults and to assess whether these effects remain after the end of training. The secondary objectives were to evaluate the locomotion capacity, balance, functional independence, and quality of life and correlate them with functional capacity. METHODOLOGY: Twenty-eight older adults were randomized into two groups: experimental (MT associated with active tDCS - a-tDCS) and control (MT associated with sham tDCS - s-tDCS). The FC was measured by the Glittre-ADL test, locomotion capacity by the 6-minute walk test, balance by the BESTest, functional independence by the FIM, and quality of life by the WHQOL. The assessments were performed pre-, post-intervention, and 30-day follow-up. RESULTS: There was a significant decrease in the time to the Glittre-ADL test when comparing the a-tDCS and s-tDCS groups after the interventions (139.77 ± 21.62, 205.10 ± 43.02, p < .001) and at the 30-day follow-up (142.74 ± 17.12, 219.55 ± 54.05, p < .001), respectively. There was a moderate correlation between FC and locomotion capacity and balance. CONCLUSIONS: The addition of tDCS potentiated the results of MT to impact FC, maintaining the positive results longer. Locomotion and balance influenced the improvement of functional capacity.

SmokeMon: Unobtrusive Extraction of Smoking Topography Using Wearable Energy-Efficient Thermal.

Smoking is the leading cause of preventable death worldwide. Cigarette smoke includes thousands of chemicals that are harmful and cause tobacco-related diseases. To date, the causality between human exposure to specific compounds and the harmful effects is unknown. A first step in closing the gap in knowledge has been measuring smoking topography, or how the smoker smokes the cigarette (puffs, puff volume, and duration). However, current gold-standard approaches to smoking topography involve expensive, bulky, and obtrusive sensor devices, creating unnatural smoking behavior and preventing their potential for real-time interventions in the wild. Although motion-based wearable sensors and their corresponding machine-learned models have shown promise in unobtrusively tracking smoking gestures, they are notorious for confounding smoking with other similar hand-to-mouth gestures such as eating and drinking. In this paper, we present SmokeMon, a chest-worn thermal-sensing wearable system that can capture spatial, temporal, and thermal information around the wearer and cigarette all day to unobtrusively and passively detect smoking events. We also developed a deep learning-based framework to extract puffs and smoking topography. We evaluate SmokeMon in both controlled and free-living experiments with a total of 19 participants, more than 110 hours of data, and 115 smoking sessions achieving an F1-score of 0.9 for puff detection in the laboratory and 0.8 in the wild. By providing SmokeMon as an open platform, we provide measurement of smoking topography in free-living settings to enable testing of smoking topography in the real world, with potential to facilitate timely smoking cessation interventions.

Perceptions of older adults living in long-term care institutions regarding recreational physiotherapy: a qualitative study.

Background: Long-term care institutions (LTCIs) present a limiting environment. Physiotherapy through recreational exercises can stimulate older adults.Objective: To explore LTCIs residents' perceptions regarding recreational physiotherapy.Method: This is a descriptive qualitative study. Participants included older adults living in two LTCIs, who took part in recreational physiotherapy and did not display severe communication problems or cognitive deficits. The activity was regularly offered in both LTCIs. Semi-structured interviews were audio-recorded to analyze the participants' perceptions of physiotherapy. We also observed video footage of the participants' behaviors during one session of the recreational activity. The audio recordings were transcribed, and content analysis was conducted with MAXQDA 12®.Results: Nine older adults participated, the majority women (n = 6), with a mean age of 83.8 ± 7.4 years. The interviews' average duration was about 30 minutes. The reports revealed three themes. In the "activity for myself" theme, participants discussed issues related to their own old age. In the "activity with others" theme, participants reported physiotherapy's value for providing sense of collectivity. In the "activity itself" theme, the components of physiotherapy and their benefits were evaluated. Observation of the video recording revealed that each resident engaged in the activity at their own pace and within their capabilities.Conclusions: The experience of older adults living in LTCIs showed that the regularly practicing physical exercises in recreational group, strengthens social bonds and provides physical and emotional well-being. When formulating and executing physiotherapy in the context of LTCIs, professionals should consider the residents' perceptions of the practice.

Liver transplantation in undifferentiated embryonal sarcoma of the liver in adults: a case report / Transplante hepático em sarcoma embrionário indiferenciado de fígado em adultos: relato de caso

Undifferentiated embryonal sarcoma of the liver (UESL) consists of a rare malignant neoplasm with a still poorly known etiopathogenesis, affecting mostly children between the ages of 6 and 10 years. It corresponds to 7% of primary liver tumors, and is the fourth most common liver cancer in pediatrics. The diagnosis of UESL is based on a set of imaging findings, age and level of alpha-fetoprotein (AFP), which is usually normal, as well as liver function tests. Early diagnosis is hampered by non-specific symptoms, such as abdominal pain, a rapidly growing palpable abdominal mass, fever, weight loss, and gastrointestinal symptoms. The most characteristic image finding is that of a large, unique, and well-defined mass. Ultrasonography shows a predominantly solid and echogenic mass. Computed tomography, on the other hand, shows a mass that takes on a mainly cystic characteristic. Histologically, myxoid tissue with spindle-shaped neoplastic cells is evidenced. Some immunohistochemical studies indicate UESL mesenchymal origin. The macroscopic aspect of the tumor appears as a large hepatic mass, with a predominantly solid component, with some cystic areas, hemorrhage, and necrosis in up to 80% of its surface. The best approach for the treatment of primary liver sarcoma is not yet well defined. Therapeutic options include surgical resection, chemotherapy, radiotherapy, and liver transplantation (LT). However, in cases of unresectable tumors, LT is an option that must be considered, since in this histological type both chemotherapy and radiotherapy have questionable benefits. This article aims to report a case of giant UESL, with vascular invasion, submitted to LT with good postoperative evolution and without signs of recurrence after nine months of LT.

O sarcoma embrionário indiferenciado de fígado (SEIF) consiste em uma neoplasia maligna rara com etiopatogenia ainda pouco conhecida, acometendo em sua maioria crianças na faixa etária entre 6 e 10 anos. Corresponde a 7% dos tumores primários de fígado, e é a quarta neoplasia hepática mais frequente na pediatria. O diagnóstico do SEIF se dá em um conjunto de achados de imagem, idade e nível de alfa-fetoproteína (AF), que geralmente está normal, assim como as provas de função hepática. O diagnóstico precoce é prejudicado pelos sintomas inespecíficos, como dor abdominal, massa abdominal palpável de rápido crescimento, febre, perda de peso e sintomas gastrintestinais. O achado de imagem mais característico é o de massa grande, única e bem-delimitada. A ultrassonografia mostra massa predominantemente sólida e ecogênica. Já a tomografia computadorizada evidencia uma massa que assume característica principalmente cística. Histologicamente é evidenciado tecido mixoide com células neoplásicas fusiformes. Alguns estudos imuno-histoquímicos indicam origem mesenquimal do SEIF. O aspecto macroscópico do tumor se apresenta como grande massa hepática, de componente sólido predominantemente, com algumas áreas císticas, hemorragia e necrose em até 80% de sua superfície. Ainda não é bem-definida a melhor abordagem para o tratamento do sarcoma primário de fígado. As opções terapêuticas incluem ressecção cirúrgica, quimioterapia, radioterapia e transplante hepático (TH). Porém, nos casos de tumores irressecáveis, o TH é uma opção que deve ser considerada, uma vez que nesse tipo histológico tanto quimioterapia como radioterapia têm benefício questionável. Este artigo tem por objetivo relatar um caso de SEIF gigante, com invasão vascular, submetido a TH com boa evolução pós-operatória e sem sinais de recidiva após nove meses de TH.

Effect of transcranial direct current stimulation and multicomponent training on functional capacity in older adults: protocol for a randomized, controlled, double-blind clinical trial.

INTRODUCTION: When physical activity contains training of at least three components such as balance, coordination and strength, among others, it is called multicomponent training. This type of training is recommended for improving the functional capacity in elderly individuals but has no lasting effects. The association of transcranial direct current stimulation (tDCS) with other types of therapy has been shown to facilitate the enhancement and prolongation of therapy outcomes. AIM: The objective of this study is to evaluate the effect of multicomponent training associated with active or sham tDCS on the performance of functional capacity in the elderly before treatment, after treatment and 30 days after the end of treatment. The secondary objective will be to correlate the performance of the primary outcome (functional capacity assessed by the Glittre Daily Life Activity Test) with walking capacity (by 6-min walk test), balance (with the mini-Balance Evaluation Systems Test), functional independence (by the Functional Independence Measure) and quality of life (with the World Health Organization Quality of Life Instrument). METHODS: Twenty-eight elderly people from the community will participate in the study, and will be randomized into two groups: 1) multicomponent training associated with active tDCS; and 2) multicomponent training associated with sham tDCS. The multicomponent training sessions will be held twice a week for 12 weeks, totaling 24 sessions. The tDCS will be administered over the dominant dorsolateral prefrontal cortex at the same time as multicomponent training, with an intensity of 2 mA, for 20 min. The evaluations will be made pretraining, after 24 training sessions and 30 days after the end of the training. DISCUSSION: We hypothesize that tDCS, when associated with multicomponent training, can potentiate and prolong the effects of this training on the functional capacity of the elderly. If this hypothesis is confirmed, this protocol may contribute to a longer-lasting physical rehabilitation of the elderly, encouraging them to maintain their independent daily activities for longer. TRIAL REGISTRATION: The study was registered in the Brazilian Clinical Trial Registry (RBR-2crd42) and received approval from the Human Research Ethics Committee of University Nove de Julho, São Paulo, Brazil (process number 3.077.953).