Biomechanics beyond the lab: Remote technology for osteoarthritis patient data-A scoping review.

The objective of this project is to produce a review of available and validated technologies suitable for gathering biomechanical and functional research data in patients with osteoarthritis (OA), outside of a traditionally fixed laboratory setting. A scoping review was conducted using defined search terms across three databases (Scopus, Ovid MEDLINE, and PEDro), and additional sources of information from grey literature were added. One author carried out an initial title and abstract review, and two authors independently completed full-text screenings. Out of the total 5,164 articles screened, 75 were included based on inclusion criteria covering a range of technologies in articles published from 2015. These were subsequently categorised by technology type, parameters measured, level of remoteness, and a separate table of commercially available systems. The results concluded that from the growing number of available and emerging technologies, there is a well-established range in use and further in development. Of particular note are the wide-ranging available inertial measurement unit systems and the breadth of technology available to record basic gait spatiotemporal measures with highly beneficial and informative functional outputs. With the majority of technologies categorised as suitable for part-remote use, the number of technologies that are usable and fully remote is rare and they usually employ smartphone software to enable this. With many systems being developed for camera-based technology, such technology is likely to increase in usability and availability as computational models are being developed with increased sensitivities to recognise patterns of movement, enabling data collection in the wider environment and reducing costs and creating a better understanding of OA patient biomechanical and functional movement data.

Technologies used to facilitate remote rehabilitation of adults with deconditioning, musculoskeletal conditions, stroke, or traumatic brain injury: an umbrella review.

OBJECTIVE: The objective of this review was to provide an overview of technologies (devices, tools, or software applications) used to facilitate remote rehabilitation of adults with deconditioning, musculoskeletal conditions, stroke, or traumatic brain injury, and to summarize the quantitative evidence of their efficacy. INTRODUCTION: Health care providers are considering how to meet longer-term rehabilitation needs of people whose health or level of activity and participation has been impacted directly or indirectly by the COVID-19 pandemic. Demands on rehabilitation services are increasing, driving a need for more services to be delivered in homes and communities. This review will identify the effectiveness of health care technologies to facilitate remote rehabilitation. INCLUSION CRITERIA: This review included quantitative systematic reviews where participants were adults requiring rehabilitation for musculoskeletal conditions, stroke, or traumatic brain injury, or older adults requiring rehabilitation for deconditioning. Interventions included a technology and focused on recovery or rehabilitation with one of the following primary outcomes: physical activity levels, balance and/or gait, physical performance (mobility), or functional performance. Secondary outcomes included levels of pain, cognitive function, health-related quality of life, and adverse effects. METHODS: Five databases were searched from 2016 to 2020 to identify English-language publications. Critical appraisal of five systematic reviews was conducted independently by two reviewers. Data extraction was performed independently by two reviewers. Data were summarized using a tabular format with supporting text. RESULTS: Despite the large number of systematic reviews found in the initial search, only five met the inclusion criteria. Of these, each explored a different technology, including wearable activity trackers, computer-based activities, non-immersive virtual reality, mobile apps, web-based rehabilitation interventions, and electronic health-based interventions (web-based or app-based with a wearable activity tracker). Computer-based activities were beneficial for improving cognitive function but showed no benefit on quality of life in post-stroke rehabilitation. Interventions that included wearable activity trackers showed mixed findings for increasing levels of physical activity for community-dwelling older adults with deconditioning. Mobile apps were beneficial for increasing levels of physical activity and physical or functional performance for post-stroke rehabilitation. Web-based rehabilitation that contained a variety of components to support home exercise was not effective in improving physical performance or QoL, reducing pain, or increasing levels of physical activity among individuals with rheumatoid arthritis. Electronic health-based interventions (web-based or app-based with a wearable activity tracker) were effective in improving physical performance and reducing pain in individuals with osteoarthritis of the knee or hip. Therapy in the form of screen-based, non-immersive virtual reality could be successfully transferred to the home environment for improving the balance/gait of individuals with stroke. CONCLUSIONS: The small number of heterogeneous systematic reviews included in this umbrella review and the very low quality of evidence, mostly from single small primary studies, make it difficult to draw overall conclusions that differ from the original review findings. This highlights a paucity of strong, high-quality evidence underpinning technologies that can be used to facilitate remote rehabilitation in the wake of the COVID-19 pandemic.

Who benefits most from resilience-building groups for 'at-risk' older people? a pilot service-evaluation.

OBJECTIVES: Resilience-building interventions have not yet targeted older adults, despite the importance of well-being for maintaining independence and health. The 'My Generation' programme aims to build resilience through greater access to social networks, well-being activities, and psycho-educational support; this paper examines service evaluation data from its pilot implementation to identify factors leading to positive outcomes. METHOD: The 'My Generation' programme comprises eight weekly 2-hour group sessions; each session includes both psychoeducation and a well-being activity. Participants were invited to complete questionnaires at the start and end of the course, and 12 weeks later. These included measures of well-being, loneliness, social connections and self-efficacy. RESULTS: Baseline assessments were completed by 239 older people (average age 71, range 50-97), attending 38 courses in four centres. Most were female (80%), 40% were widowed, 25% divorced/separated and 64% lived alone. Demographics did not differ between those completing post-intervention assessments (N = 137) and those who did not. Compared with normative data, participants had significantly lower well-being and greater feelings of loneliness than age-peers. Significant improvements in well-being, self-efficacy, social connections and one measure of loneliness were evident at post-intervention and follow-up assessments. Improvement in well-being at post-intervention was greater in those who were divorced/separated and who were not carers, and at follow-up in females and those living alone. CONCLUSION: The 'My Generation' package appeared effective in improving well-being, self-efficacy, social connections and aspects of loneliness in at-risk older people. More research is needed to identify the intervention's key components and possible between-centre differences in outcomes.

How may alternative drug policy settings influence criminal charges? A longitudinal study of cannabis patients and a general population sample.

BACKGROUND: This study examines criminal charges amongst cannabis use disorder (CUD) patients and a matched sample in a setting of drug criminalization, and simulates the effect of policy changes on the proportion obtaining a criminal record and on the number of charges for those being charged. METHODS: All CUD patients entering specialist treatment in Norway in 2009-2010 (n=3,951) were included from the Norwegian Patient Registry and a random sample matched on age and gender drawn from the general population by Statistics Norway (n=7,902). Data were linked to the Norwegian Crime Registry (2009-2014). The nature and extent of all charges were examined. A static simulation exercise assessed the hypothetical effect on charges if a) all charges for use and possession of illicit drugs were eliminated ("decriminalization") and b) in addition, all charges for cultivation, manufacturing, and sales were eliminated ("legalization"). RESULTS: Two thirds (66%) of patients and 12% of matched sample were charged during the observation period. While the most common offence for patients was drug law violations (52%), relatively few (14%) had no other charges. Road traffic violations was the most common offence for the matched sample and 1.2% were charged with drug offences only. The mean number of charges were 9 for the patients and 3 for the matched sample. Simulations suggest that decriminalization may decrease the proportion being charged by 8% for patients and 4% for the matched sample under "decriminalization", compared to 24% and 11%, respectively if all drugs were legalized. The number of charges for patients and non-patients would drop by 23% and 13% respectively, while legalization may decrease the number of charges by 46% and 25%, respectively. CONCLUSION: The simulations suggest that the impacts of decriminalisation and legalisation on the proportion being charged are relatively modest, while the policy changes are likely to lead to substantial reductions in the number of charges for both the patient and non-patient groups.

Hazardous or not? Cannabis use and early labor market experiences of young men.

We study the relationship between cannabis use and early labor market experiences of young men, focusing on the time it takes them to find their first job, and the wage rate they receive at that job. We find that early cannabis users accept job offers more quickly and at a lower wage rate compared with otherwise similar males who did not use cannabis. These differences are present only for those who use cannabis for longer than a year before starting their job search. We also find that early cannabis users are less likely to return to education and, as a consequence, will have a lower educational attainment. Overall, our findings provide new insights into the direct and indirect relationships between cannabis use and early labor market experiences.

Parental views of antenatal testing and termination following a diagnosis of cleft lip.

Fetal anomaly screening at 18-21 weeks now routinely includes cleft lip. If detected, the manner in which the diagnosis is communicated can considerably influence prospective parents' decision-making in regard to further testing and termination of pregnancy (TOP). Given the known psychological impact of an antenatal diagnosis of cleft lip on prospective parents, this study aimed to explore the decision-making process from the parents' perspective, in order to evaluate how well current practice is meeting guidelines. Data from 217 parents of children born with cleft lip (with or without cleft palate) were collected using a mixed-methods online survey. Respondents reported feeling upset, offended and/or anxious following the diagnosis, due to unsatisfactory information and a perceived lack of empathy from health professionals. Some respondents had felt under pressure to make a decision quickly, with a minority having regretted undergoing amniocentesis, and/or experiencing significant distress at having come close to TOP unnecessarily. A number of suggestions are made as to how the discussion between parents and health professionals could be improved, to ensure that the information and support needs of families affected by cleft lip are fully addressed.

Hours worked by general practitioners and waiting times for primary care.

The decline in the working hours of general practitioners (GPs) is a key factor influencing access to health care in many countries. We investigate the effect of changes in hours worked by GPs on waiting times in primary care using the Medicine in Australia: Balancing Employment and Life longitudinal survey of Australian doctors. We estimate GP fixed effects models for waiting time and use family circumstances to instrument for GP's hours worked. We find that a 10% reduction in hours worked increases average patient waiting time by 12%. Our findings highlight the importance of GPs' labor supply at the intensive margin in determining the length of time patients must wait to see their doctor.

Coping: teenagers undergoing stoma formation.

Stoma-forming surgery can raise a number of challenges for patients of any age, including psychosocial impact, altered body image and altered body function. Adolescents may experience additional challenges as they are already adapting to changes in body image and personal identity while striving for independence. Healthcare professionals supporting adolescents with stomas need to have awareness of specific issues that may be encountered and the support required to aid and promote coping and adjustment. This case study considers adolescents coping and adjusting to living with a stoma and the role of the Stoma Care Clinical Nurse Specialist.

Resilience potential of the Ethiopian coffee sector under climate change.

Coffee farming provides livelihoods for around 15 million farmers in Ethiopia and generates a quarter of the country's export earnings. Against a backdrop of rapidly increasing temperatures and decreasing rainfall, there is an urgent need to understand the influence of climate change on coffee production. Using a modelling approach in combination with remote sensing, supported by rigorous ground-truthing, we project changes in suitability for coffee farming under various climate change scenarios, specifically by assessing the exposure of coffee farming to future climatic shifts. We show that 39-59% of the current growing area could experience climatic changes that are large enough to render them unsuitable for coffee farming, in the absence of significant interventions or major influencing factors. Conversely, relocation of coffee areas, in combination with forest conservation or re-establishment, could see at least a fourfold (>400%) increase in suitable coffee farming area. We identify key coffee-growing areas that are susceptible to climate change, as well as those that are climatically resilient.

Attitudes to legalizing cannabis use.

In this paper, we investigate the relationship between cannabis use and attitudes to legalizing the use of cannabis. Predictions from theory provide a means of learning about the roles of information, self interest and regret in explaining differences in attitudes to legalization between those who currently use, those who have used in the past and those who have never used. Our empirical investigation suggests that users have a greater awareness of cannabis not being as harmful as abstainers think it is. This may explain why individuals are more inclined to be in favor of legalizing cannabis once they have used it themselves. Copyright © 2016 John Wiley & Sons, Ltd.

The association between influenza vaccination and other preventative health behaviors in a cohort of pregnant women.

OBJECTIVES: Although pregnant women are a high-priority group for seasonal influenza vaccination, vaccination rates in this population remain below target levels. Previous studies have identified sociodemographic predictors of vaccine choice, but relationships between preconception heath behaviors and seasonal influenza vaccination are poorly understood. This prospective cohort study followed pregnant women during the 2010-2011 influenza season to determine if certain health behaviors were associated with vaccination status. METHOD: Participants were pregnant women receiving prenatal care from Kaiser Permanente Northwest and Kaiser Permanente Northern California. Women were surveyed about preconception smoking, alcohol consumption, and vitamin/supplement use. Vaccination data were obtained from health plan databases and state immunization records. RESULTS: Data from 1,204 women were included in this analysis. Most participants (1,204; 66.4%) received a seasonal influenza vaccine during the study period. Women vaccinated prior to pregnancy were more likely to use a supplement containing folic acid (80%) or vitamin D (30%) compared with women who were vaccinated during pregnancy (72% and 15%, respectively) or unvaccinated women (62% and 12%, respectively, p < .001). Women vaccinated prior to or during pregnancy were more likely (75%) to have never smoked compared with women who were not vaccinated (70%, p = .005). There were no significant differences in alcohol use or household cigarette smoke exposure by vaccination group. CONCLUSIONS: Women who engaged in specific preconception health behaviors were more likely to receive seasonal influenza vaccination. Failure to participate in these health behaviors could alert health care practitioners to patients' increased risk of remaining unvaccinated during pregnancy.

Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project.

PURPOSE: Prolonged periods of mechanical ventilation are associated with significant physical and psychosocial adverse effects. Despite increasing evidence supporting early rehabilitation strategies, uptake and delivery of such interventions in Europe have been variable. The objective of this study was to evaluate the impact of an early and enhanced rehabilitation program for mechanically ventilated patients in a large tertiary referral, mixed-population intensive care unit (ICU). METHOD: A new supportive rehabilitation team was created within the ICU in April 2012, with a focus on promoting early and enhanced rehabilitation for patients at high risk for prolonged ICU and hospital stays. Baseline data on all patients invasively ventilated for at least 5 days in the previous 12 months (n = 290) were compared with all patients ventilated for at least 5 days in the 12 months after the introduction of the rehabilitation team (n = 292). The main outcome measures were mobility level at ICU discharge (assessed via the Manchester Mobility Score), mean ICU, and post-ICU length of stay (LOS), ventilator days, and in-hospital mortality. RESULTS: The introduction of the ICU rehabilitation team was associated with a significant increase in mobility at ICU discharge, and this was associated with a significant reduction in ICU LOS (16.9 vs 14.4 days, P = .007), ventilator days (11.7 vs 9.3 days, P < .05), total hospital LOS (35.3 vs 30.1 days, P < .001), and in-hospital mortality (39% vs 28%, P < .05). CONCLUSION: A quality improvement strategy to promote early and enhanced rehabilitation within this European ICU improved levels of mobility at critical care discharge, and this was associated with reduced ICU and hospital LOS and reduced days of mechanical ventilation.

Does liberalizing cannabis laws increase cannabis use?

A key question in the ongoing policy debate over cannabis' legal status is whether liberalizing cannabis laws leads to an increase in cannabis use. This paper provides new evidence on the impact of a specific type of liberalization, decriminalization, on initiation into cannabis use. Our identification strategy exploits variation in the timing of cannabis policy reforms and our estimation framework marries a difference-in-difference approach with a discrete time duration model. Our results reveal evidence of both heterogeneity and dynamics in the response of cannabis uptake to decriminalization. Overall, we find that the impact of decriminalization is concentrated amongst minors, who have a higher rate of uptake in the first five years following its introduction.

Potential benefits of relationship continuity in patient care.

Continuity of care, in the author's opinion, is synonymous with quality care. The benefits of developing relationship continuity are highlighted as beneficial to patient, department, trust and the NHS. An in-house audit revealed that the care provided in the author's stoma care department was fragmented and how a change in strategy was required to bring about the necessary changes. This paper explores the benefits of patient/relationship continuity and outlines the changes made for over 250 new ostomy patients annually.

Cannabis use and suicidal ideation.

Globally, suicide has emerged as the second leading cause of death among youth aged 10-24 years old. In order to better understand the causes of this phenomenon, we investigate the relationship between suicidal ideation and cannabis use. Our empirical analysis is based on a 30-year longitudinal study of a birth cohort. We find that intensive cannabis use - at least several times per week - leads to a higher transition rate into suicidal ideation for males. We find no evidence that suicidal ideation leads to cannabis use for either males or females.

Patient stoma care: educational theory in practice.

Patients undergoing stoma formation encounter many challenges including psychosocial issues, relationship concerns and fear of leakage. Leakage, inappropriate product usage and poor patient adaptation post stoma formation has cost implications for the NHS. Developing good, practical stoma care skills has been identified as improving patient outcomes, promoting the provision of quality care and improving efficiency within the NHS. However, a thorough literature search indicated that there is little research available on patient stoma care education. This is considered surprising by Metcalf (1999), O'Connor (2005) and the author of this article. This article considers and adapts generic educational theory to make it pertinent to patient stoma care education in order to bridge the gap between theory and practice.

The effects of cannabis use on physical and mental health.

This paper investigates whether cannabis use affects physical and mental health. To do so, information on prime aged individuals living in Amsterdam in 1994 is used. Dutch data offer a clear advantage in estimating the health impacts of cannabis use because the legal status of cannabis in the Netherlands ensures that estimates are free from confounding with the physical and psychological effects of engaging in a criminal activity. Accounting for selection into cannabis use and shared frailties in mental and physical health, the results suggest that cannabis use reduces the mental wellbeing of men and women and the physical wellbeing of men. Although statistically significant, the magnitude of the effect of using cannabis on mental and physical health is found to be small.

Patient stoma care: educational theory in practice.

Patients undergoing stoma formation encounter many challenges including psychosocial issues, relationship concerns and fear of leakage. Leakage, inappropriate product usage and poor patient adaptation post stoma formation has cost implications for the NHS. Developing good, practical stoma care skills has been identified as improving patient outcomes, promoting the provision of quality care and improving efficiency within the NHS. However, a thorough literature search indicated that there is little research available on patient stoma care education. This is considered surprising by Metcalf (1999), O'Connor (2005) and the author of this article. This article considers and adapts generic educational theory to make it pertinent to patient stoma care education in order to bridge the gap between theory and practice.

Disparities in diagnosis of bipolar disorder in individuals of African and European descent: a review.

BACKGROUND: Over the past 3 decades, a wide range of studies in the United States and the United Kingdom has reported that white individuals are more likely to be diagnosed with bipolar and affective disorders, whereas black individuals appear to be at higher risk for schizophrenia spectrum diagnoses. Despite the pressing need for strategies aimed at eliminating racial and cultural disparities in diagnosis and treatment of bipolar disorder, no systematic review of the existing literature in this area has been done. This study draws together the disparate strands of information in a comprehensive overview of the research base in this area. METHODS: An electronic literature search of the Medline and PsychINFO databases was conducted in October 2009, supplemented by a review of references in the identified articles, for a total of 51 articles included in this qualitative review. RESULTS: Black patients have consistently been found to be more likely than white patients to be diagnosed with schizophrenia rather than bipolar disorder. Four factors were identified as potential contributors to racial disparities in diagnostic rates: clinical presentation and expression of symptoms, access to care, help-seeking behaviors, and clinician judgment. CONCLUSION: Despite efforts to curtail the phenomenon, racial disparities in diagnosis of bipolar disorder persist. Racial and cultural elements may affect how patients manifest behaviors and symptoms and how these are interpreted and attributed by clinicians in the diagnostic process. As an appropriate diagnosis determines treatment options and is central to quality of care, incorrect diagnosis can potentially have a negative impact on treatment effectiveness and accuracy of prognosis.