Marketing mental health services: a mixed-methods analysis of racially and ethnically diverse college students' engagement with and perspectives on U.S. university mental health clinics' websites.

BACKGROUND: The United States (U.S.) faces a significant mental health crisis, with around 52.9 million adults experiencing mental health disorders, with young adults (18-25 years old), such as college students, having the highest prevalence and lowest service utilization rates. While efforts to expand mental health services through "push" strategies are in place (e.g., training therapists in evidence-based therapies), limited initial engagement suggests a need for "pull strategies" and targeted marketing that make services attractive to college students and increase demand. This mixed-methods study identifies U.S. university mental health clinic websites and website characteristics that are attractive and engaging to college students interested in seeking mental health services (i.e., students were considering or actively looking for mental health support). METHODS: Eleven U.S. university websites were chosen (10 randomly and one from the university where students were attending) from a pool of 44 Psychological Clinical Science Accreditation System training clinics websites. Fifty-seven college students (Mage = 20.95, SD = 2.97; 81% female; 68% racial/ethnic minority) were videorecorded engaging with two U.S. university mental health clinic websites, completed self-report engagement measures, and gave detailed feedback about websites through semi-structured interviews. RESULTS: Likert scale scores revealed moderate engagement with all websites (e.g., they were interesting and helpful). Qualitative results indicated that websites that provided important and easily understood information about key features of services (e.g., types, evidence-base, and cost), therapist backgrounds, psychoeducation, used lay language, and had an appealing website layout (e.g., color, font, images, organization, and interactive components) generated greater consumer interest and trust in their mental health services. CONCLUSIONS: This study emphasizes the importance of using marketing strategies to enhance college students' engagement through mental health service websites. Salient features, psychoeducation, and effective promotional strategies (e.g., how information is presented) were identified as crucial for website engagement and subsequent mental health service uptake. Using marketing strategies, such as tailoring language to consumer literacy levels, describing the evidence-base of services, and improving website design may address college students' needs and enhance initial mental health service engagement.

The Health Outcomes of a Telegeriatrics Follow-Up Model on Dementia Patients and Their Caregivers in Cairo.

Background/Purpose: Older patients living with dementia and their caregivers are ideal beneficiaries of telemedicine, cost-effectiveness, caregiver satisfaction, and physician acceptance. The aim is to study the effect of a telemedicine dementia enabled program on the health outcome of dementia patients and their caregivers, as regard the patient outcome, caregiver stress, and caregiver satisfaction. Methods: Ninety-seven (n = 97) elderly subjects were recruited from the outpatient clinics and inpatient ward of Geriatrics Hospital, Ain Shams University Hospitals. Seventy subjects completed 6 months of follow-up using a telegeriatrics model. Patient outcomes (delirium, behavioral and psychological symptoms of dementia [BPSD], and need for home consultations, emergency room [ER] visits, clinic visits, and hospital admissions) were assessed and followed. Caregiver stress was evaluated and monitored using the abridged Arabic version of the Zarit Burden Interview ZBI-A. Caregiver satisfaction was assessed using dedicated satisfaction questionnaire designed by Ain Shams Virtual Hospital. Results: elirium episodes, BPSD episodes, and the need for home consultations, clinic visits, ER visits, and hospital admissions. This was statistically significant after the second, fourth, and sixth months of follow-up (p-value <0.001). In addition, the telegeriatrics follow-up model had a positive effect on both caregiver stress and caregiver satisfaction. Conclusions: The telegeriatrics follow-up model is a useful tool in the improvement of health outcomes of dementia patients, reduction of caregiver stress, and achievement of caregiver satisfaction.

Pattern of cognitive impairment among community-dwelling elderly in Egypt and its relation to socioeconomic status.

BACKGROUND: Cognitive decline is one of the aging health problems that strongly affects daily functioning and quality of life of older adults and threatens their independence. The aim of this study was to assess the prevalence and pattern of cognitive impairment (CI) among community-dwelling elderly in Egypt and the contribution of socioeconomic status to inequality in cognitive impairment. METHODS: A cross-sectional study involved 470 community-dwelling elderly aged 60 years or older living in Kafr El-Sheikh Governorate, Egypt. Subjects were recruited from home visits, geriatric clubs, and outpatient clinics. The Montreal Cognitive Assessment tools (MoCA & MoCA-B) were used to assess the prevalence of cognitive impairment, Hachinski ischemic score (HIS) to investigate the type of cognitive impairment, Ain Shams Cognitive Assessment (ASCA) tool to assess the pattern of specific cognitive domain affection, and an Egyptian socioeconomic status (SES) scale to classify the SES of the study participants. RESULTS: The prevalence of cognitive impairment was 50.2% distributed as 37.7% for mild cognitive impairment (MCI) and 12.5% for dementia. The most common type of cognitive impairment was the degenerative type (47.9%). Pattern of specific domain affection among cognitively impaired subjects ranged from 94% for visuospatial function to 12.7% for abstraction. Cognitive impairment was significantly higher with increasing age, female sex, marital status (single or widow), low education, higher number of comorbidities, and positive family history of cognitive impairment (p < 0.001). Also, cognitive impairment was concentrated mainly among participants with low socioeconomic score (p < 0.001). CONCLUSION: In Egypt, cognitive impairment is significantly prevalent and concentrated among those who are in low socioeconomic status. Patients with mild CI were more than those with dementia, and the most common type of CI was the degenerative type. Increasing educational level of low SES population and improving their access to healthcare services are highly recommended to improve the inequity of cognitive impairment.

Sarcopenia and Related Functional Outcomes Following Hip Surgery Among Egyptian Geriatric Patients With Hip Fracture.

Background Sarcopenia is highly prevalent among elderly patients with hip fracture. Studies reported a significant association between sarcopenia and clinical outcomes in patients with hip fractures. The current study aimed to determine the prevalence of sarcopenia among elderly patients with hip fracture and its effect on short-term functional outcomes, highlighting predictors of postoperative functional decline.  Methods This is a cross-sectional study followed by a prospective cohort. Elderly patients (60 years and above) with hip fractures were recruited from the orthopedic department. Patients were followed by the ortho-geriatric team in the perioperative period and for three postoperative months. Patients were subjected to comprehensive geriatric assessment including a full history and physical examination. In the preoperative state and after three months of follow-up the following were assessed: functional independence using the Barthel index (BI); nutritional state using a checklist named DETERMINE Your Nutritional Health; sarcopenia using the SARC-F questionnaire assessing strength, ambulation, rising from a chair, climbing stairs, and fall history. Perioperative risk assessment and post-discharge care were obtained through medical records and by questioning patients or families. Preoperative sarcopenia was confirmed using the Ishii equation which is an equation that includes (age, calf circumference, and hand grip strength). Results Preoperative sarcopenia screening showed that 29.3% of patients suffered sarcopenia by SARC-F questionnaire and 28.6% by Ishii equation score. At the end of the follow-up, 57.9% of patients suffered sarcopenia by SARC-F questionnaire. There was a marked post-fracture decline in independence level; 52.1% had slight dependence in function, 27.1% had moderate dependence in function, and 20.7% had total dependence in function. Conclusion This study gives us the chance for a greater understanding of the negative effects of sarcopenia on the outcomes following hip fracture surgery in the geriatric population. It shows a prevalence of sarcopenia among the elderly with hip fractures at 29.3%. The elderly experience a marked post-fracture decline in their level of independence concerning basic activities of daily living. Those with older age, higher comorbidities, cognitive impairment, and functional dependence with poor nutritional state are more vulnerable to functional decline. Other perioperative risks include delayed surgery, surgery type, postoperative complications, longer hospital stays, lack of planned rehabilitative and nutritional plans, and postoperative depression. Early detection of sarcopenia helps establish early interventional plans to reverse such poor outcomes.

Triggers of Atrial Fibrillation in the Geriatric Medical Intensive Care Unit: An Observational Study.

Background: Atrial fibrillation (AF) is a common arrhythmia in the non-cardiac intensive care unit (ICU). However, data concerning AF incidence and predictors in such populations are scarce and controversial. The study aimed to investigate the contributing factors of new-onset AF in elderly patients within the medical intensive care setting. Methods: Patients admitted to ICU during a 6-month period were prospectively studied. Patients admitted for short period postoperative monitoring and patients with chronic or paroxysmal AF were excluded. The conditions involved as AF risk factors or "triggers" from demographic data, history, and echocardiography were recorded. Acute Physiology and Chronic Health Evaluation II score was calculated. Electrolytes including some trace elements (zinc, copper, and magnesium) were analyzed. Results: The study included 142 patients (49% females). Mean age was 69.5 ± 7.3 years. AF was observed in 12%. Diagnosis of pneumonia (P < 0.001), low copper (P < 0.0001) and low zinc levels (P < 0.0001) was significantly associated with the occurrence of AF. By multivariate analysis, they remained statistically significant (odds ratio, 7.0; 95% confidence interval, 2.0 - 24.6; P < 0.01). Conclusions: A significant fraction of ICU elderly patients manifests AF. The relevant factors contributing to AF incidence in the elderly are pneumonia and low zinc and low copper.

Interaction between apolipoprotein E genotyping, serum inflammatory biomarkers and cognitive functions in Egyptian elderly.

There is evidence consistent with the hypothesis that genetic, inflammatory and immune mechanisms are involved in the pathogenesis of AD. The aim of this study is to assess the relationship between Apolipoprotein E (Apo E), serum levels of inflammatory markers, and cognitive functions among elderly patients with Alzheimer's disease (AD) and Mild cognitive impairment (MCI) compared to elderly with normal cognitive function. 88 participants (≥60 years) from Ain Shams University Hospital were enrolled. They were divided into 3 groups: Group A (32 elderly patients with AD), Group B (32 elderly patients with MCI) and Group C (24 controls with normal cognitive function). All participants were subjected to comprehensive geriatric assessment, Apo E genotyping, measurement of C-reactive protein (CRP) and Alpha-1-antichymotrypsin (ACT), by PCR-RFLP, ELIZA and semi-quantitative method respectively. The most common variant of Apo E gene was E3/E3 being more frequent in healthy control group (HC) than the other two groups and the least common variant was E4/E4 detected only in the AD group. ApoE4 allele was associated with 40.6% of AD patients (where 31.4% were heterozygous and 8.6 % homozygous) and 17.1% of MCI patients, whereas ApoE2 was more prevalent in the control group (P<0.05). A significant difference was observed when Mini mental status Examination (MMSE) score in different Apo E alleles was compared (P<0.01). The highest score was associated with (E2/E3) allele whereas, the lowest score was associated with (E4/E4) allele. Regarding inflammatory markers; CRP levels showed a statistically significant difference between the 3 groups and were higher in the AD group than the other 2 groups. (P<0.01). There was no statistically significant difference between the 3 groups as regard ACT level (P>0.05). Carriers of at least one E4 allele showed great risk to develop AD when combined with high CRP serum levels (OR = 36; CI: 11.4-113.7; P< 0.01). In conclusion, Apo E together with CRP may be a useful tool to predict Alzheimer's disease.

Multidimentional Preoperative Frailty Assessment and Postoperative Complication Risk in Egyptian Geriatric Patients Undergoing Elective Cardiac Surgery.

BACKGROUND: Frailty affects up to 51%of the geriatric population in developing countries which leads to increased morbidity and mortality. OBJECTIVE: To determine the association between pre-operative frailty through multidimentional assessment score, and the incidence of post-operative complications and to validate Robinson score in geriatric Egyptian patients undergoing elective cardiac surgery. METHODS: We recruited 180 elderly participants aged 60 years old and above, who underwent elective cardiac surgery. They were divided into frail, pre-frail, and non-frail groups after application of Robinson score (which includes cognitive and functional and fall risk assessment, number of comorbidities, and different laboratory data). Type and duration of operations and the presence and severity of complications at days 3 and 7 post-surgery, and the 30-day readmission rate were assessed. RESULTS: Operation duration and the occurrence of postoperative complications at days 3 and 7 were lowest in non-frail and highest in the frail group (p < 0.001 for both). Length of hospital stay and 30-day readmission rate also increased in the frail group. A positive, moderate correlation between frailty and blood transfusion (r = 0.405) and functional dependence (r = 0.552) was found at day-3 post-surgery. Finally, logistic regression analysis identified a 6-fold increase in postoperative complications in the frail group (OR = 6). CONCLUSION: Preoperative frailty was associated with higher incidence of postoperative complications among geriatric patients undergoing elective cardiac surgery. Frailty assessment by Robinson score can be considered as an accurate tool to predict postoperative complications during preoperative assessment of elderly patients.

The relation between falls and medication use among elderly in assisted living facilities.

PURPOSE: Many elderly are concerned about falling transfer to assisted living facilities (ALF). Previous literatures studied the medication use and falls in the community, hospitals, or nursing homes, with scanty data about ALF. Therefore, the aim of the current case-control study was to assess the relation between medication use and falls among elderly in ALF. METHODS: A matched case-control study was conducted. The study was conducted in ALF in Cairo, Egypt. The study participants were 188 individuals; they were subdivided into two groups: fallers and nonfallers; timed up and go test (TUGT) was performed by all subjects. Medication data were collected according to the fall risk-increasing drugs list and the list of drugs that cause or worsen orthostatism. Other fall risk factors, as suggested by American Geriatric Society, were assessed. RESULTS: The use of vasodilators, diuretics, alpha blockers, opioids, antipsychotics, and sedative hypnotics were more common in fallers than in nonfallers (P < 0.001, P = 0.03, P < 0.001, P = 0.013, P < 0.001, and P < 0.001, respectively). Vasodilators, alpha blockers, and antipsychotics were significant predictors of falls even after adjustment for the possible confounding factors. Vasodilators, alpha blockers, opioids, sedative hypnotics, and recent dose changes in oral hypoglycemics were significant predictors of higher TUGT after adjustment for the possible confounding factors. CONCLUSION: The current study supported the risk of psychotropic and cardiovascular medications, with especial emphasis on vasodilators, alpha blockers, and antipsychotics, with raising concern about opioids, sedative hypnotics, and recent dose change in oral hypoglycemics.

Synthesis of Electrical Conductive Silica Nanofiber/Gold Nanoparticle Composite by Laser Pulses and Sputtering Technique.

Biocompatible-sensing materials hold an important role in biomedical applications where there is a need to translate biological responses into electrical signals. Increasing the biocompatibility of these sensing devices generally causes a reduction in the overall conductivity due to the processing techniques. Silicon is becoming a more feasible and available option for use in these applications due to its semiconductor properties and availability. When processed to be porous, it has shown promising biocompatibility; however, a reduction in its conductivity is caused by its oxidization. To overcome this, gold embedding through sputtering techniques are proposed in this research as a means of controlling and further imparting electrical properties to laser induced silicon oxide nanofibers. Single crystalline silicon wafers were laser processed using an Nd:YAG pulsed nanosecond laser system at different laser parameters before undergoing gold sputtering. Controlling the scanning parameters (e.g., smaller line spacings) was found to induce the formation of nanofibrous structures, whose diameters grew with increasing overlaps (number of laser beam scanning through the same path). At larger line spacings, nano and microparticle formation was observed. Overlap (OL) increases led to higher light absorbance's by the wafers. The gold sputtered samples resulted in greater conductivities at higher gold concentrations, especially in samples with smaller fiber sizes. Overall, these findings show promising results for the future of silicon as a semiconductor and a biocompatible material for its use and development in the improvement of sensing applications.

Does self-reported sleep quality predict poor cognitive performance among elderly living in elderly homes?

OBJECTIVES: Sleep complaints are common among elderly, especially institutionalized elderly, as they experience poorer sleep quality and higher use of sedative hypnotics, when compared to community-dwelling elderly. Recent findings suggest that there may be a relationship between poor quality of sleep and cognitive deficits. This study aimed at studying the relation between sleep quality and cognitive performance in older adults living in elderly homes. METHOD: 100 elderly living in an elderly home in El Mansoura, Egypt, were recruited in this study, 50 cases with subjective poor quality of sleep and 50 controls with subjective good quality of sleep as assessed by Pittsburgh sleep quality index (PSQI). Each participant went through comprehensive geriatric assessment (CGA), including geriatric depression scale (GDS), assessment of cognitive function by mini mental state examination (MMSE). RESULTS: 52% of poor sleepers showed impaired MMSE, while only 24% of good sleepers had impaired MMSE. Both orientation and (attention and calculation) were more affected (P = 0.027 and 0.035, respectively). Linear correlation coefficient between PSQI and different variables revealed significant negative correlation with total MMSE score, attention and calculation. CONCLUSION: Poor quality of sleep is related to cognitive impairment among elderly living in elderly homes and this problem should be taken in consideration among this group of elders.

Immune response of 23-valent pneumococcal polysaccharide vaccinated elderly and its relation to frailty indices, nutritional status, and serum zinc levels.

AIM: To detect the immunoglobulin M memory B cell population response following vaccination with the 23-valent pneumococcal polysaccharide vaccine and determine its relation to frailty indices, nutritional status, and serum zinc levels. METHODS: A cross-sectional study was carried out in the outpatient geriatric clinic, Ain Shams University Hospital. It included 80 community-dwelling elderly, 32 male and 48 female. Each participant underwent vaccination with the 23-valent pneumococcal polysaccharide vaccine, comprehensive geriatric assessment, nutritional assessment with the DETERMINE check list, frailty indices assessment, and serum zinc level measurement. The percentage of immunoglobulin M memory B cells was evaluated before and 4 weeks after vaccination. Immune response was calculated as the difference between cell percentage before and after vaccination. RESULTS: Before the vaccination, the immunoglobulin M memory B cell percentage was significantly lower among those eating fewer than two meals a day and taking three or more drugs a day; after vaccination significance was observed among those with tooth or mouth problems that make eating difficult. Immune response was significantly lower among those with tooth or mouth problems (P < 0.001), weight loss (P < 0.001), shrinking (P = 0.001), poor endurance (P = 0.04), multiple comorbidities (P = 0.013), and cognitive impairment (P = 0.001). Participants with immune response ≥10% showed significantly higher serum zinc levels compared to those with immune response <10% of increase in cell percentage. CONCLUSION: Poor nutritional status, frailty and a lower zinc level impair the immunological response of elderly individuals.

Proinflammatory cytokines in Egyptian elderly with chronic obstructive pulmonary disease.

BACKGROUND: The pulmonary component of chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. HYPOTHESIS: The levels of the proinflammatory cytokines, interleukin 1 beta (IL-1ß), tumor necrosis factor alfa (TNF-α), and C-reactive protein (CRP), in elderly patients suffering from COPD are increased. SETTINGS AND DESIGN: A case control study involving 90 elderly participants from the outpatient clinics of Ain Shams University hospitals. MATERIALS AND METHODS: The 90 subjects were subdivided into three equal groups ' group I (control), group II (patients with COPD), and group III (patients with COPD and cardiovascular complications). Comprehensive clinical assessment, pulmonary functions, and echocardiography were performed. The levels of IL-1ß, TNF-α, and CRP were measured in the patients' serum and compared. STATISTICAL ANALYSIS: SPSS (Statistical Package for Social Science) version 10. RESULTS: IL1-ßand CRP were significantly higher in the third group than the first group (P <0.05). There was a similar significant difference between the second and third group as regards IL1-ßand CRP (P < 0.05). Positive significant correlation between CRP and TNF-α with stage of COPD according to FEV1 (P <0.05) were found. CONCLUSIONS: Complicated cases of COPD had higher levels of IL1-ß and CRP and the more severe the cases, the higher the levels of CRPand TNF-α.

Prevalence of asymptomatic bacteriuria among Egyptian elder persons living in the rural areas.

This study detected the prevalence of asymptomatic bacteriuria among elder Egyptians living in the rural areas Serrey village (Qaulyobia G.). Complete history taking, clinical examination, urine analysis and culture, blood glucose level and serum creatinine were performed for 86 elders. The asymptomatic bactiruria was 24.4% and the most common organism was Klebsiella followed by Staphylococcus and the least was E. coli. Regular urine culture is a must for the elders in rural areas.