Intervention to promote preventive dental care for older Korean-American Medi-Cal enrollees in Los Angeles.

BACKGROUND: In California, preventive dental care is covered by Medi-Cal (California's Medicaid program). However, many beneficiaries do not use their dental benefits. Given that a lack of knowledge about oral health and insurance coverage contributes to this underutilization, promoting the use of dental benefits among eligible individuals via an educational program is imperative. Responding to the particular needs of older immigrants with limited English proficiency, we developed a digital oral health intervention for older Korean-American Medi-Cal enrollees in Los Angeles. This educational intervention is designed to be delivered via computers and the Internet. It consists of a 15-min self-running PowerPoint presentation narrated in Korean with links to additional information on the Internet. The slides contain information about the basic etiology of oral diseases, oral hygiene, common myths about oral health and dental care, Medi-Cal coverage of preventive dental care, and how to find a dental clinic. METHODS: We pilot tested the intervention with 12 participants to examine its feasibility and acceptability. We also obtained participants' qualitative feedback about the intervention. RESULTS: A post-intervention quantitative assessment yielded high participant satisfaction and improved oral health and dental care knowledge. Participant responses to the intervention yielded four themes: (1) content and structure, (2) linguistic and cultural aspects, (3) delivery mode, and (4) additional concerns and suggestions. CONCLUSIONS: Our findings confirm the intervention's feasibility and acceptability and suggest further refinement.

Youth perspectives on mobile health adherence interventions: A qualitative study guided by the supportive accountability model.

OBJECTIVE: We applied a Supportive Accountability Model lens to understand how youth view remote human coaching versus automated reminders targeting medication adherence. METHODS: We used thematic analysis to interpret (N = 22) youths' responses to semi-structured interviews after 12 weeks of mobile health intervention. RESULTS: Participants reported that both coaching and automated reminders prompted them to take medication, improving their adherence. Participants found coaching helpful because they developed routines and strategies, were motivated to avoid disappointing their coach, and felt their coach cared for them. Automated support could be motivational for some but demanded less engagement. Participants described phone calls as disruptive to their daily lives, but conducive to developing a personal connection with their coach, whereas texts were easier and more flexible. Youth emphasized that individual preferences often differ. CONCLUSION: Human coaching was viewed as a more potent, engaging adherence intervention than automated reminders, although individual needs and preferences differed. Phone calls may enhance the experience of supportive accountability for adherence, but also pose greater acceptability and usability barriers than texting. PRACTICE IMPLICATIONS: Intervention developers should provide opportunities for youth to make personal connections with human adherence supporters and attend to youth preferences for communication modality.

"Do Your Best to Avoid it": Appraisals and Coping with Discrimination-Related Stress Among Older Chinese Immigrants in Affordable Senior Housings During the COVID-19 Pandemic.

This study investigated how older Chinese immigrants in affordable senior housing facilities (ASHs) appraise and cope with anti-Asian discrimination and related stress during the COVID-19 pandemic. Qualitative interviews were conducted with 26 participants aged over 65, analyzing verbatim transcripts and field notes using thematic analysis. Four major domains were identified: (1) discriminatory experience, (2) appraisals of discrimination stress, (3) coping strategies, and (4) rationales behind coping. Among the participants, 11 (42%) reported experiencing discrimination either personally or by someone they know. Participants' appraisals of discrimination stress varied, and most of them opted for disengagement coping strategies (e.g., avoidance, rationalization) attributing them to health concerns, individual characteristics, environmental and societal factors, and low acculturation. The findings suggest the need for more social and community resources to enhance coping capacity and resilience in this vulnerable population.

Assessment of Machine Learning Methods to Predict Massive Blood Transfusion in Trauma.

BACKGROUND: Accurately predicting which patients are most likely to benefit from massive transfusion protocol (MTP) activation may help patients while saving blood products and limiting cost. The purpose of this study is to explore the use of modern machine learning (ML) methods to develop and validate a model that can accurately predict the need for massive blood transfusion (MBT). METHODS: The institutional trauma registry was used to identify all trauma team activation cases between June 2015 and August 2019. We used an ML framework to explore multiple ML methods including logistic regression with forward and backward selection, logistic regression with lasso and ridge regularization, support vector machines (SVM), decision tree, random forest, naive Bayes, XGBoost, AdaBoost, and neural networks. Each model was then assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Model performance was compared to that of existing scores including the Assessment of Blood Consumption (ABC) and the Revised Assessment of Bleeding and Transfusion (RABT). RESULTS: A total of 2438 patients were included in the study, with 4.9% receiving MBT. All models besides decision tree and SVM attained an area under the curve (AUC) of above 0.75 (range: 0.75-0.83). Most of the ML models have higher sensitivity (0.55-0.83) than the ABC and RABT score (0.36 and 0.55, respectively) while maintaining comparable specificity (0.75-0.81; ABC 0.80 and RABT 0.83). CONCLUSIONS: Our ML models performed better than existing scores. Implementing an ML model in mobile computing devices or electronic health record has the potential to improve the usability.

Social network and mental health of Chinese immigrants in affordable senior housing during the COVID-19 pandemic: a mixed-methods study.

OBJECTIVE: Chinese immigrant older adults who live in affordable housing are at high risk of experiencing social isolation during the COVID-19 pandemic, which can affect their mental health. Using a triangulation mixed-methods approach, this study describes Chinese immigrant older adults' social network, mental health status, and their associations during the pandemic. METHODS: Semi-structured in-depth interviews were conducted with 26 Chinese immigrant older adults from June to August 2021. The structure and characteristics of participants' social networks were assessed with a name-generating approach. Mental health status was self-reported with Geriatric Depression Scale and UCLA loneliness scale. RESULTS: This sample (mean age = 78.12, 69.23% female), on average, had 5.08 social ties in their network, and 58% were family ties. Participants reported decreased social contact, family and friends interaction patterns specific to immigrants, and constantly being in a low mood and bored. Having closer relationships with others and maintaining the same or higher contact frequency after COVID-19 onset was associated with fewer depressive symptoms. Resilience from religious beliefs, neighbors as role models, and wisdom learned from past experiences were reported. CONCLUSION: Knowledge built in this study can inform respondence to future crises like the COVID-19 pandemic in affordable housing settings serving older immigrant populations.

Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis.

OBJECTIVES: Spousal caregivers of older adults, especially new spousal caregivers, face increased risks of negative health outcomes due to the demands of caregiving and their own health decline. Estimating the impacts of caregiving on health without controlling for caregivers' own aging-related health decline could exaggerate the negative health consequences of caregiving, while focusing solely on caregivers could result in selection bias where healthier individuals enter and/or remain in caregiving. This study aims to estimate the impacts of caregiving on health of new spousal caregivers while controlling for observable confounders. METHODS: We utilized coarsened exact matching analysis to compare health outcomes between new spousal caregivers and spousal noncaregivers using pooled panel data from 2006 to 2018 in the Health and Retirement Study. We analyzed 242,123 person-wave observations from 42,180 unique individuals, among whom 3,927 were new spousal caregivers. Variables used for matching were classified into 3 categories: care needs, willingness to provide care, and ability to provide care. Two-year outcomes assessed are spouse's self-rated health, depressive symptoms, and cognitive functioning. RESULTS: A total of 3,417 (87.01%) new spousal caregivers were matched with 129,798 observations of spousal noncaregivers. Regression analysis indicated being a new spousal caregiver was associated with a 0.18- (standard error = 0.05) unit increase in number of depressive symptoms. No statistically significant results were identified for self-rated health and cognitive functioning. DISCUSSION: Our results highlighted the needs to address mental health among new spousal caregivers and emphasized the importance of addressing mental health in long-term care programs and policies.

Health Information-Seeking Behavior of Latino Caregivers of People Living with Dementia: A Mixed-Methods Study.

This mixed-methods study examined the health information-seeking behavior of Latino caregivers of people living with dementia. A structured survey and semi-structured interviews were conducted with 21 Latino caregivers in Los Angeles, California. For triangulation, semi-structured interviews were also conducted with six healthcare and social service providers. The interview transcripts were coded and analyzed via thematic analysis, while the survey data were summarized using descriptive statistics. The results show that caregivers sought information on what changes to expect as dementia progresses. Some desired detailed (limited) information to be better prepared (to worry less). The most common action to address their information needs was searching the Internet. However, those who did this tended to be concerned about the quality of information. Overall, this study sheds light on how much detail Latino caregivers desire in the information they need and the actions they take to obtain this information.

Technology for activity participation in older people with mild cognitive impairment or dementia: expert perspectives and a scoping review.

PURPOSE: This two-phased study aimed to collate, summarize and characterize - through the lens of an occupation-based, person-centred framework - ongoing research and practice featuring activity participation-supportive digital health technology (DHT) for direct use by older persons with mild cognitive impairment or Alzheimer's disease and related dementias (PwMCI/ADRD). MATERIALS AND METHODS: Phase 1: Using scoping review procedures, PubMed, MEDLINE and PsycInfo were searched to identify primary research studies. Phase 2: Semi-structured interviews were completed with MCI/ADRD expert stakeholders identified through publicly available biographies and snowball referral. Thematic analysis was used to identify, synthesize and cross-compare emergent themes from both data sources that were subsequently organized into core facets of the Human Activity Assistive Technology (HAAT) model. RESULTS: The scoping review resulted in 28 studies, which were primarily feasibility work with small sample sizes. Interviewed experts (N = 17) had 4+ years of MCI/ADRD experience, came from a variety of settings, and held myriad roles. Real world and research-based use of DHTs held some commonalities, particularly around support for social participation and instrumental activities of daily engagement. No DHT for sleep or work/volunteerism were noted in either phase. People with milder MCI/ADRD conditions were most often targeted users. Soft technology strategies facilitating implementation centred on product design (e.g., prompting software, customisability, multimedia/multisensory experiences), instructional methods and technology partner involvement. CONCLUSIONS: This study demonstrates that although DHT supportive of activity participation is being studied and integrated into the lives of PwMCI/ADRD, there are still key opportunities for growth to meet the needs of diverse MCI/ADRD end users.Implications for rehabilitationMainstream digital health technologies (DHTs) are being utilized by persons with mild cognitive impairment and Alzheimer's disease and related dementias (PwMCI/ADRD) in everyday life, in limited capacities, to support social participation, leisure, health management and instrumental activities of daily living (IADL).Innovative research-based technologies to be used directly by PwMCI/ADRD are under development, particularly to facilitate management of ADL, social participation and IADL in persons with mild-to-moderate forms of cognitive impairment.Soft technology strategies to support technology implementation with MCI/ADRD target users include close attention to design of the technology (e.g., customisability, sensory stimulators and prompting features), instructional strategies that promote learning and motivation and involvement of technology partners to facilitate engagement with the technology.Future studies will require more robust research designs with transparent reports of participant characteristics and facilitative instructional methods to expand DHT's potential to account for and better meet the needs of diverse MCI/ADRD communities in real-world contexts.

Lipid Droplets in Lung Cancers Are Crucial for the Cell Growth and Starvation Survival.

For rapid and unlimited cell growth and proliferation, cancer cells require large quantities of nutrients. Many metabolic pathways and nutrient uptake systems are frequently reprogrammed and upregulated to meet the demand from cancer cells, including the demand for lipids. The lipids for most adult normal cells are mainly acquired from the circulatory system. Whether different cancer cells adopt identical mechanisms to ensure sufficient lipid supply, and whether the lipid demand and supply meet each other, remains unclear, and was investigated in lung cancer cells. Results showed that, despite frequent upregulation in de novo lipogenesis and the lipid transporter system, different lung cancer cells adopt different proteins to acquire sufficient lipids, and the lipid supply frequently exceeds the demand, as significant amounts of lipids stored in the lipid droplets could be found within lung cancer cells. Lipid droplet surface protein, PLIN3, was found frequently overexpressed since the early stage in lung cancer tissues. Although the expression is not significantly associated with a specific gender, age, histology type, disease stage, and smoking habit, the frequently elevated expression of PLIN3 protein indicates the importance of lipid droplets for lung cancer. These lipid droplets are not only for nutrient storage, but are also crucial for tumor growth and proliferation, as well as survival in starvation. These results suggest that manipulation of lipid droplet formation or TG storage in lung cancer cells could potentially decrease the progression of lung cancer. Further exploration of lipid biology in lung cancer could help design novel treatment strategies.

Technological Proficiencies, Engagement, and Practical Considerations for mHealth Programs at an Urban Safety-Net Hospital Emergency Departments: Data Analysis.

BACKGROUND: Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department. OBJECTIVE: We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments. METHODS: We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A1c levels >8.5% were enrolled. A text message-based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination. RESULTS: Of 1876 patients who were approached, 44.2% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% (124/166) of patients as highly technologically proficient and 25% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90%) than minimally technologically proficient patients (53.64 years old; high school or more: 18%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001). CONCLUSIONS: This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message-based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message-based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2019.03.003.

The Effect of Support From Secondary Caregiver Network on Primary Caregiver Burden: Do Men and Women, Blacks and Whites Differ?

OBJECTIVES: Many older adults receive informal care from multiple caregivers, including support from a primary caregiver and a secondary caregiver network (SCN). This study examined the association between SCN support and primary caregiver burden, and whether the association varies across women and men, Black and White. METHODS: Data came from the 2015 National Health and Aging Trend Study and the National Study of Caregiving, including non-Hispanic White and Black men and women who were identified as primary caregivers (n = 967) and their secondary caregivers (n = 2,253). SCN support was indicated by (a) care domain overlap and (b) proportion of caregiving by SCN. Multiple regression models were estimated for the analyses. RESULTS: Both SCN support variables were found to reduce primary caregiver burden, and the effect of proportion of caregiving by SCN was found to vary by gender-race groups. With the increase of the proportion of caregiving by SCN, both Black and White women caregivers tend to experience faster decrease in caregiver burden than Black men. DISCUSSION: Our findings support the role of SCN in reducing primary caregiver burden and demonstrate that the benefit of SCN support varies across the 4 gender-race groups. The results indicate that it is imperative to further examine caregiving experience and protective mechanisms of SCN support using an intersectional perspective.

Caregiving Burden Among Caregivers of People With Dementia Through the Lens of Intersectionality.

BACKGROUND AND OBJECTIVES: Caregivers may be at different risks of various types of burdens by virtue of their gender and racial/ethnic status. This article explores the differences in caregiving burdens across the intersectionality of race and gender. RESEARCH DESIGN AND METHODS: Using Round 5 (conducted in 2015) and Round 7 (conducted in 2017) of National Study of Caregiving and National Health and Aging Trends Study data, the study examined differences in caregiver burdens across and within different gender and racial/ethnic groups, within the realms of financial, emotional, and physical burdens. The sample consisted of 1,206 caregivers who provided services to Medicare beneficiaries. Logistic regressions were performed to assess the 3 types of burdens each subgroup was experiencing. RESULTS: Results indicated that within the intersectionality framework, compared to White female caregivers, Black male caregivers were 3.3 times (95% confidence interval [CI] 1.77-6.22) more likely to experience financial burden, and Black female caregivers were 54% less likely to experience physical burden. Surprisingly, compared to White female caregivers, all the other groups were 37% (95% CI 0.41-0.95) to 71% (95% CI 0.15-0.56) less likely to have emotional burden. DISCUSSION AND IMPLICATIONS: The findings highlighted that Black male caregivers are experiencing financial burden and White female caregivers are experiencing emotional burden disproportionately. To develop effective interventions and programs for dementia caregivers, a special focus should be put on monitoring the differences in the types of burdens that the above-mentioned population subgroups experience.

A single intraarticular platelet-rich plasma improves pain and function for patients with early knee osteoarthritis: Analyses by radiographic severity and age.

BACKGROUND: Most studies use platelet-rich plasma (PRP) requiring multiple intraarticular injections for knee osteoarthritis (OA). OBJECTIVE: To investigate the efficacy of a single intraarticular PRP injection for patients with early knee OA and consider subgroup analyses of radiographic severity and age, respectively. METHODS: Forty-one patients with knee OA (Kellgren-Lawrence grade 1-2) received a single PRP injection into the target knee and were assessed at baseline and 1, 3, and 6 months postinjection. The primary outcome was the mean change from baseline in the visual analog scale (VAS) pain (0-100 mm) at 6 months postinjection. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patients' satisfaction. RESULTS: Thirty-eight patients completed the study. The mean pain VAS decreased significantly from 45.6 ± 13.0 mm at baseline to 16.9 ± 13.4 mm, 14.0 ± 13.1 mm and 15.5 ± 14.0 mm at 1, 3 and 6-month follow-ups (p< 0.001 for all). Significant improvements in WOMAC, Lequesne index, SLS and consumption of analgesics from baseline (p< 0.001 for all) were noted at each follow-up. Patients' satisfaction was high. No serious adverse events occurred. Subgroup analyses revealed that patients with grade 1 OA showed significantly greater VAS pain reduction at 3 months (p= 0.006) and 6 months (p= 0.005) than patients with grade 2 OA. The older-age group (age > 60) showed significantly greater improvements in VAS pain, WOMAC function subscale scores and total scores at 6-month postinjection, compared with the younger age-group (age ≤ 60). The younger-age group reported better satisfaction at 1 and 3-month postinjection. CONCLUSIONS: One injection of PRP improved pain and function for 6 months for patients with early knee OA. This study supports putting the one-injection regimen into clinical practice. Further research is needed for more definite conclusions.

An informatics approach to examine decision-making impairments in the daily life of individuals with depression.

Mental health informatics studies methods that collect, model, and interpret a wide variety of data to generate useful information with theoretical or clinical relevance to improve mental health and mental health care. This article presents a mental health informatics approach that is based on the decision-making theory of depression, whereby daily life data from a natural sequential decision-making task are collected and modeled using a reinforcement learning method. The model parameters are then estimated to uncover specific aspects of decision-making impairment in individuals with depression. Empirical results from a pilot study conducted to examine decision-making impairments in the daily lives of university students with depression are presented to illustrate this approach. Future research can apply and expand on this approach to investigate a variety of daily life situations and psychiatric conditions and to facilitate new informatics applications. Using this approach in mental health research may generate useful information with both theoretical and clinical relevance and high ecological validity.

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial.

Importance: Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. Objective: To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). Design, Setting, and Participants: This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. Interventions: Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. Main Outcomes and Measures: The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. Results: Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. Conclusions and Relevance: This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. Trial Registration: ClinicalTrials.gov Identifier: NCT01763203.

Efficacy and Safety of a Single Intra-articular Injection of Platelet-rich Plasma on Pain and Physical Function in Patients With Ankle Osteoarthritis-A Prospective Study.

Ankle osteoarthritis (OA) can cause disabling symptoms, and some patients prefer to be treated with minimally invasive procedures. The aim was to evaluate the efficacy and safety of a single intraarticular injection of platelet-rich plasma (PRP) for patients with ankle OA. In a prospective study done in a university-affiliated tertiary care medical center, 44 patients with symptomatic ankle OA for at least 6 months were recruited. Patients received a single injection of PRP (3 mL) into symptomatic ankles. The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0-10 cm) at 6 months. Secondary outcomes included the Ankle Osteoarthritis Scale (AOS) score, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, single-leg stance test (SLS), rescue analgesics consumption and patient satisfaction. Thirty-nine participants (88.64%) completed the study. Significantly improvement in the VAS and AOS was noted at 1-, 3-, and 6-month follow-ups (p < .001). The mean VAS pain decreased significantly from 4.1 ± 1.7 at baseline to 2.2 ± 1.9, 1.7 ± 1.5, and 1.8 ± 1.6 at 1, 3, and 6 months (p < .001). The mean total AOS score reduced by 1.5, 2.2, and 2.1 from baseline respectively postinjection (p < .001). The mean AOFAS hindfoot-ankle score improved from 80.3 points at baseline to 87.2, 91.6, and 89.7 points at 1, 3, and 6 months (p < .001). SLS tests improved significantly (p < .001) at each follow-up. Acetaminophen consumption dropped significantly (p < .001) and no serious adverse events occurred. The study showed promise for a single intraarticular injection of PRP in the treatment of ankle OA.

Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis.

Intraarticular hyaluronan or platelet-rich plasma (PRP) is widely used in the treatment of knee osteoarthritis (OA). The efficacy of combined hyaluronan with PRP remained inconclusive. This study aimed to investigate the efficacy of combined a single crosslinked hyaluronan (HYAJOINT Plus) and a single PRP versus a single PRP in patients with knee OA. In a prospective randomized-controlled trial, 85 patients with knee OA (Kellgren-Lawrence 2) were randomized to receive a single intraarticular injection of HYAJOINT Plus (3 ml, 20 mg/ml) followed by 3 ml PRP (the combined-injection group, N = 43) or a single injection of 3 ml PRP (the one-injection group, N = 42). The primary outcome was the change from baseline in the visual analog scale (VAS) pain (0-00 mm) at 6 months. Secondary outcomes included The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, Likert Scale), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patient satisfaction at 1, 3 and 6 months. Seventy-eight patients were available for the intention-to-treat analysis at 6 months. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at each follow-up visit (p < 0.001). Patients receiving a single PRP experienced significantly greater improvements in VAS pain than patients receiving combined injections at 1-month follow-up (adjusted mean difference: - 5.6; p = 0.017). There were no significant between-group differences in several of the second outcomes at each follow-up visit, except the WOMAC-pain and WOMAC-stiffness scores favoring the one-injection group at 1 month (p = 0.025 and p = 0.011). However, at 6-month follow-up, the combined-injection group achieved significantly better VAS pain reduction (p = 0.020). No serious adverse events occurred following injections. In conclusion, either combined injections of HYAJOINT Plus and PRP or a single PRP alone was safe and effective for 6 months in patients with Kellgren-Lawrence 2 knee OA. Combined injections of HYAJOINT Plus and PRP achieved better VAS pain reduction than a single PRP at 6 months. The results indicating a long term benefit effect of a combination of HYAJOINT Plus and PRP in a particular subset of patients with moderate knee OA need to be replicated in larger trials.ClinicalTrials.gov number NCT04315103.

Internet Use and Loneliness of Older Adults Over Time: The Mediating Effect of Social Contact.

OBJECTIVES: The internet is increasingly commonly used by older adults. However, it remains controversial in the literature on whether older people are more or less lonely with internet adoption. The current paper aims to test the longitudinal association of internet use and loneliness and to theorize the relationship by examining the mediating effect of social contact. METHOD: This study employed data from 2006, 2010, and 2014 waves of the Health and Retirement Study. Loneliness was measured with the three-item UCLA loneliness scale, social contact was operationalized as contact frequency with family and friends, and internet use was measured using a self-assessed dichotomous item. Longitudinal associations and mediation effects were tested using hierarchical linear modeling. RESULTS: Internet use was associated with decreased loneliness over an 8-year period (b = -0.049, p < .001) and more social contact (b = 0.285, p < .001), which was related to lower perceived loneliness (b = -0.088, p < .001). On a scale ranges from 0 to 2 (0 = never lonely, 2 = often lonely), the total effect of internet use on loneliness was -0.060, and the mediated effect was -0.025. DISCUSSION: These findings imply that internet use may be an effective tool for reducing loneliness in older people by maintaining social contact.

Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness.

OBJECTIVES: In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness. DESIGN: Longitudinal panel study. SETTING AND PARTICIPANTS: The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis. METHODS: Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain. RESULTS: Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline. CONCLUSION AND IMPLICATIONS: Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.

Serial cardiopulmonary exercise testing in an asymptomatic young female receiving percutaneous balloon dilatation for cor triatriatum sinistrum at an early age.

A young female was diagnosed as classic cor triatriatum sinistrum (CTS) at 38 months old incidentally and she received percutaneous catheter-based balloon dilatation twice at 41 and 48 months old. She took regular follow-up by echocardiography biannually with no re-stenosis of the orifice in the membrane between two chambers in the left atrium and she denied any cardiac-related symptoms. Serial cardiopulmonary exercise testing (CPET) by treadmill under Ramped-Bruce protocol was done at her 13, 19, and 23-year old. She could reach maximal effort and complete the three CPETs. No significant change of metabolic equivalent at anaerobic (MET) threshold, peak MET, and pulmonary function were noted in the serial CPETs and all of them were within normal limits comparing to the reference values of Chinese specific to her age. Our case report demonstrated that the concept of percutaneous catheter-based balloon dilatation of obstructive membrane for classic CTS without other associated congenital heart diseases is sound and feasible. The prognosis is well without re-obstruction and the cardiopulmonary fitness after that could be maintain as healthy peers for up to 18 years.