scholarly journals Closing the Digital Divide in Speech, Language, and Cognitive Therapy: Cohort Study of the Factors Associated With Technology Usage for Rehabilitation

10.2196/16286 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e16286 ◽  
Author(s):  
Michael Munsell ◽  
Emily De Oliveira ◽  
Sadhvi Saxena ◽  
Jason Godlove ◽  
Swathi Kiran
Keyword(s):  
Disease Onset ◽  
Geographic Location ◽  
Language Disorders ◽  
Rehabilitation Program ◽  
Future Research ◽  
Linear Regression Models ◽  
Real World Data ◽  
Technological Adoption ◽  
The Impact ◽  
At Home

Background For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient’s ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient’s level of engagement with technology-based therapy are currently unknown. Objective This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). Methods Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. Results Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. Conclusions An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.

scholarly journals Closing the Digital Divide in Speech, Language, and Cognitive Therapy: Cohort Study of the Factors Associated With Technology Usage for Rehabilitation (Preprint)

2019 ◽  
Author(s):  
Michael Munsell ◽  
Emily De Oliveira ◽  
Sadhvi Saxena ◽  
Jason Godlove ◽  
Swathi Kiran
Keyword(s):  
Disease Onset ◽  
Geographic Location ◽  
Language Disorders ◽  
Rehabilitation Program ◽  
Future Research ◽  
Linear Regression Models ◽  
Real World Data ◽  
Technological Adoption ◽  
The Impact ◽  
At Home

BACKGROUND For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient’s ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient’s level of engagement with technology-based therapy are currently unknown. OBJECTIVE This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). METHODS Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An <i>active</i> day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. RESULTS Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (<i>P</i>=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (<i>P</i>=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. CONCLUSIONS An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.

Real-world treatment and outcomes of frontline chemotherapy in patients with metastatic pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16249-e16249
Author(s):  
Salwan Al Mutar ◽  
Muhammad Shaalan Beg ◽  
Eric Hansen ◽  
Andrew J. Belli ◽  
Maegan Vaz ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Trial ◽  
Real World ◽  
Univariate Analysis ◽  
The United States ◽  
Metastatic Pancreatic Cancer ◽  
Future Research ◽  
Real World Data ◽  
The Real ◽  
The Impact

e16249 Background: The difference between the FOLFIRINOX and gemcitabine/nab-paclitaxel (GnP) regimens’ clinical trial designs limit the ability to generate cross-study comparisons. Therefore, there is a significant need to understand the impact of various demographic and clinical characteristics on the effectiveness of these systemic therapies in the real-world treatment setting. This study seeks to compare the real-world outcomes of patients with metastatic pancreatic cancer treated with frontline FOLFIRINOX or GnP. Methods: Patients with primary metastatic pancreatic cancer who received first-line (1L) FOLFIRINOX or GnP were identified in the COTA real-world database. The COTA database is a de-identified database of real-world data (RWD) derived from the electronic health records of healthcare providers in the United States. Real-world overall response rate (rwORR) was calculated as the proportion of patients achieving complete response (CR) or partial response (PR). Overall survival (OS) was calculated using the Kaplan-Meier method and multivariate analyses utilized Cox proportional hazards. Results: The overall qualified cohort (n=236) was stratified by 1L FOLFIRINOX (n=109) or GnP (n=127). Select patient characteristics are shown in table. Patients treated with 1L FOLFIRINOX showed greater rwORR as compared to those treated with GnP (68.8% vs. 55.9%, p=0.04). Additionally, patients treated with 1L FOLFIRINOX had longer median OS (14.4 vs 11.4 mos, respectively). In univariate analysis, patients treated with GnP had a greater chance of mortality (HR: 1.3, 95% CI: 1.0, 1.8, p=0.05). This relationship strengthened in multivariate analysis (GnP treated HR: 1.6, 95% CI: 1.1, 2.1, p=0.01). Conclusions: Due to lack of enrollment of representative patients in clinical trials and in the absence of a comparative clinical trial, real-world experience with chemotherapy regimens provide critical insights on the outcome of treatments. In our cohort, patients treated with frontline GnP had a significantly greater chance of mortality as compared to patients treated with frontline FOLFIRINOX. The FOLFIRINOX cohort also showed greater rwORR. Future research will continue to expand on treatment patterns in subsequent lines of therapy, as well as emerging therapy types, in order to better understand the optimal treatment sequence in metastatic pancreatic cancer.[Table: see text]

scholarly journals The Impact of Independent of Activity Daily Living among Stroke Patients on Caregivers Burden

Jurnal NERS ◽  
2020 ◽  
Vol 14 (3) ◽  
pp. 188
Author(s):  
Nikmatul Fadilah ◽  
Loetfia Dwi Rahariyani
Keyword(s):  
Community Health ◽  
Daily Living ◽  
Care Pathway ◽  
Simple Random Sampling ◽  
Rehabilitation Program ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Care At Home ◽  
The Impact ◽  
At Home

Introduction: Weakness among stroke patients causes obstacles when fulfilling their activities in daily living (ADL). This condition also has an impact on the caregivers who provide daily care at home. The purpose of this study was to analyze the effect of independent ADL among the stroke patients on caregiver burden.Methods: The study used an analytical design through a cross-sectional approach. The variables included independent ADL and caregiver burden. A sample of 120 caregivers was taken from 2 community health centers in Surabaya through simple random sampling. The instruments used were Zarit Burden's Interview Schedule and the Katz Index of Independent for ADL. Regression ordinal was used to analyze the influence of independent ADL among stroke patients on caregiver burden.Results: The results showed that the caregiver who take care of stroke patients with severe functional impairment will feel burdened 3 times more than no burden. Post-stroke care at home through a rehabilitation program plays an important role in improving the condition of patients and their families at home, especially the caregivers.Conclusion: Nurses in a community health center through the family health care pathway provide comprehensive bio-psycho-socio-spiritual care in the rehabilitation period as expected. They are expected to improve and maintain the fulfillment of human needs comprehensively for stroke patients and their caregivers, so the quality of life of stroke patients, caregivers and their families remains optimal.

scholarly journals Effect of living arrangement on anthropometric traits in first-year university students from Canada: The GENEiUS study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241744
Author(s):  
Tanmay Sharma ◽  
Christine Langlois ◽  
Rita E. Morassut ◽  
David Meyre
Keyword(s):  
Weight Gain ◽  
University Students ◽  
Living Arrangements ◽  
Living Arrangement ◽  
Rank Test ◽  
First Year ◽  
Linear Regression Models ◽  
First Year University ◽  
The Impact ◽  
At Home

Background The transition to university often involves a change in living arrangement for many first-year students. While weight gain during first year of university has been well documented, Canadian literature on the impact of living arrangement within this context is limited. The objective of this investigation was to explore the effect of living arrangement on anthropometric traits in first-year university students from Ontario, Canada. Methods 244 first-year undergraduate students were followed longitudinally with data collected early in the academic year and towards the end of the year. Anthropometric parameters including weight, waist and hip circumference, body mass index (BMI), and waist-to-hip ratio (WHR) were examined. The Wilcoxon signed-rank test was used for pairwise comparison of traits from the beginning to end the year in the absence of adjustments. Additionally, linear regression models with covariate adjustments were used to investigate effect of the type of living arrangement (i.e. on-campus, off-campus, or family home) on the aforementioned traits. Results In the overall sample, a significant weight increase of 1.55kg (95% CI: 1.24–1.86) was observed over the school year (p<0.001), which was also accompanied by significant gains in BMI, and waist and hip circumferences (p<0.001). At baseline, no significant differences were found between people living on-campus, off-campus, and at home with family. Stratified analysis of change by type of living arrangement indicated significant gains across all traits among students living on-campus (p<0.05), and significant gains in weight and BMI among students living at home with family. Additionally, a comparison between living arrangements revealed that students living on campus experienced significantly larger gains in weight and BMI compared to students living off-campus (p<0.05). Conclusion Our findings indicate that living arrangement is associated with different weight gain trajectories in first-year university students.

scholarly journals Status of Retinoids and Carotenoids and Associations with Clinical Outcomes in Maternal-Infant Pairs in Nigeria

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1286 ◽  
Author(s):  
Corrine Hanson ◽  
Elizabeth Lyden ◽  
Ann Anderson-Berry ◽  
Nicholas Kocmich ◽  
Amy Rezac ◽  
...  
Keyword(s):  
Vitamin A ◽  
Clinical Outcomes ◽  
Vitamin A Deficiency ◽  
Plasma Concentrations ◽  
Future Research ◽  
Linear Regression Models ◽  
Nigerian Women ◽  
Plasma Retinol ◽  
Highly Correlated ◽  
The Impact

Vitamin A is an essential nutrient in pregnancy, and other carotenoids have been independently associated with maternal-infant outcomes. The objective of this study was to quantify the status of vitamin A and carotenoids in Nigerian maternal-infant pairs at delivery, compare these to a cohort from a developed nation, and determine the impact on clinical outcomes. Maternal and cord blood samples were collected in 99 Nigerian mother-infant pairs. Concentrations of lutein + zeaxanthin, β-cryptoxanthin, lycopene, α- and β-carotenes, and retinol were measured using HPLC. Descriptive statistics were calculated and Spearman coefficients were used to assess correlations between maternal and cord measurements; Mann-Whitney tests were used to compare median plasma values between dichotomous variables. Linear regression models were used to adjust for relevant confounders. A p < 0.05 was considered statistically significant. Thirty-five percent of mothers had plasma retinol concentrations ≤0.70 µmol/L; 82% of infants had plasma retinol concentrations ≤0.70 µmol/L at delivery. Maternal and infant concentrations of vitamin A compounds were highly correlated and were associated with newborn growth and Apgar scores. Despite plasma concentrations of pro-vitamin A carotenoids higher than those reported in other populations, pregnant Nigerian women have a high prevalence of vitamin A deficiency. As vitamin A related compounds are modifiable by diet, future research determining the clinical impact of these compounds is warranted.

scholarly journals Social Media and Environmental Sustainability: An Overview of European Countries

2016 ◽  
Vol 11 (6) ◽  
pp. 1 ◽  
Author(s):  
Federica De Leo ◽  
Ginevra Gravili ◽  
Pier Paolo Miglietta
Keyword(s):  
Social Media ◽  
Cultural Values ◽  
Environmental Sustainability ◽  
Environmental Performance ◽  
Integrated Approach ◽  
Cultural Dimensions ◽  
European Countries ◽  
Future Research ◽  
Linear Regression Models ◽  
The Impact

<p>The theme of the relationship between social media and sustainability has prompted many scholars to analyze the impact that “virtual information” has on the environment. This study empirically tests two models that examine the effects of cultural values and social media on environmental performance by considering different variables such as Social Media penetration, Hofstede’s Cultural Dimensions and Environmental Performance Index. Two multiple linear regression models were employed to test the hypotheses on a sample of 30 European Countries.</p><p>Empirical results, extensible to all of Europe, conclude that the cultural dimensions analyzed, as well as social media penetration, significantly influence environmental performance of European Countries when we execute a combined model.</p>Social media are arguably an integral part of sustainability strategy and future research on IT and sustainability needs to take a more integrated approach. If we consider that social media have a positive effect on the environment it is easy to intuit that if governance implements effective policies to ensure social media access for everyone, real sustainable development could be achieved.

Early treatment delays long-term disability accrual in RRMS: Results from the BMSD network

2021 ◽  
pp. 135245852110101
Author(s):  
Pietro Iaffaldano ◽  
Giuseppe Lucisano ◽  
Helmut Butzkueven ◽  
Jan Hillert ◽  
Robert Hyde ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cox Regression ◽  
Disease Onset ◽  
Optimal Time ◽  
Optimal Timing ◽  
Real World Data ◽  
Treatment Start ◽  
Time To First Treatment ◽  
The Impact

Background: The optimal timing of treatment starts for achieving the best control on the long-term disability accumulation in multiple sclerosis (MS) is still to be defined. Objective: The aim of this study was to estimate the optimal time to start disease-modifying therapies (DMTs) to prevent the long-term disability accumulation in MS, using a pooled dataset from the Big Multiple Sclerosis Data (BMSD) network. Methods: Multivariable Cox regression models adjusted for the time to first treatment start from disease onset (in quintiles) were used. To mitigate the impact of potential biases, a set of pairwise propensity score (PS)-matched analyses were performed. The first quintile, including patients treated within 1.2 years from onset, was used as reference. Results: A cohort of 11,871 patients (median follow-up after treatment start: 13.2 years) was analyzed. A 3- and 12-month confirmed disability worsening event and irreversible Expanded Disability Status Scale (EDSS) 4.0 and 6.0 scores were reached by 7062 (59.5%), 4138 (34.9%), 3209 (31.1%), and 1909 (16.5%) patients, respectively. The risk of reaching all the disability outcomes was significantly lower ( p < 0.0004) for the first quintile patients’ group. Conclusion: Real-world data from the BMSD demonstrate that DMTs should be commenced within 1.2 years from the disease onset to reduce the risk of disability accumulation over the long term.

scholarly journals The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study

2021 ◽  
pp. 070674372110118
Author(s):  
Martin Rotenberg ◽  
Andrew Tuck ◽  
Kelly K. Anderson ◽  
Kwame McKenzie
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Psychotic Disorders ◽  
Geographic Location ◽  
Population Based ◽  
Incidence Rates ◽  
Future Research ◽  
Incident Cases ◽  
The Impact

Background: There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario. Methods: We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices. Results: There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs. Conclusions: There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.

scholarly journals The impact of shielding during the COVID-19 pandemic on mental health: Evidence from the English Longitudinal Study of Ageing

2021 ◽  
Author(s):  
Giorgio Di Gessa ◽  
Debora Price
Keyword(s):  
Mental Health ◽  
Longitudinal Study ◽  
Older People ◽  
Social Contact ◽  
Human Interaction ◽  
Linear Regression Models ◽  
Physical And Mental Health ◽  
The Impact ◽  
English Longitudinal Study ◽  
At Home

Background: During the COVID-19 pandemic, older and clinically vulnerable people were instructed to shield or stay at home to save lives. Policies restricting social contact and human interaction pose a risk to mental health, but we know very little about the impact of shielding and stay at home orders on the mental health of older people. Aims: Understand the extent to which shielding contributes to poorer mental health. Method: Exploiting longitudinal data from Wave 9 (2018/19) and two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing we use logistic and linear regression models to investigate associations between patterns of shielding during the pandemic and mental health, controlling for socio-demographic characteristics, pre-pandemic physical and mental health, and social isolation measures. Results: By December 2020, 70% of older people were still shielding or staying at home, with 5% shielding throughout the first 9 months of the pandemic. Respondents who shielded experienced worse mental health. Although prior characteristics and lack of social interactions explain some of this association, even controlling for all covariates, those shielding throughout had higher odds of reporting elevated depressive symptoms (OR=1.87, 95%CI=1.22;2.87) and reported lower quality of life (B=-1.28, 95%CI=-2.04;-0.52) than those who neither shielded nor stayed at home. Shielding was also associated with increased anxiety. Conclusions: Shielding itself seems associated with worse mental health among older people, highlighting the need for policymakers to address the mental health needs of those who shielded, both in emerging from the current pandemic and for the future.

scholarly journals Working from the Home Office and Homeschool(-ing): Experiences of Austrian Employees (Parents) in the Time of Covid-19

2021 ◽  
Vol 11 (4) ◽  
pp. 76
Author(s):  
Michal Beno
Keyword(s):  
School Environment ◽  
Future Research ◽  
Working Parents ◽  
Home Office ◽  
Entire Family ◽  
Living Space ◽  
Home Space ◽  
The Impact ◽  
Home And School ◽  
At Home

Due to Covid-19, many working parents are facing new challenges. The aim of this paper is to share their personal experiences and the best recommendations for resolving their difficulties. We summarise their complex thoughts on the subject of the home office in relation to the household, homeschooling and the education of all concerned. In order to address this question, a qualitative research paradigm using WhatsApp as a medium in order to explore the following research questions was used: 1) How are employees able to manage the home office, homeschooling and the household under one roof? and 2) Will WFH and homeschooling disadvantage working mothers more than working fathers? Data were collected from 10 working parents (five males and five females) in Austria. According to coding, four major themes were explored: 1) Compatibility, 2) Work/home space, 3) Work week separation and 4) Suggestions and organisational recommendations. It was determined that at the beginning of the lockdown drawing a clear boundary between the home, office and school environments caused some difficulties. Especially parents with younger children experienced problems of compatibility. Secondly, flexibility and housing in relation to the home-office-school environment was a common topic throughout the interviews. Furthermore, before Covid-19 all participants had a more classic separation of roles. Roles and expectations changed as all the family members stayed at home day in and day out. Finally, in privileged situations (more living space, jobs that could be done remotely or support of the entire family), it was often easier to deal with the current challenges. This pandemic has brought many changes in everyday life and in terms of performing old tasks and new ones. This includes work at home and homeschooling. The obtained data provide important insights into how to deal with the impact of Covid-19 on work, home and school while emphasising the importance of these questions as well as of future research for support and information.   Received: 31 March 2021 / Accepted: 26 May 2021 / Published: 8 July 2021

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