Validation of a Frailty Ladder Using Rasch Analysis: If the Shoe Fits

The current measurement approach to frailty is to classify people on frailty status, rather than measure the degree to which they are frail. Here, we test the extent to which a set of items identified within the frailty concept fits a hierarchical linear model (Rasch model) and form a true measure reflective of the frailty construct and confirm the model using the NuAge dataset. The development sample included 234 individuals (aged 57 to 97) drawn from three sources: at-risk seniors (n=141); post-colorectal surgery (n=47); and post-rehabilitation hip fracture (n=46). We defined our frailty construct based on items commonly used in frailty indices, self-report measures, and performance tests. Of the 68 items, 29 fit the Rasch Model: 19 self-report items on physical function and 10 performance tests including one for cognition. Items typically identified as reflecting the frailty concept fit the Rasch model. The Frailty Ladder would facilitate personalized intervention.

A social-healthcare pathway to facilitate return to work of cancer survivors in Italy: The UNAMANO project

BACKGROUND: Return to work (RTW) is a major goal to promote cancer survivors’ social participation. OBJECTIVE: This study describes the multidisciplinary social-healthcare pathway called UNAMANO, conceived to support RTW in this population. METHODS: UNAMANO was developed by the Azienda USL-IRCCS di Reggio Emilia, in partnership with the local branch of the Italian Medical Association, nonprofit associations, vocational training institutions, social cooperatives, a labour union, and a chartered accounting firm. RESULTS: UNAMANO is directed towards employed individuals diagnosed with cancer living in the province of RE. It was developed through four actions: A) training healthcare professionals on work-related occupational rehabilitation; B) dissemination among community and stakeholders; C) recruitment and training of volunteers; D) cancer survivor engagement and provision of a personalized comprehensive intervention. This consists in providing information and either occupational therapy to overcome barriers and facilitate RTW or social support through re-training and tailored job search strategies based on individual risk of job loss. CONCLUSIONS: UNAMANO is the first Italian multidisciplinary social-healthcare pathway supporting RTW of cancer survivors. Addressing a wide area of cancer survivors’ needs, it provides personalized intervention to resolve work-related issues. We propose this patient-centred RTW model to promote an easier transition from hospital to community.

Virtual Reality at the Service of People with Functional Diversity: Personalized Intervention Spaces

Virtual reality allows to generate an environment of great realism, while achieving the immersion of the user in it. The purpose of this project is to use this technology as a complementary tool in the rehabilitation of people with functional diversity. To do this, an application is being developed that will offer different environments that simulate situations in everyday life. Through its initial menu, the professional will be able to select the virtual work environment, with different configuration options to adapt each scenario to the user’s needs. This customization of the scenarios will allow such things as configuring the degree of difficulty of the activity to eventually adapting the elements of the scenario to the functional capacity of the user.

Intelligent Coaching Assistant for the Promotion of Healthy Habits in a Multidomain mHealth-Based Intervention for Brain Health

Brain Health is defined as the development and preservation of optimal brain integrity and neural network functioning for a given age. Recent studies have related healthy habits with better maintenance of brain health across the lifespan. As a part of the Barcelona Brain Health Initiative (BBHI), a mHealth platform has been developed with the purpose of helping people to improve and monitor their healthy habits, facilitating the delivery of health coaching strategies. A decision support system (DSS), named Intelligent Coaching Assistant (ICA), has been developed to ease the work of professional brain health coaches, helping them design and monitor adherence to multidomain interventions in a more efficient manner. Personalized recommendations are based on users’ current healthy habits, individual preferences, and motivational aspects. Taking these inputs, an initial user profile is defined, and the ICA applies an algorithm for determining the most suitable personalized intervention plan. An initial validation has been done focusing on assessing the feasibility and usability of the solution, involving 20 participants for three weeks. We conclude that this kind of technology-based intervention is feasible and implementable in real-world settings. Importantly, the personalized intervention proposal generated by the DSS is feasible and its acceptability and usability are high.

Research on Key Technologies of Personalized Intervention for Chronic Diseases Based on Case-Based Reasoning

In recent years, with the acceleration of industrialization, urbanization, and aging process, the number of patients with chronic diseases in the world is increasing year by year. In China, the number of chronic diseases has increased tenfold in 10 years. The percentage of the disease burden in the whole society accounts for 79.4%. Chronic diseases have become the top killer for Chinese people’s health. However, for chronic diseases, prevention is more important than treatment. It is the best way to keep healthy. Therefore, health intervention is the key to prevent chronic diseases. Especially now, with the spread of COVID-19 pandemic, reducing the times of hospital check-ups and treatments for chronic patients is practically significant for releasing the stress on medical staffs and decreasing the rate of transmission and infection of COVID-19. In this paper, case-based reasoning (CBR) technology is used to assist personalized intervention for chronic diseases, and the key technologies of personalized intervention for chronic diseases based on case-based reasoning are proposed. The case organization, case retrieval, and case retention techniques of CBR technology in chronic disease personalized intervention are designed, and the calculation of interclass dispersion is added to the distribution of feature words, which is used to describe the distribution of feature attributes in different categories of cases. It provides an effective method for the establishment of personalized intervention model for chronic disease.

Ergonomic evaluation in community pharmacies

Background The risk of a health professional contracting work-related diseases is about 1.5 times greater than the risk of all other workers. For this reason, the present study focused on community pharmacies, aiming ergonomic risks, which allows a more personalized intervention individualized in an assessment and control of ergonomic risks. Methods We proposed as an objective of this study, to evaluate the ergonomic risks to which the workers of the community pharmacies are exposed. This study was of the Descriptive-Correlational, Analytical type, and of a transversal nature where the working conditions in pharmacies of the municipality of Coimbra were evaluated. The sample being represented by 15 workers. A questionnaire was carried out and the KIM and RULA methodologies were applied for ergonomic evaluation. The results were evaluated using the IBM SPSS Statistics version 26.0 program using descriptive tests and inference tests. Results The ergonomic assessment indicated greater risk of exposure in the task of replacing goods, the perception of workers proved to be positive in relation to existing non-conformities. There were no statistically significant differences in psychosocial and ergonomic risks between men and women. Conclusion The ergonomic conditions of the workplace for the professionals in community pharmacies are unfavourable in some points. However, if they try to adapt the workplace to the worker considering ergonomic aspects, they will promote well-being and thus guarantee better performance for their professionals and consequent increase in productivity

Exploring the Interactions Between Neurophysiology and Cognitive and Behavioral Changes Induced by a Non-pharmacological Treatment: A Network Approach

Dementia due to Alzheimer’s disease (AD) is a neurological syndrome which has an increasing impact on society, provoking behavioral, cognitive, and functional impairments. AD lacks an effective pharmacological intervention; thereby, non-pharmacological treatments (NPTs) play an important role, as they have been proven to ameliorate AD symptoms. Nevertheless, results associated with NPTs are patient-dependent, and new tools are needed to predict their outcome and to improve their effectiveness. In the present study, 19 patients with AD underwent an NPT for 83.1 ± 38.9 days (mean ± standard deviation). The NPT was a personalized intervention with physical, cognitive, and memory stimulation. The magnetoencephalographic activity was recorded at the beginning and at the end of the NPT to evaluate the neurophysiological state of each patient. Additionally, the cognitive (assessed by means of the Mini-Mental State Examination, MMSE) and behavioral (assessed in terms of the Dementia Behavior Disturbance Scale, DBD-13) status were collected before and after the NPT. We analyzed the interactions between cognitive, behavioral, and neurophysiological data by generating diverse association networks, able to intuitively characterize the relationships between variables of a different nature. Our results suggest that the NPT remarkably changed the structure of the association network, reinforcing the interactions between the DBD-13 and the neurophysiological parameters. We also found that the changes in cognition and behavior are related to the changes in spectral-based neurophysiological parameters. Furthermore, our results support the idea that MEG-derived parameters can predict NPT outcome; specifically, a lesser degree of AD neurophysiological alterations (i.e., neural oscillatory slowing, decreased variety of spectral components, and increased neural signal regularity) predicts a better NPT prognosis. This study provides deeper insights into the relationships between neurophysiology and both, cognitive and behavioral status, proving the potential of network-based methodology as a tool to further understand the complex interactions elicited by NPTs.

Attention bias modification in drug addiction: Enhancing control of subsequent habits

A relapse in addiction is often precipitated by heightened attention bias to drug-related cues, underpinned by a subcortically mediated transition to habitual/automatized responding and reduced prefrontal control. Modification of such automatized attention bias is a fundamental, albeit elusive, target for relapse reduction. Here, on a trial-by-trial basis, we used electroencephalography and eye tracking with a task that assessed, in this order, drug cue reactivity, its instructed self-regulation via reappraisal, and the immediate aftereffects on spontaneous (i.e., not instructed and automatized) attention bias. The results show that cognitive reappraisal, a facet of prefrontal control, decreased spontaneous attention bias to drug-related cues in cocaine-addicted individuals, more so in those with less frequent recent use. The results point to the mechanisms underlying the disruption of automatized maladaptive drug-related attention bias in cocaine addiction. These results pave the way for future studies to examine the role of such habit disruption in reducing compulsive drug seeking outside the controlled laboratory environment, with the ultimate goal of developing a readily deployable cognitive-behavioral and personalized intervention for drug addiction.

Management of Childhood Obesity—Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.