Digital Health Coaching Programs Among Older Employees in Transition to Retirement: Systematic Literature Review

Background

The rapid increase of the aging population is pushing many national governments to reshape retirement legislation in order to extend older adults’ working life. Once retired, older adults can be invaluable resources for the community as family carers, as volunteers, or by returning to work. Healthy aging is one of the main conditions for being able to work longer and being active after retirement. The latter, indeed, represents a very sensitive life transition, which can entail psychological and social difficulties. Interventions for promoting older workers’ health and well-being and supporting the transition to retirement are on the top of the policy agenda of most European countries. Recently, computer-based and digital health interventions have been seen as promising means to reach this purpose.

Objective

This systematic literature review aimed to explore studies on digital health coaching programs for older workers that followed a user-centered design approach and evaluated their effectiveness in providing older adults with guidance for adopting a healthy lifestyle and being active in the community.

Methods

The search identified 1931 papers, and 2 relevant articles were selected by applying specific eligibility criteria.

Results

To our knowledge, only few digital health coaching programs have targeted the population of older workers to date; there is an insufficient number of studies on the efficacy of such programs. The results show the difficulties of assessing the efficacy of digital coaching itself and with respect to older employees. The 2 studies suggest that digital health programs for workplaces can improve various aspects of older employees’ well-being; however, they considered health mainly from a physical perspective and neglected contextual, social, psychological, and cultural factors that can influence older workers’ health and general well-being. Future digital health coaching programs should adopt the healthy aging paradigm as a multidimensional lens for interpreting the impact of eHealth technology on aging and retirement. The literature around this issue remains at an embryonic state, and this gap needs to be filled by further investigations that apply a user-centered approach for designing the technology, test innovative research methodologies, and adopt new technical solutions for high-quality interaction design.

Conclusions

Further digital health coaching programs aimed at supporting healthy and active living for older workers and retirees are necessary. The user-centered design approach is recommended in order to fully address the users’ health needs and the technological requirements throughout development. Moreover, the healthy aging perspective allows inclusion of physical, social, and psychological factors influencing the transition from work to retirement, as well as the experiences and interactions of individuals with the technology.

Positive and Negative Impacts of Caring among Adolescents Caring for Grandparents. Results from an Online Survey in Six European Countries and Implications for Future Research, Policy and Practice

Although up to 8% of European youngsters carry out high-intensity care for a family member, adolescent young carers (AYCs), especially those caring for their grandparents (GrPs), remain an under-researched group. This study aimed at addressing the current knowledge gap by carrying out an online survey in Italy, the Netherlands, Slovenia, Sweden, Switzerland, and the United Kingdom. The analysis included a final sample of 817 AYCs aged 15-17 years old. AYCs of grandparents (GrPs) were compared to AYCs of other care recipients (OCRs), in order to identify any difference in positive and negative caregiving outcomes and exposure factors between the two groups. Linear or logistic regression models were built, and multivariate analyses were repeated, including a fixed effect on the country variable. AYCs of GrPs experienced more positive caregiving outcomes than AYCs of OCRs across all six countries. Being female or non-binary, and having a migration background, were associated with more negative outcomes, regardless of the relationship with the care recipient. Further research on intergenerational caregiving outcomes is recommended for shaping measures and policies, which preserve the intergenerational emotional bonds, whilst protecting AYCs from inappropriate responsibilities, undermining their mental health and well-being.

Neuron-Derived Neurotrophic Factor Is Mutated in Congenital Hypogonadotropic Hypogonadism

Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disorder characterized by infertility and the absence of puberty. Defects in GnRH neuron migration or altered GnRH secretion and/or action lead to a severe gonadotropin-releasing hormone (GnRH) deficiency. Given the close developmental association of GnRH neurons with the olfactory primary axons, CHH is often associated with anosmia or hyposmia, in which case it is defined as Kallmann syndrome (KS). The genetics of CHH are heterogeneous, and >40 genes are involved either alone or in combination. Several CHH-related genes controlling GnRH ontogeny encode proteins containing fibronectin-3 (FN3) domains, which are important for brain and neural development. Therefore, we hypothesized that defects in other FN3-superfamily genes would underlie CHH. Next-generation sequencing was performed for 240 CHH unrelated probands and filtered for rare, protein-truncating variants (PTVs) in FN3-superfamily genes. Compared to gnomAD controls the CHH cohort was statistically enriched for PTVs in neuron-derived neurotrophic factor (NDNF) (p = 1.40 × 10^-6). Three heterozygous PTVs (p.Lys62^∗, p.Tyr128Thrfs^∗55, and p.Trp469^∗, all absent from the gnomAD database) and an additional heterozygous missense mutation (p.Thr201Ser) were found in four KS probands. Notably, NDNF is expressed along the GnRH neuron migratory route in both mouse embryos and human fetuses and enhances GnRH neuron migration. Further, knock down of the zebrafish ortholog of NDNF resulted in altered GnRH migration. Finally, mice lacking Ndnf showed delayed GnRH neuron migration and altered olfactory axonal projections to the olfactory bulb; both results are consistent with a role of NDNF in GnRH neuron development. Altogether, our results highlight NDNF as a gene involved in the GnRH neuron migration implicated in KS.

Can a Green Care Informal Learning Program Foster Active Aging in Older Adults? Results From a Qualitative Pilot Study in Central Italy

Due to population aging worldwide, it is important for Health Care Systems to design new services fostering Active Aging dimensions (e.g., physical health, psychological well-being, social engagement, and lifelong learning). The aim of this pilot study was to develop new services fostering Active Aging dimensions by means of a 12-month green care informal learning program targeting 112 individuals among community-dwelling older people and day care center users. The impact of the intervention was assessed through three rounds of focus groups. Individuals' perception of the training benefits depended on their health and social condition at baseline. The program improved the social participation and learning attitudes of community-dwelling older people and the perceived well-being and health of day care center users. Green care activities triggered an Active Aging virtuous spiral where learning new practical and relational competencies helped older people recognize their value. Thus, it is recommendable to include green care therapy within the practice of services for older people, especially day care centers.

The impact of the absorbent products distribution system on family caregivers of older people with incontinence in Italy: perception of the support received

Background

Urinary incontinence is a chronic, age-related disorder, likely to increase in the future due to global population ageing. In Italy, as in most countries, older people with incontinence are often cared for by family caregivers, whose burden might be worsened by the perception of receiving an inadequate support, due to the lack of customized services. The aim of this study was to evaluate the impact of the absorbent products distribution method on family caregivers’ perception of the support received.

Methods

The study compared the distribution of pads to homes and in pharmacy via a survey reaching 101 family caregivers of older people with incontinence living in two geographical areas of the Marche Region (Central Italy) with different distribution systems. The association between “Quality of perceived support” (the outcome variable) and two types of absorbent products delivery methods (i.e. pharmacy and home distribution) was analysed by means of a general linear model.

Results

Findings show that family caregivers receiving pads at home (HODs) perceived a higher support than those gaining them at the pharmacy (PHADs) (respectively 68.1% vs 35%). The association between perceived support level and distribution system remained even after correction for confounding factors. 70.2% of PHADs reported “Poor well-being”, versus only 53.7% of HODs. The latter are more satisfied with the type of products distribution and thus less inclined to experiment different systems for the supply of products for the urinary continence (e.g. by voucher). The results are virtually reversed among PHADs and the difference is statistically significant (p <  0.001).

Conclusions

When family caregivers feel supported by a more customized service delivery system, their perception of the care-related burden is mitigated. Thus, it is important to consider the needs of both family caregivers and cared for older people, and not only of the latter for designing a more suitable distribution of absorbent products. The best solution could be leaving end-users the freedom to choose how they want to get products (e.g. voucher or personal budget). This requires a reorganization of the current pads delivery systems adopted by the Marche and by other Italian Regional Health Systems.

Impact of the lack of integrated care for older people with urinary incontinence and their family caregivers: results from a qualitative pilot study in two large areas of the Marche Region

OBJECTIVES

Urinary incontinence (UI) may have a severe impact on older people and on their family caregivers' quality of life, especially when support services are scanty or inadequate. This study investigated the support needs and expectations of community-dwelling older people with UI and their family caregivers in the Marche Region (Central Italy).

METHODS

Face-to-face semi-structured interviews were carried out to eight over-60-year-old patients with UI, four family caregivers, two representatives of the Regional Health System and two pharmacists.

RESULTS

Findings show that the insufficient supply and low quality of continence products and the lack of integrated care services negatively affects the well-being of both older people and family caregivers.

DISCUSSION

Integrated care services and a standardized system for the periodic assessment of sufferers and a more customized service delivery, including the possibility of choosing brand and type of products for users, may improve the current provision in this Italian Region.

DCC/NTN1 complex mutations in patients with congenital hypogonadotropic hypogonadism impair GnRH neuron development

Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disease characterized by absent puberty and infertility due to GnRH deficiency, and is often associated with anosmia [Kallmann syndrome (KS)]. The genetic etiology of CHH is heterogeneous, and more than 30 genes have been implicated in approximately 50% of patients with CHH. We hypothesized that genes encoding axon-guidance proteins containing fibronectin type-III (FN3) domains (similar to ANOS1, the first gene associated with KS), are mutated in CHH. We performed whole-exome sequencing in a cohort of 133 CHH probands to test this hypothesis, and identified rare sequence variants (RSVs) in genes encoding for the FN3-domain encoding protein deleted in colorectal cancer (DCC) and its ligand Netrin-1 (NTN1). In vitro studies of these RSVs revealed altered intracellular signaling associated with defects in cell morphology, and confirmed five heterozygous DCC mutations in 6 probands-5 of which presented as KS. Two KS probands carry heterozygous mutations in both DCC and NTN1 consistent with oligogenic inheritance. Further, we show that Netrin-1 promotes migration in immortalized GnRH neurons (GN11 cells). This study implicates DCC and NTN1 mutations in the pathophysiology of CHH consistent with the role of these two genes in the ontogeny of GnRH neurons in mice.

A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy

The aim of this study was to evaluate a 1-year social farming programme conducted between 2014 and 2015, including horticultural and occupational activities on six agricultural farms for older people in good general health. Social farming is a practice that uses agricultural resources to provide health, social or educational services to vulnerable groups of people. Activity participation, social relationships, physical activity, and the quality of life of the participants were assessed using a pretest, posttest design. A total of 112 subjects were interviewed at baseline, though only 73 participants were retained through the end of the follow-up, resulting in a dropout rate of 34%. Data analysis revealed significant improvements in both social relationships and overall occupational engagement at the end of the programme, with significant increases in the frequency of contact with friends or relatives as well as the number of activities performed by the participants. This work adds to the literature on the effects of social farming and indicates that farming may provide opportunities for older people to engage in activities that stimulate social behaviours.

Intergenerational Programs Involving Adolescents, Institutionalized Elderly, and Older Volunteers: Results from a Pilot Research-Action in Italy

Changes in traditional family structures, public policy arrangements, and new family care patterns are reducing opportunities for interaction between younger and older people in Europe and in Italy, especially when the latter live in residential care facilities. This may bolster age-related stereotypes in both generations and end up with affecting older people's self-confidence, devaluing their emotional and relational capabilities. "Let's Re-Generate" is a pilot research-action project-based on an intergenerational program carried out in a nursing home in Central Italy-which aimed at prompting institutionalized older people and adolescents in the community to enhance intergenerational ties through various shared activities. Results from focus groups with 25 teenagers and in-depth interviews with 16 older residents and 16 older volunteers provide an in-depth insight on the positive impact of intergenerational programs, which foster the interaction between different ages, help overcome age-related stereotypes, and improve older people's mental well-being and older volunteers' generativity. The main recommendation emerging from this study is that intergenerational activities should be integrated in the daily routine of nursing homes, acting as useful tools for fostering older residents' capability of reacting to dependency and social isolation.

What Happens to Retirement Plans, and Does This Affect Retirement Satisfaction?

This study examines the role of planning and plan fulfillment for retirement satisfaction using a dynamic resource theory approach. A 3-year qualitative longitudinal design was deployed with interviews conducted first on the cusp of retirement, then 1 and 2 years after retirement. The final sample comprised 41 individuals from England, 40 from Italy, and 30 from the United States. Realizing plans was found to be linked to retirement satisfaction. However, many retirees adjusted well to retirement without planning in advance, or when plans were thwarted, and sometimes retirement did not live up to expectations despite fulfillment of plans. Psychological resources and resilience were key dimensions of satisfaction regardless of planning. Retirement satisfaction was also associated with social integration, adoption of new social roles, and opportunities to be active within and beyond the private sphere, such as volunteering or participating in leisure oriented clubs or activities. Regardless of planning, the quality of family relationships was a particularly important element for retirement satisfaction or dissatisfaction.

Congenital hypogonadotropic hypogonadism and constitutional delay of growth and puberty have distinct genetic architectures

OBJECTIVE

Congenital hypogonadotropic hypogonadism (CHH) and constitutional delay of growth and puberty (CDGP) represent rare and common forms of GnRH deficiency, respectively. Both CDGP and CHH present with delayed puberty, and the distinction between these two entities during early adolescence is challenging. More than 30 genes have been implicated in CHH, while the genetic basis of CDGP is poorly understood.

DESIGN

We characterized and compared the genetic architectures of CHH and CDGP, to test the hypothesis of a shared genetic basis between these disorders.

METHODS

Exome sequencing data were used to identify rare variants in known genes in CHH (n = 116), CDGP (n = 72) and control cohorts (n = 36 874 ExAC and n = 405 CoLaus).

RESULTS

Mutations in at least one CHH gene were found in 51% of CHH probands, which is significantly higher than in CDGP (7%, P = 7.6 × 10^-11) or controls (18%, P = 5.5 × 10^-12). Similarly, oligogenicity (defined as mutations in more than one gene) was common in CHH patients (15%) relative to CDGP (1.4%, P = 0.002) and controls (2%, P = 6.4 × 10^-7).

CONCLUSIONS

Our data suggest that CDGP and CHH have distinct genetic profiles, and this finding may facilitate the differential diagnosis in patients presenting with delayed puberty.

Power frequency magnetic field promotes a more malignant phenotype in neuroblastoma cells via redox-related mechanisms

In accordance with the classification of the International Agency for Research on Cancer, extremely low frequency magnetic fields (ELF-MF) are suspected to promote malignant progression by providing survival advantage to cancer cells through the activation of critical cytoprotective pathways. Among these, the major antioxidative and detoxification defence systems might be targeted by ELF-MF by conferring cells significant resistance against clinically-relevant cytotoxic agents. We investigated whether the hyperproliferation that is induced in SH-SY5Y human neuroblastoma cells by a 50 Hz, 1 mT ELF magnetic field was supported by improved defence towards reactive oxygen species (ROS) and xenobiotics, as well as by reduced vulnerability against both H2O2 and anti-tumor ROS-generating drug doxorubicin. ELF-MF induced a proliferative and survival advantage by activating key redox-responsive antioxidative and detoxification cytoprotective pathways that are associated with a more aggressive behavior of neuroblastoma cells. This was coupled with the upregulation of the major sirtuins, as well as with increased signaling activity of the erythroid 2-related nuclear transcription factor 2 (NRF2). Interestingly, we also showed that the exposure to 50 Hz MF as low as 100 µT may still be able to alter behavior and responses of cancer cells to clinically-relevant drugs.

Distribution patterns of microbial communities in ultramafic landscape: a metagenetic approach highlights the strong relationships between diversity and environmental traits

Microbial species richness and assemblages across ultramafic ecosystems were investigated to assess the relationship between their distributional patterns and environmental traits. The structure of microorganism communities in the Koniambo massif, New Caledonia, was investigated using a metagenetic approach correlated with edaphic and floristic factors. Vegetation cover and soil properties significantly shaped the large phylogenetic distribution of operational taxonomic unit within microbial populations, with a mean per habitat of 3.477 (±317) for bacteria and 712 (±43) for fungi. Using variance partitioning, we showed that the effect of aboveground vegetation was the most significant descriptor for both bacterial and fungal communities. The floristic significant predictors explained 43% of the variation for both the bacterial and fungal community structures, while the edaphic significant predictors explained only 32% and 31% of these variations, respectively. These results confirm the previous hypothesis that the distribution of microorganisms was more structured by the vegetation cover rather than the edaphic characteristics and that microbial diversity is not limited in ultramafic ecosystems.

Impact of incontinence on the quality of life of caregivers of older persons with incontinence: A qualitative study in four European countries

The aim of this study was to assess the impact of incontinence management on informal caregivers of older persons with incontinence. In order to investigate this phenomenon in different welfare systems via qualitative interviews and a content analysis methodology, the study was carried out in four European countries (Italy, the Netherlands, Slovak Republic and Sweden). To this purpose, 50 semi-structured interviews were conducted with spouses and children of older people receiving their help to manage the consequences of involuntary urinary and/or faecal leakage. Findings show that incontinence has a remarkably strong effect on caregivers' quality of life, because it results in progressive social isolation, causing them financial problems as well as psychological and physical exhaustion. The lack of appropriate support and the general silence regarding the problem, which is still considered a taboo by many, aggravate the caregivers' situation. It is therefore crucial that caregivers can count on a strong public and private support network, appropriate information and suitable incontinent products, in order to better handle incontinence and care tasks in general.

FAS-ligand regulates differential activation-induced cell death of human T-helper 1 and 17 cells in healthy donors and multiple sclerosis patients

Functionally distinct T-helper (Th) subsets orchestrate immune responses. Maintenance of homeostasis through the tight control of inflammatory Th cells is crucial to avoid autoimmune inflammation. Activation-Induced Cell Death (AICD) regulates homeostasis of T cells, and it has never been investigated in human Th cells. We generated stable clones of inflammatory Th subsets involved in autoimmune diseases, such as Th1, Th17 and Th1/17 cells, from healthy donors (HD) and multiple sclerosis (MS) patients and we measured AICD. We find that human Th1 cells are sensitive, whereas Th17 and Th1/17 are resistant, to AICD. In particular, Th1 cells express high level of FAS-ligand (FASL), which interacts with FAS and leads to caspases' cleavage and ultimately to cell death. In contrast, low FASL expression in Th17 and Th1/17 cells blunts caspase 8 activation and thus reduces cell death. Interestingly, Th cells obtained from healthy individuals and MS patients behave similarly, suggesting that this mechanism could explain the persistence of inflammatory IL-17-producing cells in autoimmune diseases, such as MS, where their generation is particularly substantial.

Steric Inhibition of Resonance in Ortho- substituted Diphenylsulphides Studied by Photo- electron (He I) Spectroscopy

The analysis of the four lowest ionization energy values related to π MO's in diphenylsulphide and its o-o'-dimethyl and o-o-o'-o'-tetramethyl derivatives indicates that the conformation of the unsubstituted compound largely deviates from planarity, that this deviation increases with ortho-substitution and that the two phenyl rings in the tetramethyl derivative are nearly orthogonal to each other

Homoconjugation in Aryl Benzyl Sulphides

The possible occurrence of non classical conjugation involving sulphur in aryl benzyl sulphides has been investigated. From the charge transfer spectra and the stability constants of the complexes formed between iodine and aryl benzyl sulphides, and from the UV spectral behaviour of the ArI–S–CH2–Ar, system, it may be concluded that through space conjugation in aryl benzyl sulphides is not important.

Lateral periodontal cyst (LPC) mimicking periodontal socket in a young patient: report of a case and review of the literature

Background: Lateral Periodontal cyst (LPC) is an uncommon development odontogenic cyst. Most papers are single case reports or series. Methods: We present a case of LPC occurred in a patient which symptoms and signs could mislead the diagnosis. A review of the literature is reported, emphasizing the clinical, radiographic and histopathological features of LPC. Results: A 28-years old female patient presented reporting pain and swelling at the lingual site of the #31.Spot lingual probing depth was 9 mm; sulcus bleeding and suppuration were found at probing. Radiographically well-defined radiolucency appeared in periodontal foramen area. The patient was treated with non-surgical and surgical therapy. Conclusions: LPC is an infrequent cystic lesion that occurs on lateral root vital tooth. In this case, the cyst mimicked a periodontal lesion. The surgical LPC excision solved the symptoms reported by the patient and improved periodontal parameters of the dental element. After 18 months since surgical treatment there aren't signs or symptoms of recurrence.

Clinical characteristics and plasma lipids in subjects with familial combined hypolipidemia: a pooled analysis

Angiopoietin-like 3 (ANGPTL3) regulates lipoprotein metabolism by modulating extracellular lipases. Loss-of function mutations in ANGPTL3 gene cause familial combined hypolipidemia (FHBL2). The mode of inheritance and hepatic and vascular consequences of FHBL2 have not been fully elucidated. To get further insights on these aspects, we reevaluated the clinical and the biochemical characteristics of all reported cases of FHBL2. One hundred fifteen FHBL2 individuals carrying 13 different mutations in the ANGPTL3 gene (14 homozygotes, 8 compound heterozygotes, and 93 heterozygotes) and 402 controls were considered. Carriers of two mutant alleles had undetectable plasma levels of ANGPTL3 protein, whereas heterozygotes showed a reduction ranging from 34% to 88%, according to genotype. Compared with controls, homozygotes as well as heterozygotes showed a significant reduction of all plasma lipoproteins, while no difference in lipoprotein(a) [Lp(a)] levels was detected between groups. The prevalence of fatty liver was not different in FHBL2 subjects compared with controls. Notably, diabetes mellitus and cardiovascular disease were absent among homozygotes. FHBL2 trait is inherited in a codominant manner, and the lipid-lowering effect of two ANGPTL3 mutant alleles was more than four times larger than that of one mutant allele. No changes in Lp(a) were detected in FHBL2. Furthermore, our analysis confirmed that FHBL2 is not associated with adverse clinical sequelae. The possibility that FHBL2 confers lower risk of diabetes and cardiovascular disease warrants more detailed investigation.