Evidence and Perspectives on the 24-hour Management of Hypertension: Hemodynamic Biomarker-Initiated 'Anticipation Medicine' for Zero Cardiovascular Event

There are notable differences between Asians and Westerners regarding hypertension (HTN) and the relationship between HTN and cardiovascular disease (CVD). Asians show greater morning surges in blood pressure (BP) and a steeper slope illustrating the link between higher BP and the risk of CVD events. It is thus particularly important for Asian hypertensives to achieve 24-h BP control, including morning and night-time control. There are three components of 'perfect 24-h BP control:' the 24-h BP level, nocturnal BP dipping, and BP variability (BPV), such as the morning BP surge that can be assessed by ambulatory BP monitoring. The morning BP-guided approach using home BP monitoring (HBPM) is the first step toward perfect 24-h BP control, followed by the control of nocturnal HTN. We have been developing new HBPM devices that can measure nocturnal BP. BPV includes different time-phase variability from the shortest beat-by-beat, positional, diurnal, day-by-day, visit-to-visit, seasonal, and yearly changes. The synergistic resonance of each type of BPV would produce a great dynamic BP surge (resonance hypothesis), which triggers a CVD event, especially in the high-risk patients with systemic hemodynamic atherothrombotic syndrome (SHATS). In the future, the innovative management of HTN based on the simultaneous assessment of the resonance of all of the BPV phenotypes using a beat by beat wearable 'surge' BP monitoring device (WSP) and an information and communication technology (ICT)-based data analysis system will produce a paradigm shift from 'dots' BP management to 'seamless' ultimate individualized 'anticipation medication' for reaching a zero CVD event rate.

Definition, symptoms and risk of techno-stress: a systematic review

PURPOSE

Techno-stress (TS) is an emergent phenomenon closely related to the pervasive use of information and communication technologies in modern society. Despite numerous studies existing in the literature, only few comprehensive reviews have been performed, which has led to fragmented information about TS. This systematic review aimed to clarify the definition, the symptoms, and the risk factors of TS, focusing on the differences between work-related and non-work-related sources of TS.

METHODS

A comprehensive literature review of three electronic databases was performed according to the PRISMA statement. 'Technostress' was used as the only keyword.

RESULTS

In the qualitative synthesis, 105 studies were included: 84 cross-sectional studies, 8 experimental studies and 13 reviews (11 narrative and 2 systematic reviews). 70 studies (67%) addressed work-related TS, 26 (25%) addressed non-work-related TS, while 8 (8%) did not differentiate between work and non-work fields. The presence and level of TS among individuals was described in 38 studies (29%), whilst the techno-stressors, and the consequences of TS, were described in 53 studies (51%). The antecedents of TS were reported in 47 studies (45%), its moderators in 40 studies (38%), whilst its symptoms in only 11 studies (10%).

CONCLUSIONS

TS affects both professional and private life. It can determine a reduction in job and life satisfaction and in productivity, and is often associated to the occurrence of psychological and behavioral disorders. Efforts should be made to recognize situations with a high risk of causing TS, to prevent its progressive development in a prospective way using mainly cohort studies.

Carbon dioxide emissions, total factor productivity, ICT, trade, financial development, and energy consumption: testing environmental Kuznets curve hypothesis for Tunisia

The main objective of this study is to examine the linkage between CO₂ emissions, total factor productivity as a measure of income, information and communication technology (ICT), trade, financial development, and energy consumption in Tunisia from 1975 to 2014. To achieve this goal, the autoregressive distributed lag (ARDL) with the break point method is performed. The results demonstrate the rejection of the Kuznets environmental curve (EKC) hypothesis by obtaining a higher value of the long-term total factor productivity parameter compared to the short-term one. Moreover, our result shows an insignificant impact of ICT on CO₂ emissions as a measure of pollution. In addition, trade, financial development, and energy consumption affect negatively the environmental quality. As a result, Tunisian policymakers should enhance the total factor productivity, expand the information and communication technology, further develop the financial sector, enhance the share of renewable energy consumption, and reduce the energy consumption resulting in import and export goods. These goals will be achieved by improving Tunisia's technological and innovation capacity, enhancing the use of ICT in transport, building, and industry sectors considered as the most pollutant ones, and creating renewable energy projects.

A review on technologies and their usage in solid waste monitoring and management systems: Issues and challenges

In the backdrop of prompt advancement, information and communication technology (ICT) has become an inevitable part to plan and design of modern solid waste management (SWM) systems. This study presents a critical review of the existing ICTs and their usage in SWM systems to unfold the issues and challenges towards using integrated technologies based system. To plan, monitor, collect and manage solid waste, the ICTs are divided into four categories such as spatial technologies, identification technologies, data acquisition technologies and data communication technologies. The ICT based SWM systems classified in this paper are based on the first three technologies while the forth one is employed by almost every systems. This review may guide the reader about the basics of available ICTs and their application in SWM to facilitate the search for planning and design of a sustainable new system.

Valorization of food waste as adsorbents for toxic dye removal from contaminated waters: A review

Industrial contaminants such as dyes and intermediates are released into water bodies, making the water unfit for human use. At the same time large amounts of food wastes accumulate near the work places, residential complexes etc. polluting the air due to putrefaction. The need of the hour lies in finding innovative solutions for dye removal from wastewater streams. In this context, the article emphasizes adoption or conversion of food waste materials, an ecological nuisance, as adsorbents for the removal of dyes from wastewaters. Adsorption, being a well-established technique, the review critically examines the specific potential of food waste constituents as dye adsorbents. The efficacy of food waste-based adsorbents is examined, besides addressing the possible adsorption mechanisms and the factors affecting phenomenon such as pH, temperature, contact time, adsorbent dosage, particle size, and ionic strength. Integration of information and communication technology approaches with adsorption isotherms and kinetic models are emphasized to bring out their role in improving overall modeling performance. Additionally, the reusability of adsorbents has been highlighted for effective substrate utilization. The review makes an attempt to stress the valorization of food waste materials to remove dyes from contaminated waters thereby ensuring long-term sustainability.

The effects of information and communication technologies on informal caregivers of persons living with dementia: A systematic review

INTRODUCTION

Information and communication technology (ICT) has emerged as promising to support health care consumers, including informal caregivers. This systematic review seeks to evaluate the state of the science of ICT interventions on the health of informal dementia caregivers.

METHODS

We searched PubMed, CINAHL, Web of Science, and PsycINFO using concepts associated with ICT, dementia, and caregiver. Studies were assessed using the Quality Assessment Tool for Quantitative Studies.

RESULTS

We identified 657 full-text publications. After removal of duplicates and title, abstract, and full-text screening, the quality of 12 studies was assessed. Studies varied in technology, implementation, results, and intervention evaluation.

DISCUSSION

The methodological quality of the ICT intervention studies among dementia family caregivers was moderate to strong, yet outcome measurement was not uniform. The evidence is strongest for various forms of telephone-based interventions. However, there is a need for research that includes heterogeneous participants based on gender, race, and ethnicity.

Socio-economic status, self-rated health and mental health: the mediation effect of social participation on early-late midlife and older adults

Background

Socioeconomic status (SES) is a major determinant of diverse health outcomes, among these are self-rated-health and mental health. Yet the mechanisms underlying the SES—health relation are not fully explored. Socioeconomic inequalities in health and mental health may form along several pathways. One is social participation which is linked to better self-rated-health and mental health. We examined (1) whether various social participation practices, including the usage of information and communication technology, relate to a unidimensional or multidimensional phenomenon (2) the relationship among SES, social participation, self-rated-health and mental health; (3) whether social participation and mental health mediates the association between SES and self-rated-health; (4) whether social participation and self-rated-health mediates the links between SES and mental health.

Method

Cross-sectional data for individuals aged 35 and older were taken from the Israeli Social Survey for 2016 (N = 4848). Social participation practices included connection with family and friends, self-perceived-support, self-perceived trust, volunteering, civic and political involvement, and information and communication technology usage. An exploratory factor analysis was conducted for all social participation practices. We then constructed structural Equation Modeling (SEM) to explore paths of relations among SES, social participation, self-rated-health and mental health.

Results

We found disparities in self-rated health and mental health across SES. Social participation practice, ‘frequency of meeting with friends’, mediated the links between SES-self-rated health and SES-mental health. Formal social participation practices along with internet usage mediated the SES- self-rated health link. Informal social participation practices and self-perceived trust mediated the SES-mental health link. Mental health mediated the SES- self-rated health link and self-rated health mediated the SES-mental health link.

Conclusion

The links between SES and the two health constructs were enhanced by common and distinct social participation practices. Enhancement of social participation practices among low SES individuals is recommended. Social participation should be a prominent aspect of preventive medicine practice and health promotion interventions. Policy makers are called to support such programs as an important way to promote public health.

Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services

Background

Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients’ information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes.

Methods

Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients’ information needs was explored using patient journey model.

Results

Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients’ post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients’ journeys.

Conclusions

Patient journey models and qualitative analysis of patients’ information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients’ understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients’ information needs, it is imperative to understand the current care and rehabilitation processes and identify patients’ information needs throughout their journey.

Older family carers in rural areas: experiences from using caregiver support services based on Information and Communication Technology (ICT)

The aim of this intervention study was to illuminate the meaning of ICT-based caregiver support as experienced by older family carers living in vast rural areas, caring for a spouse at home. In order to access, the support service participants were provided with a computer and high speed Internet in their homes. Semi structured webcam-interviews were carried out with 31 family carers. A strategy for webcam interviewing was developed to ensure quality and create a comfortable interview situation for the family carers. Interviews were analysed using content analyses, resulting in the themes: Adopting new technology with help from others and Regaining social inclusion. The results indicate that ICT-based support can be valuable for older family carers in rural areas as it contributes to improve quality in daily life in a number of ways. In order to fully experience the benefits, family carers need to be frequent users of the provided support. Adequate training and encouragement from others were essential in motivating family carers to use the support service. Access to Internet and webcamera contributed to reducing loneliness and isolation, strengthening relationships with relatives living far away and enabled access to services no longer available in the area. Use of the ICT-service had a positive influence on the relationship between the older carer and adult grandchildren. It also contributed to carer competence and promote feelings of regaining independence and a societal role.

Assessment of personal care and medical robots from older adults' perspective

Demographic reports indicate that population of older adults is growing significantly over the world and in particular in developed nations. Consequently, there are a noticeable number of demands for certain services such as health-care systems and assistive medical robots and devices. In today’s world, different types of robots play substantial roles specifically in medical sector to facilitate human life, especially older adults. Assistive medical robots and devices are created in various designs to fulfill specific needs of older adults. Though medical robots are utilized widely by senior citizens, it is dramatic to find out into what extent assistive robots satisfy their needs and expectations. This paper reviews various assessments of assistive medical robots from older adults’ perspectives with the purpose of identifying senior citizen’s needs, expectations, and preferences. On the other hand, these kinds of assessments inform robot designers, developers, and programmers to come up with robots fulfilling elderly’s needs while improving their life quality.

Examining the effect of information and communication technology, innovations, and renewable energy consumption on CO2 emission: evidence from BRICS countries

The increasing use of information and communication technology (ICT) in this digital era and its interlinkage with other economic and environmental factors have gotten considerable attention from researchers. ICT tools are considered very important in economic activities such as international trade, the financial sector, and foreign direct investment. ICT is also interlinked with innovation and energy consumption. However, ICT with these activities influences ecological footprint, especially in emerging economies such as BRICS (Brazil, Russia, India, China, and South Africa) countries. Therefore, this topic has got considerable attention from researchers and policy makers on the impact of ICT and economic growth activities on environmental quality. Consequently, this study investigates the impact of information and communication technology, renewable energy consumption and innovation on carbon dioxide emission in BRICS countries from 1990 to 2019 using cointegration, generalized least square, and panel corrected standard errors models. The findings show that two ICT indicators, mobile cellular subscription and fixed broadband subscription, negatively affect carbon emission along with economic growth and financial development. Innovation and renewable energy consumption also significantly reduce emission in presence of ICT indicators, while trade openness and fixed telephone subscriptions increase it. In the case of the ICT index model, all variables are positively associated with carbon emission except renewable energy consumption, however, the square and interaction term of all indicators significantly reduce carbon emission and evidence the environmental Kuznets curve hypothesis except trade openness. ICT growth should be considered in the energy sector, innovation, and financial development to enhance environmental quality. The findings of the study have considerable policy implications for the sample countries.

Responding to COVID-19: New Trends in Social Workers' Use of Information and Communication Technology

COVID-19 changed the context for Information and Communication Technology (ICT) use globally. With face-to-face practice restricted, almost all communication with clients shifted to ICTs. Starting in April 2019, we conducted semi-structured interviews with social workers from four agencies serving diverse populations in a large urban centre, with the aim of exploring social workers' informal ICT use with clients. Approximately 6 weeks after the cessation of face-to-face practice in March 2020 due to COVID-19 measures, we re-interviewed social workers (n = 11) who had participated in our study. Second interviews were based on a newly developed interview guide that explored social workers' use of ICTs with clients in the context of COVID-19. Analysis of transcribed interviews revealed that the context of COVID-19 had generated two main themes. One, a paradigm shift for social workers was characterized by (a) diverse ICT options, (b) client-driven approach, and (c) necessary creativity. The second theme entails the impact of this transition which involved (a) greater awareness of clients' degree of access, (b) confidentiality and privacy, and (c) professional boundaries. We discuss these themes and sub-themes and present implications for practice and research in a Post-COVID-19 world.

Digital healthcare for dementia and cognitive impairment: A scoping review

BACKGROUND

Cognitive disorders, such as Alzheimer's disease, are a global health problem. Digital healthcare technology is an innovative management tool for delaying the progression of dementia and mild cognitive impairment. Thanks to digital technology, the possibility of safe and effective care for patients at home and in the community is increasing, even in situations that threaten the continuity of care, such as the COVID-19 pandemic. However, it is difficult to select appropriate technology and alternatives due to the lack of comprehensive reviews on the types and characteristics of digital technology for cognitive impairment, including their effects and limitations.

OBJECTIVE

This study aims to identify the types of digital healthcare technology for dementia and mild cognitive impairment and comprehensively examine how its outcome measures were constructed in line with each technology's purpose.

METHODS

According to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines, a literature search was conducted in August 2021 using Medline (Ovid), EMBASE, and Cochrane library. The search terms were constructed based on Population-Concept-Context mnemonic: 'dementia', 'cognitive impairment', and 'cognitive decline'; digital healthcare technology, such as big data, artificial intelligence, virtual reality, robots, applications, and so on; and the outcomes of digital technology, such as accuracy of diagnosis and physical, mental, and social health. After grasping overall research trends, the literature was classified and analysed in terms of the type of service users and technology.

RESULTS

In total, 135 articles were selected. Since 2015, an increase in literature has been observed, and various digital healthcare technologies were identified. For people with mild cognitive impairment, technology for predicting and diagnosing the onset of dementia was studied, and for people with dementia, intervention technology to prevent the deterioration of health and induce significant improvement was considered. Regarding caregivers, many studies were conducted on monitoring and daily living assistive technologies that reduce the burden of care. However, problems such as data collection, storage, safety, and the digital divide persisted at different intensities for each technology type.

CONCLUSIONS

This study revealed that appropriate technology options and considerations may differ depending on the characteristics of users. It also emphasises the role of humans in designing and managing technology to apply digital healthcare technology more effectively.

How does financial development influence carbon emission intensity in the OECD countries: Some insights from the information and communication technology perspective

Based on an extended STIRPAT framework, this paper investigates the effects of financial development on carbon emission intensity in OECD countries from linear and non-linear perspectives, where financial development is proxied by three dimensions: financial deepening, financial deepening, and financial size, and financial efficiency. Fortunately, three types of financial development significantly alleviate carbon emission intensity. An extended moderation effect model is built to estimate the effect of financial development via information and communication technology on carbon emission intensity. The results reveal that internet-based information and communication technology and service-based information and communication technology are positively correlated with carbon emission intensity. To effectively handle the endogeneity issue triggered by causal relationships between variables and allow potential non-linear nexus, an advanced dynamic panel threshold model incorporating the generalised method of moments is employed to investigate how financial development affects carbon emission intensity under different types of information and communication technology. Empirical evidence demonstrates the significance of the non-linear nexus between financial development and carbon emission intensity. Lastly, heterogeneity analysis demonstrates the existence of heterogeneity associated with institutional quality, degree of economic development, and resource endowment concerning the effect of financial development on carbon emission intensity among the OECD countries.

Pilot testing a digital pet avatar for older adults

Social isolation in older adults is a major public health concern. An embodied conversational agent (ECA) has the potential to enhance older adults' social interaction. However, little is known about older adults' experience with an ECA. In this paper, we conducted a pilot study to examine the perceived acceptance and utility of a tablet-based conversational agent in the form of an avatar (termed "digital pet") for older adults. We performed secondary analysis of data collected from a study that employed the use of a digital pet in ten older adults' homes for three months. Most of the participants enjoyed the companionship, entertainment, reminders, and instant assistance from the digital pet. However, participants identified limited conversational ability and technical issues as system challenges. Privacy, dependence, and cost were major concerns. Future applications should maximize the agent's conversational ability and the system's overall usability. Our results can inform future designs of conversational agents for older adults, which need to include older adults as system co-designers to maximize usability and acceptance.

Ethics of emergent information and communication technology applications in humanitarian medical assistance

New applications of information and communication technology (ICT) are shaping the way we understand and provide humanitarian medical assistance in situations of disaster, disease outbreak or conflict. Each new crisis appears to be accompanied by advancements in humanitarian technology, leading to significant improvements in the humanitarian aid sector. However, ICTs raise ethical questions that warrant attention. Focusing on the context of humanitarian medical assistance, we review key domains of ICT innovation. We then discuss ethical challenges and uncertainties associated with the development and application of new ICTs in humanitarian medical assistance, including avoiding harm, ensuring privacy and security, responding to inequalities, demonstrating respect, protecting relationships, and addressing expectations. In doing so, we emphasize the centrality of ethics in humanitarian ICT design, application and evaluation.

How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals

Background

The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks.

Methods

Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital’s electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire.

Results

Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy.

Conclusions

In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.

Early intervention at home in infants with congenital brain lesion with CareToy revised: a RCT protocol

BACKGROUND

Congenital brain lesions expose infants to be at high-risk for being affected by neurodevelopmental disorders such as cerebral palsy (CP). Early interventions programs can significantly impact and improve their neurodevelopment. Recently, in the framework of the European CareToy (CT) Project ( www.caretoy.eu ), a new medical device has been created to deliver an early, intensive, customized, intervention program, carried out at home by parents but remotely managed by expert and trained clinicians. Reviewing results of previous studies on preterm infants without congenital brain lesion, the CT platform has been revised and a new system created (CT-R). This study describes the protocol of a randomised controlled trial (RCT) aimed to evaluate, in a sample of infants at high-risk for CP, the efficacy of CT-R intervention compared to the Infant Massage (IM) intervention.

METHODS/DESIGN

This RCT will be multi-centre, paired and evaluator-blinded. Eligible subjects will be preterm or full-term infants with brain lesions, in first year of age with predefined specific gross motor abilities. Recruited infants will be randomized into CT-R and IM groups at baseline (T0). Based on allocation, infants will perform an 8-week programme of personalized CareToy activities or Infant Massage. The primary outcome measure will be the Infant Motor Profile. On the basis of power calculation, it will require a sample size of 42 infants. Moreover, Peabody Developmental Motor Scales-Second Edition, Teller Acuity Cards, standardized video-recordings of parent-infant interaction and wearable sensors (Actigraphs) will be included as secondary outcome measures. Finally, parents will fill out questionnaires (Bayley Social-Emotional, Parents Stress Index). All outcome measures will be carried out at the beginning (T0) and at end of 8-weeks intervention period, primary endpoint (T1). Primary outcome and some secondary outcomes will be carried out also after 2 months from T1 and at 18 months of age (T2 and T3, respectively). The Bayley Cognitive subscale will be used as additional assessment at T3.

DISCUSSION

This study protocol paper is the first study aimed to test CT-R system in infants at high-risk for CP. This paper will present the scientific background and trial methodology.

TRIAL REGISTRATION

NCT03211533 and NCT03234959 ( www.clinicaltrials.gov ).

The effectiveness of non-pharmacological interventions using information and communication technologies for behavioral and psychological symptoms of dementia: A systematic review and meta-analysis

BACKGROUND

Although behavioral and psychological symptoms of dementia are a global public health challenge, non-pharmacological interventions using information and communication technologies can be an affordable, cost-effective, and innovative solution.

OBJECTIVES

This study aimed to examine the effectiveness of non-pharmacological interventions using information and communication technologies on the behavioral and psychological symptoms of dementia and identify potential moderators of intervention effects.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

METHODS

A systematic literature review was conducted using PubMed, CINAHL, PsycINFO, Embase, and the Cochrane Library from May 2022. Randomized controlled trials that examined the effects of non-pharmacological interventions using information and communication technologies on the behavioral and psychological symptoms of dementia were included. A meta-analysis using a random-effects model was performed to calculate the pooled standardized mean differences between overall symptoms and each type of symptom. For moderator analyses, subgroup and meta-regression analyses were performed.

RESULTS

Sixteen trials (15 articles) met the eligibility criteria. The interventions were grouped into activity engagement interventions using digital health that provided music and reminiscence therapy, physical exercise, social interaction interventions using social robots, and telehealth-based care aid interventions that provided coaching or counseling programs. Pooled evidence demonstrated that non-pharmacological interventions using information and communication technologies exerted a large effect on depression (SMD = -1.088, 95% CI -1.983 to -0.193, p = 0.017), a moderate effect on overall behavioral and psychological symptoms of dementia (SMD = -0.664, 95% CI -0.990 to -0.338, p < 0.001), and agitation (SMD = -0.586, 95% CI -1.130 to -0.042, p = 0.035). No effects on neuropsychiatric symptoms (SMD = -0.251, 95% CI -0.579 to 0.077, p = 0.133), anxiety (SMD = -0.541, 95% CI -1.270 to 0.188, p = 0.146), and apathy (SMD = -0.830, 95% CI -1.835 to 0.176, p = 0.106) were reported. Moderator analyses identified the mean age of the participants as a potential moderator of intervention effects.

CONCLUSIONS

Evidence from this systematic review and meta-analysis suggests that non-pharmacological interventions, using information and communication technologies, were an applicable approach to managing behavioral and psychological symptoms among older adults with dementia, with moderate to large effect sizes. However, evidence on anxiety and apathy is inconclusive due to the limited number of existing randomized controlled trials. Future studies with subgroup analyses are warranted to conclude the most effective types of intervention using information and communication technologies for each type of symptom.

REGISTRATION

CRD42021258498.

ICT-based adherence monitoring in kidney transplant recipients: a randomized controlled trial

Background

Prior studies have explored the use of regular reminders to improve adherence among kidney transplant recipients (KTRs), but none have included real-time alarms about drug dosage, frequency, and interval. In the present study, we aimed to evaluate the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system for increasing medication adherence among Korean KTRs.

Methods

In this prospective, multicenter, randomized controlled study, enrolled KTRs were randomized to either the ICT-based centralized monitoring group or control group. The ICT-based centralized monitoring system alerted both patients and medical staff with texts and pill box alarms if there was a missed dose or a dosage/time error. We compared the two groups in terms of medication adherence and transplant outcomes over 6 months, and evaluated patient satisfaction with the ICT-based monitoring system.

Results

Among 114 enrolled KTRs, 57 were assigned to the ICT-based centralized monitoring group and 57 to the control group. The two groups did not significantly differ in mean adherence at each follow-up visit. The intrapatient variability of tacrolimus and mycophenolic acid levels, renal function, and adverse transplant outcomes did not differ between the intervention and control groups, or between the intervention group with feedback generation and the intervention group without feedback generation. Patients showed high overall satisfaction with the ICT-based centralized monitoring system, which significantly improved across the study period (p = 0.012).

Conclusions

Due to high baseline adherence, the ICT-based centralized monitoring system did not maximize medication adherence or enhance transplant outcomes among Korean KTRs. However, patients were highly satisfied with the system. Our results suggest that the ICT-based centralized monitoring system could be successfully applied in clinical trials.

Trial registration

ClinicalTrials.gov, NCT03136588. Registered 20 April 2017 - Retrospectively registered.

Loneliness Shapes the Relationship between Information and Communications Technology Use and Psychological Adjustment among Older Adults

BACKGROUND

Given findings that generally support the benefits of information and communication technology (ICT) for older adults' psychosocial adjustment, one might surmise that lonely older adults, who have a stronger need for psychological support, would reap more psychosocial benefits from ICT use. However, scant research has examined this view, much less the likelihood that ICT use might worsen the psychological well-being of lonely older adults, as has been shown to be the case in younger adults.

OBJECTIVE

To examine whether the association between ICT use and psychological adjustment (i.e., psychological distress and sense of community [SOC]) among older adults depends on their loneliness levels.

METHODS

A representative sample of 738 Hong Kong SAR Chinese older adults aged 60 years or older (56% female) was interviewed in 2017 on loneliness, frequency of ICT use (i.e., Internet and smart devices), psychological distress (6-item Kessler scale; K6), and SOC.

RESULTS

Regression analyses showed that loneliness significantly moderated the relationship between ICT use frequency and psychological adjustment (psychological distress and SOC); more frequent ICT use was associated with more psychological distress and less SOC, with higher levels of loneliness.

CONCLUSION

These findings suggest that ICT use may be a mixed blessing for older adults, i.e., using more ICT might predict worse psychological adjustment among lonelier older adults. Efforts that promote ICT use among older adults should take their loneliness levels into account.

Telemedicine and Community Health Projects in Asia

Telemedicine has the potential to deliver high-quality, affordable health care to underserved populations that otherwise would not have adequate access to care. The authors provide a snapshot of several telemedicine initiatives that have used information and communication technologies to connect patients with health care providers across various Asian countries with differing socioeconomic statuses. They highlight several factors thought to contribute to the success of telemedicine programs, such as financial sustainability, ease of use, and utilization of existing resources. Challenges these programs have faced include lack of technological infrastructure, limitations in funding, and conflicting health system priorities.

Multidimensional assessment of challenging behaviors in advanced stages of dementia in nursing homes-The insideDEM framework

INTRODUCTION

Assessment of challenging behaviors in dementia is important for intervention selection. Here, we describe the technical and experimental setup and the feasibility of long-term multidimensional behavior assessment of people with dementia living in nursing homes.

METHODS

We conducted 4 weeks of multimodal sensor assessment together with real-time observation of 17 residents with moderate to very severe dementia in two nursing care units. Nursing staff received extensive training on device handling and measurement procedures. Behavior of a subsample of eight participants was further recorded by videotaping during 4 weeks during day hours. Sensors were mounted on the participants' wrist and ankle and measured motion, rotation, as well as surrounding loudness level, light level, and air pressure.

RESULTS

Participants were in moderate to severe stages of dementia. Almost 100% of participants exhibited relevant levels of challenging behaviors. Automated quality control detected 155 potential issues. But only 11% of the recordings have been influenced by noncompliance of the participants. Qualitative debriefing of staff members suggested that implementation of the technology and observation platform in the routine procedures of the nursing home units was feasible and identified a range of user- and hardware-related implementation and handling challenges.

DISCUSSION

Our results indicate that high-quality behavior data from real-world environments can be made available for the development of intelligent assistive systems and that the problem of noncompliance seems to be manageable. Currently, we train machine-learning algorithms to detect episodes of challenging behaviors in the recorded sensor data.

Older adults' perceptions of contexts surrounding their social participation in a digitalized society-an exploration in rural communities in Northern Sweden

Social participation and digital engagement can contribute to health and well-being among older adults. Because of older adults' decline in abilities, coupled with complex technology and its perceived insufficient relevance to daily life, there is a need to create and tailor social opportunities and services that are supported by digital technologies for older adults to continue participating in society. Thus, it becomes relevant to explore older adults' perceptions about contexts surrounding their social participation in a digital society. This exploration used a qualitative research design with focus group interviews and qualitative content analysis. Eighteen older adults, aged 66-81 years, from rural communities in Northern Sweden, participated in this study. The analysis resulted in three categories: experiencing conditions for social participation in a state of flux, perceiving drawbacks of urbanization on social participation, and welcoming digital technology that facilitates daily and community living. These categories were encapsulated in the theme-the juxtaposition of narrowing offline social networks and expanding digital opportunities for social participation. The findings suggested that co-creating usable digitalized services and facilitating satisfactory use of digital technologies could support older adults' social participation through activities that they find relevant in their lives, and subsequently, might enable them to live longer at home.

Examining the determinants of eHealth usage among elderly people with disability: The moderating role of behavioural aspects

BACKGROUND

Existing studies have demonstrated that behavioural barriers impede eHealth usage among senior citizens. However, thus far, no analysis of how such barriers affect elderly people with disabilities (PwD) has been conducted. Thus, the study investigates the predictors of eHealth usage among elderly PwD.

METHODS

Using data from a 2018 nationwide disability survey comprising 14,798 respondents in Australia, multivariate logistic regression models are used to predict the relationship between eHealth usage and the various characteristics of respondents, including access to information and communication technologies (ICTs), socioeconomic status, and level of education.

RESULTS

Although most participants (approximately 88%) have access to ICTs, few (only around 9%) have used eHealth services. The results show a number of factors are associated with an increased likelihood of using eHealth services, including higher educational attainment (odds ratio [OR] = 3.12, 95% confidence interval [CI]: 2.38, 4.24), employment (OR = 1.43, 95% CI: 1.06, 1.94), higher household income (OR = 1.39, 95% CI: 1.00, 1.96), and ICT access (OR = 15.92, 95% CI: 10.51, 27.01). The probability of eHealth use is lower for the oldest-old (OR = 0.35, 95% CI: 0.22, 0.45). In addition, the estimates from interaction effects suggest the effect of ICT penetration on use of eHealth falls by a negligible amount because of resistive attitudinal barriers (OR = 0.01, 95% CI: 0.01, 0.06).

CONCLUSION

Given the challenges of ageing populations and pandemics, such as COVID-19, eHealth services are a vital part of an effective, inclusive, and robust health care system. This study demonstrates the presence of a significant digital divide among elderly PwD and suggests that public and private efforts should be made to increase the availability of ICT infrastructure. Training could also increase inclusion in this regard.