Digital Inclusion in Parkinson's Disease: A Case-Control Study.

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Association between depressive symptoms and cognitive performance in middle-aged and older adults across digital divide.

COVID-19 and the digital divide in the UK

Digital exclusion, characterized by a lack of access to digital technology, connectivity, or digital skills, disproportionally affects marginalized groups. An important domain impacted by digital exclusion is access to health care. During COVID-19, health care services had to restrict face-to-face contact to limit the spread of the virus. The subsequent shift toward remote delivery of mental health care exacerbated the digital divide, with limited access to remote mental health care delivery. In response, Camden and Islington National Health Service Foundation Trust launched the innovative Digital Inclusion Scheme (DIS). This study aimed to examine the impact of facilitating digital inclusion in mental health access. Camden and Islington National Health Service Foundation Trust implemented the trust-wide DIS for service users who were digitally excluded, that is, were without devices or connectivity or reported poor digital skills. The scheme provided access to a loan digital device (a tablet), internet connectivity devices, and mobile data, as well as personalized digital skills support. The DIS went live in October 2021 and received 106 referrals by June 2022. Semistructured interviews were conducted with 12 service users to ask about their experience of accessing the DIS. A thematic analysis identified themes and subthemes relating to the extent of their digital exclusion before engaging with the scheme and the impact of accessing a scheme on their ability to engage with digital technology and well-being. There were 10 major themes. A total of 6 themes were related to factors impacting the engagement with the scheme, including digital exclusion, relationship to the trust, the importance of personalized digital support, partnership working, device usability and accessibility, and personal circumstances. The remaining 4 themes spoke to the impact of accessing the scheme, including improved access to services, impact on well-being, financial implications, and a greater sense of empowerment. Participants reported an increased reliance on technology driving the need for digital inclusion; however, differences in motivation for engaging with the scheme were noted, as well as potential barriers, including lack of awareness, disability, and age. Overall, the experience of accessing the DIS was reported as positive, with participants feeling supported to access the digital world. The consequences of engaging with the scheme included greater perceived access to and control of physical and mental health care, improved well-being, and a greater sense of empowerment. An overview of the lessons learned are provided along with suggestions for other health care settings that are looking to implement similar schemes.

Purpose: The purpose of this paper is to analyse the key factors of the digital exclusion in selected European Union countries. Specifically, it examines the economic, social, and demographic determinants that shape digital accessibility and digital literacy in these nations. Design/Methodology/Approach: This study analyses the factors associated with the level of digital skills, as measured by the DSI indicator, which is considered a key representation of digital exclusion. The analysis covers the 27 European Union countries from 2014 to 2023, enabling the identification of trends and changes over the examined period. Furthermore, correlations between the DSI levels and selected factors are investigated to determine the primary determinants of digital exclusion. Findings: Significant variation in digital skill levels and the factors influencing them was observed across European Union countries. Strong correlations were identified between digital skills, GDP, and the level of education (both formal and informal). Additionally, the average age of the population was found to be a negative factor, which, in the context of aging societies, may play a crucial role in shaping future policies aimed at promoting digital inclusion for this demographic group. Research Limitations/Implications: The conducted study provides a starting point for further analysis using a cross-sectional and temporal approach, focusing on digital exclusion in Europe. Practical Implications: The results of the study have facilitated the identification of socio- economic factors associated with digital exclusion in European Union countries. These findings highlight key areas that require targeted action by policy-makers, particularly in addressing social inequalities and the digital marginalization of certain demographic groups. Social Implications: The studies highlight the need for comprehensive education to develop key digital skills, enabling individuals to engage effectively and safely with the digital transformation of society and to prevent digital exclusion. They also indicate that, despite significant advancements in the availability of Internet technology over the years, digital exclusion remains unresolved, pointing to various underlying determinants of this issue. Originality/Value: The paper identifies the factors associated with digital exclusion and provides recommendations for actions aimed at reducing digital inequality. Keywords: sustainability, digital exclusion, digital transformation. Category of the paper: Research paper.

This study aimed to investigate (a) motor planning difficulty by using a two-step test in Parkinson’s disease (PD) compared with age-matched healthy subjects and (b) the relationship between motor planning difficulty and clinical factors. The two-step test was performed by 58 patients with PD with Hoehn & Yahr (H&Y) stage I–IV and 110 age-matched healthy older adult controls. In the two-step test, the participants estimated the two-step distance with maximum effort. Subsequently, they performed the actual two-step trial to measure the actual maximum distance. We calculated the accuracy of the estimation (estimated distance minus actual distance). In both groups, subjects who estimated >5 cm were defined as the overestimation group, and those who estimated <5 cm over- and underestimation were defined as the non-overestimation group. The overestimation group consisted of 17 healthy older adults (15.5%) and 23 patients with PD (39.7%). The number of patients with PD with overestimation was significantly more than that of healthy controls by Chi-squared test. H&Y stage and the Unified Parkinson’s Disease Rating Scale (UPDRS) part II and III scores in overestimation group in PD patients were significantly higher than those in overestimation group in PD patients. Moreover, multiple regression using H&Y stage and UPDRS parts II and III as independent variables showed that the UPDRS part II score was the only related factor for the estimation error distance. Estimation error distance was significant correlated with UPDRS parts II and III. Patients with PD easily have higher rates of motor-related overestimation than age-matched healthy controls. In addition, UPDRS parts II and III expressed ability of activities of daily living and motor function as influences on motor-related overestimation. Particularly, multiple regression indicated that UPDRS part II directly showed the ability of daily living as an essential factor for overestimation.

The majority of patients with advanced Parkinson's disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson's disease; the proportion of Parkinson's patients with advanced Parkinson's disease, the referral process, and the clinical features used to characterize advanced Parkinson's disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson's patients identified as advanced patients according to physician's judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson's disease status was assessed with Unified Parkinson's Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson's disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson's disease from 126 sites were documented. In Hungary, 100 patients with Parkinson's disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson's disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson's disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson's patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson's disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.

OBJECTIVES: The main neuropathological feature in Parkinson's disease is a severe degeneration of the dopaminergic neurons in the substantia nigra resulting in a loss of dopamine (DA) transporters in the...

Advancements in digital technologies have transformed the world by providing more opportunities and possibilities. However, elderly persons have several challenges utilizing modern technology, leading to digital exclusion, which can negatively impact sustainable development. This research attempts to address the current digital exclusion by addressing the challenges older people face considering evolving digital technologies, focusing on economic, social, and environmental sustainability. Three distinct goals are pursued in this study: to perform a detailed literature review to identify gaps in the current understanding of digital exclusion among the elderly, to identify the primary factors affecting digital exclusion in the elderly, and to analyze the patterns and trends in different countries, with a focus on differentiating between High-Income Countries (HICs) and Lower Middle-Income Countries (LMICs). The research strategies used in this study involve a combination of a literature review and a quantitative analysis of the digital exclusion data from five cohorts. This study uses statistical analysis, such as PCA, chi-square test, one-way ANOVA, and two-way ANOVA, to present a complete assessment of the digital issues that older persons experience. The expected results include the identification of factors influencing the digital divide and an enhanced awareness of how digital exclusion varies among different socio-economic and cultural settings. The data used in this study were obtained from five separate cohorts over a five-year period from 2019 to 2023. These cohorts include ELSA (UK), SHARE (Austria, Germany, France, Estonia, Bulgaria, and Romania), LASI (India), MHAS (Mexico), and ELSI (Brazil). It was discovered that the digital exclusion rate differs significantly across HICs and LMICs, with the UK having the fewest (11%) and India having the most (91%) digitally excluded people. It was discovered that three primary factors, including socio-economic status, health-related issues, and age-related limitations, are causing digital exclusion among the elderly, irrespective of the income level of the country. Further analysis showed that the country type has a significant influence on the digital exclusion rates among the elderly, and age group plays an important role in digital exclusion. Additionally, significant variations were observed in the life satisfaction of digitally excluded people within HICs and LMICs. The interaction between country type and digital exclusion also showed a major influence on the health rating. This study has a broad impact since it not only contributes to what we know academically about digital exclusion but also has practical applications for communities. By investigating the barriers that prevent older people from adopting digital technologies, this study will assist in developing better policies and community activities to help them make use of the benefits of the digital era, making societies more equitable and connected. This paper provides detailed insight into intergenerational equity, which is vital for the embedding principles of sustainable development. Furthermore, it makes a strong case for digital inclusion to be part of broader efforts (and policies) for creating sustainable societies.

Libraries on the Front Lines of the Digital Divide: The Oxfordshire Digital Inclusion Project Report

This paper reports on the progress of a current PhD research study. The research study will evolve through four phases and eventually develop a conceptual framework for effective teaching and learning approaches that influence digital inclusion and exclusion of students from diverse backgrounds. It will also seek to identify differences in learner characteristics and how these characteristics impact on needs, experiences and engagement with technology for learning, specifically within a blended learning programme. The research will move away from traditional definitions of diversity and explore the differing characteristics of a varied learner population. The research adopts a critical realist perspective, using a qualitative multi-phase methodology that will evolve sequentially in the future. The focus of this paper is to outline the research to date. Phase 1 and Phase 2 have been completed and are reported in this paper. Findings suggest that digital exclusion cannot be predicted or dealt with by categorising students into groupings of: gender, age, ethnicity, geography, socio-economic status and educational background. Additionally, the findings indicate that digital exclusion is influenced by organisational factors, such as elements of the course content or navigation of the virtual learning environment rather than intrinsic factors such as individual technological skills.

The COVID‐19 pandemic has meant a rapid transfer of everyday activities to the online world. Information and communication technologies (ICTs) have become more embedded than ever in people's lives. This investigation addresses how this change has affected the lives of people with intellectual disabilities (ID). A two‐step design was used. A rapid review was conducted on empirical studies published between January 2019 and June 2021. Search terms related to ID, ICT use and COVID‐19. A qualitative international bricolage was also conducted corresponding to author nationalities. Data gathered from the review and bricolage were analysed separately using thematic analysis and relationally synthesised. Digital solutions to provide access to COVID‐19 information and guidance seemed inadequate but were seldom empirically studied. Digital poverty, literacy and exclusion remain significant issues for people with ID internationally. People and their carers experienced reduced and removed service provision, loneliness and impoverished daily lives during the pandemic; amelioration of which was facilitated by digital solutions. One solution often used was videoconferencing. Prior experience of digital participation, adequate finances, connection, support and digital literacy mentoring for both people with ID and those providing services and support facilitated digital inclusion. Digital exclusion during COVID‐19 was exacerbated by sociopolitical, structural, individual and support‐related barriers. Although awareness of digital exclusion appears to have been raised, the extent to which this has led to action and change remains unclear. Despite digital exclusion and digital participation benefitting continuation of life, social and emotional well‐being and autonomy, COVID‐19 has not provided the impetus to eradicate digital poverty for people with ID. Governmental support, digital education, creativity and problem solving are required to enable people with ID the human right to be included in the digital world at this essential time and into the future.

Glucose dysregulation in Parkinson's disease: Too much glucose or not enough insulin?

Low plasma thiamine and phosphate in male patients with Parkinson's disease is associated with mild cognitive impairment

Abnormal involuntary movements (dyskinesias) are common in patients with Parkinson disease (PD) as a consequence of the disease and dopaminergic replacement therapy. Early morning off-medication choreic dyskinesias have been recently reported after fetal dopaminergic cell transplantations in patients with advanced PD. To determine the frequency and severity of the early morning off-medication dyskinesias in consecutive patients with advanced PD and an insufficient response to medical management before they undergo neurosurgery. Consecutive patients with advanced idiopathic PD were examined and videotaped before undergoing neurosurgery that included pallidotomy, fetal transplantation, or deep brain stimulation. The examination took place in the morning in the practically defined off state, at least 12 hours after the last dose of dopaminergic drugs. Parkinson disease was characterized using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr stage. Dyskinesias were rated with the Abnormal Involuntary Movements Scale and the Rush Dyskinesia Rating Scale. Patients' characteristics and medications were compared using the Wilcoxon rank sum and the Fisher exact tests. Of 68 consecutive patients (44 [65%] men and 24 [35%] women), 11 (16%) had early morning off-medication dyskinesia, with a 95% upper confidence limit of 24%. Focal dystonia was the most common off-medication dyskinesia, and occurred in 10 patients (15%), with a 95% upper confidence limit of 22%; and off-choreic dyskinesia occurred in 1 patient (1.5%), with a 95% upper confidence limit of 4%. There was no difference in PD medications between the patients with and those without dyskinesias. The most common form of off-medication dyskinesia seen in patients with advanced PD is dystonia. Early morning off-medication choreic dyskinesias are rare but do occur in patients with advanced PD before surgical intervention. The presence and type of off-medication dyskinesias should be monitored in clinical and surgical studies in patients with PD as part of the safety and evaluation of clinical benefits.