Changes In Health Indicators Research Articles

Changes in Health Indicators Among Caregivers - United States, 2015-2016 to 2021-2022.

Caregivers provide support to persons who might otherwise require placement in long-term care facilities. Approximately one in five U.S. adults provides care to family members or friends who have a chronic health condition or disability. Promoting the well-being of this large segment of the population is a public health priority as recognized by the 2022 National Strategy to Support Family Caregivers. Although negative associations between caregiving and caregiver health are known, changes in the health status of caregivers over time are not. Data from the 2015-2016 and 2021-2022 Behavioral Risk Factor Surveillance System were analyzed to compare changes in the prevalence of 19 health indicators among cross-sectional samples of caregivers and noncaregivers at different time points. Caregivers experienced improvements in prevalence of four health indicators, whereas six worsened. Some health indicators, such as cigarette smoking, improved for both caregivers and noncaregivers, although smoking prevalence remained higher for caregivers (16.6% versus 11.7%). Prevalence of lifetime depression increased for both groups and remained higher among caregivers (25.6%) than among noncaregivers (18.6%). During 2021-2022, age-adjusted estimates for caregivers were unfavorable for 13 of the 19 health indicators when compared with noncaregivers. Strategies for supporting caregivers are available, and integrating these with existing programs to address mental health and chronic diseases among this population might improve caregiver well-being. For example, many community organizations support caregivers by offering interventions designed to relieve caregiver strain, including skills training, support groups, and care coordination.

Do Health and Housing Attributes Motivate Residential Moves Among Older Chinese Adults? Evidence From an 8‑Year Follow‑up Study.

Despite the widespread belief in aging-in-place as the preferred housing arrangement for older adults, they are increasingly embracing moving. The person-environment fit theory explains that environmental changes due to residential moves can pose health risks, discouraging older people from moving. However, it also suggests that moves may be suitable when living conditions no longer meet their physical needs. The correlation between older people's health, housing, and their subsequent moving or staying actions in China remains underexplored. Using alternative operating variables of key concepts and the China Family Panel Studies 2012-2018 data sets, this study examines the effects of health and housing status on older people's residential moves in China. The study outlines changes in health indicators and housing characteristics during multiple moves, as well as examines the relationship between the health and housing status of older adults and moving over a relatively long period of time using both regression models with lagged explanatory variables and fixed effects binary choice models. The results reveal that: (1) higher rates of subsequent moves were observed among older adults with better self-rated health, positive self-rated health changes, and no ADL impairment, but no significant associations were found between most health variables and moving; and (2) the correlation between older persons' house ownership/type and their residential moves was significant and consistent over time, steady and lasting. Potential mechanisms explaining the association between specific housing types and ownership statuses on moving are discussed. The findings encourage a focus on the positive benefits of moving in later life and how to provide additional housing options for older individuals.

Systematic Literature Review: Ability of the IBDQ-32 to Detect Meaningful Change in Ulcerative Colitis Health Indicators.

Previous reviews produced weak evidence regarding the responsiveness of the Inflammatory Bowel Disease Questionnaire (IBDQ-32) to changes in ulcerative colitis (UC) health indicators. This systematic review and meta-analysis provide an updated synthesis on IBDQ-32 responsiveness. A systematic literature review identified 11 articles reporting IBDQ-32 responder analyses in randomized control trials, which were included in a random effects meta-analysis, and 15 articles linking IBDQ-32 change to change in UC health indicators, which were summarized narratively. Meta-analysis compared differences between IBDQ-32 responder proportions in efficacious and nonefficacious treatment arms relative to placebo. Linear meta-regression examined the association of treatment efficacy and proportions of IBDQ-32 responders in active treatment compared with placebo. Meta-analysis showed larger differences in IBDQ-32 response proportions between active treatment and placebo for efficacious treatments (pooled OR, 2.19; 95% CI, 1.83-2.63) than nonefficacious treatments (pooled OR, 1.21; 95% CI, 0.84-1.74; Cochran's Q[df = 1] = 8.26, P = .004). Meta-regression showed that the magnitude of treatment efficacy positively predicted IBDQ-32 response in active treatments relative to placebo (β = 0.21, P < .001). Moderate to strong correlations were found between change in IBDQ-32 and change in health indicators (eg, patient-reported measures, disease activity, endoscopic indices; correlations, 0.37-0.64 in absolute values). Patients achieving clinical response or remission showed greater change in IBDQ-32 total scores (range, 22.3-50.1 points) and more frequently met clinically meaningful thresholds on the IBDQ-32 than those not achieving clinical response or remission (all P < .05). The IBDQ-32 is responsive to changes in UC health indicators and disease activity, including in response to efficacious treatment (relative to placebo).

Participation in the Georgia Food for Health programme and CVD risk factors: a longitudinal observational study.

To assess the relationship between programme attendance in a produce prescription (PRx) programme and changes in cardiovascular risk factors. The Georgia Food for Health (GF4H) programme provided six monthly nutrition education sessions, six weekly cooking classes and weekly produce vouchers. Participants became programme graduates attending at least 4 of the 6 of both the weekly cooking classes and monthly education sessions. We used a longitudinal, single-arm approach to estimate the association between the number of monthly programme visits attended and changes in health indicators. GF4H was implemented in partnership with a large safety-net health system in Atlanta, GA. Three hundred thirty-one participants living with or at-risk of chronic disease and food insecurity were recruited from primary care clinics. Over three years, 282 participants graduated from the programme. After adjusting for programme site, year, participant sex, age, race and ethnicity, Supplemental Nutrition Assistance Program participation and household size, we estimated that each additional programme visit attended beyond four visits was associated with a 0·06 kg/m2 reduction in BMI (95 % CI -0·12, -0·01; P = 0·02), a 0·37 inch reduction in waist circumference (95 % CI -0·48, -0·27; P < 0·001), a 1·01 mmHg reduction in systolic blood pressure (95 % CI -1·45, -0·57; P < 0·001) and a 0·43 mmHg reduction in diastolic blood pressure (95 % CI -0·69, -0·17; P = 0·001). Each additional cooking and nutrition education visit attended beyond the graduation threshold was associated with modest but significant improvements in CVD risk factors, suggesting that increased engagement in educational components of a PRx programme improves health outcomes.

Condition monitoring and fault diagnosis of hydropower generator based on LSTM correction model

Hydropower station is vital for the stable growth of the national economy. How to timely warn the possible faults of hydropower stations has become an increasingly popular research topic. The traditional detection model is difficult to detect the small abnormal changes in the data, and these abnormal changes are often the precursor of faults. To improve the sensitivity of the traditional detection model, this study introduced a weight factor into the traditional LSTM detection model. By using the correction mechanism, the LSTM correction model makes the prediction model never deviate from the normal track following the appearance of abnormal data. This ensures that the model can generate large residuals after abnormal data occur so that we can detect these abnormal data in time. Finally, this paper puts forward two factors related to equipment health and integrates these two factors to form a health index. The results show that the LSTM correction model based on the health index can not only detect small changes that cannot be detected by traditional detection models but also knows the wear and tear of equipment during operation based on the changes in health indicators.

Опыт применения технологий искус- ственного интеллекта для развития профилактического здравоохранения на примере Кировской области.

Healthcare is one of the priority sectors for the practical application of artificial intelligence (AI) systems. In 2018, in the Kirov region, it was decided to launch its own regional project for the implementation of AI technologies in order to gain practical experience and understand the features, advantages and barriers to the use of AI. Improvement of preventive medicine was chosen as a priority direction. The Russian predictive analytics platform Webiomed was chosen as the base software product. The project implementation included 3 stages: pilot testing in 2019–2020, commercial operation in the “second opinion” mode in 2021–2022. and implementation in the digital assistant mode, launched in 2023. As a result of the implementation of the 1st and 2nd stages of the project, it was possible to prove that the main advantage of AI in the analysis of big medical data is the autonomous and high accuracy of interpretation of the information available in it. An AI system for independently extracting the data necessary for analysis from electronic medical records, comparing them with data from past periods, assessing the dynamics of changes in health indicators, and identifying the emergence of dangerous trends and risk factors. Together, this allows the formation of the so-called “digital profiles” of patients, which in turn are a valuable resource for supporting management and clinical decision-making.

Dynamics of changes in expenditures on medical services over the last ten years, their structure in parallel with the dynamics of changes in health indicators

Despite increasing public spending on healthcare in Georgia, the country still needs to catch up to the world health organization's (WHO) recommendation of allocating at least 15% of public expenditure on healthcare. As a result, the population must pay high medical service costs. Additionally, the quality of healthcare in Georgia needs to improve. Chronic diseases are particularly prevalent, and lifestyle risk factors such as tobacco and alcohol consumption, low physical activity, and unhealthy diet contribute to their development. This study aims to assess the cost-effectiveness of state programs in Georgia and compare them with the best working model of world health recommendations. It also aims to identify factors contributing to the development of chronic diseases in Georgia. The research methodology is a meta-analysis, where have been used reports of the national health of Georgia, there have been discussed the results of all state programs operating in Georgia-to analyze the dynamics of changes in health indicators in Georgia over the last ten years. The study finds that public funding for healthcare in Georgia is increasing yearly, but the country still needs to catch up to the WHO's recommendation. The population must pay excessive costs for medical services, and the quality of healthcare remains low. Lifestyle risk factors such as tobacco and alcohol consumption, low physical activity, and unhealthy diet contribute to developing chronic diseases in Georgia. The study also finds that the cost-effectiveness of state programs in Georgia could be better compared to global best practices. The study concludes that despite increasing trends in public funding expenditures in Georgia, healthcare quality remains low. The development of chronic diseases in Georgia is due to lifestyle risk factors such as tobacco and alcohol consumption, low physical activity, and an unhealthy diet. The cost-effectiveness of state programs in Georgia needs improvement, and global best practices should be considered. The study highlights the need for increased public spending on healthcare in Georgia and better resource utilization to achieve better health outcomes.

Higher blood pressure and weight observed among early adolescents during the COVID-19 pandemic

The COVID-19 pandemic led to significant disruptions in the lifestyle behaviors of adolescents; however, there is a paucity of data on objective changes in health indicators of adolescents such as blood pressure, hypertension, and weight. The aim of this study is to quantify differences in blood pressure and weight before and during the COVID-19 pandemic among a demographically diverse national sample of early adolescents. We analyzed cross-sectional data from 2018 to 2020, corresponding to the second follow-up year (Year 2) of the Adolescent Brain Cognitive Development (ABCD) Study. Among 4,065 early adolescents (mean age 12.00, 49.4% female, 55.5% white), 3.4% vs 6.4% of adolescents had hypertension pre-pandemic vs during the pandemic (p < 0.001). The pandemic was associated with a 4.65 percentile (95% CI 2.65, 6.66) higher diastolic blood pressure, and a 1.68 kg (95% CI 0.51, 2.85) higher weight when adjusting for covariates. The pandemic was associated with a 1.97 higher odds of hypertension (95% CI 1.33, 2.92) compared to pre-pandemic when adjusting for covariates. Future studies should explore mechanisms and longitudinal trends in blood pressure among adolescents as they return to pre-pandemic lifestyle behaviors.

Relationship between Greenness and Health Indicators in Urban Patients with Heart Failure

The environment has a significant impact on a person’s general well-being. Distance to green space has been found to be an important factor influencing health. Urban green spaces enhance people’s quality of life and physical and mental health. According to recent research, living near green space may reduce one’s risk of developing cancer, cardiovascular and respiratory diseases, as well as other harmful health issues. In this study, the health data was collected in 2007– 2009 in Kaunas, Lithuania. The study participants (144) randomly were divided into two groups, control, and trained groups. Long-term aerobic physical training was applied to the exposure group. General clinical, echocardiography, and spiroergometry parameters were evaluated for the study participants. Greenness was estimated from satellite-derived normalized difference vegetation index (NDVI) in zones with radii of 1 km, 1.5 km, and 2 km surrounding the participants’ residences. To assess the effect of greenness on the effects of rehabilitation, changes in health indicators during a period of 6 months in the groups of low/high greenness environment were presented separately for participants in control and training group. For this purpose, the paired t-test was used. For changes in patient characteristics, the effect of greenness within a radius of 1.5 km was stronger, also the effect within a radius of 1 km was similar. It was discovered that in the trained group, people who lived in high greenness experienced the best increases in the distance walked over the course of six minutes (6 MWT) and a decrease in the mean heart rate. Spiroergometry indication improvements were notable and more pronounced for residents of high greenness areas. After 6 months, a decrease in echocardiographic indicators was found when living in low greenness. Living in low greenness was found to raise diastolic blood pressure and reduce 6 MWT in the control group. Only the control group’s ejection fraction was non-significant alterations in the low greenness environment. It can be concluded that greater greenness, according to NDVI, may lead to better rehabilitation outcomes for heart failure patients undergoing an aerobic exercise training program.

The impact of health disorders on automated sensor measures and feed intake in lactating Holstein dairy cattle

Animal health and feed intake are closely interrelated, with the latter being an important indicator of an animal’s health status. Automated sensors for dairy cattle have been developed to detect changes in indicators of health, such as decreased rumination or activity. Previous studies have identified associations between sensor measurements and feed intake. Thus, the objective of this study was to determine if health disorders impact the associations identified between sensors and dry matter intake (DMI), and to measure the impact of health disorders on DMI. A total of 934 cows with health disorders (lameness, mastitis, and other), of which 57, 94, and 333 cows had observations for a rumen bolus and one of two ear tags, were analyzed to determine how health disorders impact the association of sensors with DMI. Eleven sensor measurements were collected across the three sensors, including total and point-in-time activity, rumination time, inner-ear temperature, rumen pH and rumen temperature. Associations of health disorders and sensor measures with DMI were evaluated when accounting for systematic effects (i.e., contemporary group, parity, and days in milk) and energy sinks accounted for in determination of feed efficiency (e.g., milk production, body weight and composition). In order to determine if inclusion of health disorders or sensor measures improved model fit, model AICs were assessed. Health disorders were significantly associated with all sensor measurements (P&amp;lt; 0.0001), with the direction of association dependent on sensor measure and health disorder. Moreover, DMI decreased with all health disorders, with larger impacts observed in animals in third and higher lactations. Numerous sensor measurements were associated with DMI, including when DMI was adjusted for energy sink variables and health. Inclusion of rumen bolus temperature, rumination or activity with health data reduced model AIC when evaluating DMI as the dependent variable. Some sensor measures, including measurements of activity, temperature and rumination, accounted for additional variation in feed intake when adjusted for health disorders. Results from the study indicate that feed intake and sensor measures are impacted by health disorders. These findings may have implications for use of sensors in genetic evaluations and precision feeding of dairy cattle.

Public Health Expenditure and Life Expectancy: A Healthy Investment

During the financial crisis and subsequent economic recession, life expectancy in Spain continued its growth trend, rising from 82.3 years in 2008 to 82.92 years in 2014. However, in a context of low mortality rates, it is also important to know about the evolution of time in which we live in good and bad health. Spain’s great regional heterogeneity and its decentralised public health system make it possible to observe how a variety of regional economic and sociodemographic factors may be associated with changes in health indicators. In this study, we analyse the evolution of years lived with and without the most prevalent and disabling health conditions after the age of 50 in 17 Spanish Autonomous Communities in order to understand their association with several macro socioeconomic factors, public provision of health services, public health expenditure, and health-related behaviours. The period of analysis is from 2006 to 2019 in order to cover the phases of expansion, crisis, and economic recovery that the country has experienced in the recent years. The results show that per capita public health expenditure is one of the components that most clearly explains health differences between regions; and higher public health expenditure means more years lived in good health and fewer years lived in bad health.

COVID-19 Experiences and Health-Related Implications: Results From a Mixed-Method Longitudinal Study of Urban Poor Adolescents in Shanghai

PurposeThis analysis aimed to investigate gender differences in adolescents’ concerns and the health implications of COVID-19. MethodsWe used two rounds of the Global Early Adolescent Study (GEAS) collected in Shanghai in 2018 and 2020. We analyzed data from 621 adolescents, comparing boys’ and girls’ concerns about COVID-19 and examining trends in general health and mental health by sex between the pre-COVID-19 and COVID-19 periods. Changes in health indicators over time were assessed using generalized estimating equation (GEE) models. ResultsAdolescent girls reported more health concerns (52.0% vs. 42.7%) and educational concerns (61.0% vs. 46.3%) than boys, whereas boys expressed more worries about the economic consequences of COVID-19 (32.9% vs. 25.4%). Changes in health-related outcomes during the pandemic compared to the prepandemic era differed by sex and varied by COVID-related experiences. Boys reported improved overall health (OR: 1.54, 95% CI: 1.00, 2.35) in the COVID-19 period relative to the pre-COVID-19 period. Such improvements were only observed among boys who reported no family economic hardships (OR: 2.10, 95% CI: 1.24, 3.58). We found no significant change for girls (OR: 1.14, 95% CI: 0.83, 1.55), regardless of COVID-19 economic impacts. In contrast, girls reported increased anxiety (OR: 1.63, 95% CI: 1.09, 2.45), especially among those who were concerned about their academic performance (OR: 1.85, 95% CI: 1.16, 2.97). Boys experienced no such increase (OR: 0.92, 95% CI: 0.55, 1.54), regardless of their education concerns. DiscussionAdolescents’ COVID-19 experiences are highly gendered and result in increased health inequalities, with greater mental health implications for girls.

Do changes in frailty, physical functioning, and cognitive functioning predict mortality in old age? Results from the Longitudinal Aging Study Amsterdam

BackgroundThe ability to accurately predict survival in older adults is crucial as it guides clinical decision making. The added value of using various health indicators as well as changes in these indicators for predicting mortality remains unclear. The aim of this study was to investigate whether changes in health indicators such as frailty and physical performance improve mortality predictions in old age.MethodsThis is a population based prospective cohort study on 995 community-dwelling people aged 68–92 years from the Longitudinal Aging Study Amsterdam. Two measurements at a three-year interval (1995/1996 and 1998/1999) were available for the frailty index, frailty phenotype, grip strength, walking speed, and Mini-Mental State Examination (MMSE). Cox regression was used to analyze mortality risks associated with the current health status and changes in health, with mortality data up to 2017. The extent to which these health indicators improved mortality predictions compared to models with age and sex only was assessed by the area under the receiver operating characteristic curve (AUC).ResultsThe AUC of age and sex for five-year mortality was 72.8% (95% CI 69.0 – 76.5) and was the lowest in the oldest old (age > 80.5 years). The added AUC of the current status of health indicators ranged from 0.7 to 3.3%. The added AUC of the three-year change was lower, ranging from -0.0 to 1.1%, whereas the added AUC of three-year change and current status combined was similar to current status alone, ranging from 0.6 to 3.2%. Across age, the added AUC of current status was highest in the oldest old, however there was no such pattern using three-year change. Overall, the frailty index appeared to improve mortality predictions the most, followed by the frailty phenotype, MMSE, grip strength, and walking speed.ConclusionsCurrent health status improved mortality predictions better than changes in health. Its contribution was highest in the oldest old, but the added value to models with age and sex only was limited.

Temporal Changes of Metabolic Indicators and Quality of Life by a Two-Day Patient Education Program for Metabolic Syndrome Patients.

Metabolic syndrome (MetS) is a disease with a high prevalence that threatens the health of modern people. Patient education is essential to control MetS. This prospective study aimed to evaluate 6-month changes in health indicators following a two-day education program for patients with MetS aged 45 or older. Education about MetS, lifestyle modification, nutrition, and physical activity was provided. At 3 and 6 months after the program, participants visited for follow-up. Twenty-two patients completed the 6-month study. Waist circumference was reduced, and life quality and depression index improved in 3 and 6 months compared to pre-education. Blood pressure decreased, and anxiety index improved at three months. Nutritional knowledge was well maintained for 3 and 6 months. High-density lipoprotein-cholesterol levels increased at six months. Three out of twenty-two patients did not satisfy MetS criteria at the end of the study due to improved indicators. A two-day multidisciplinary education program positively affected health indicators in MetS patients. Participation in the program also help with life satisfaction and positive emotional condition. However, some indicators improved in 3 months, but the effect disappeared 6 months after the program.

Changes in the Health Indicators of Hospital Medical Residents During the Four-Year Training Period in Korea.

BackgroundIn South Korea, the legal maximum working hours per week for medical residents is 88 hours, which are longer than those for other occupations, and the intensity of the workload is also remarkably high. Long working hours and job-related stress can worsen the health status of residents. This study aimed to analyze the four-year annual health checkup (AHC) data of residents to identify changes in their health indicators.MethodsThis study included 457 male residents who received 4 years of training at a university hospital. They underwent an AHC every year during the training period. Changes in health indicators and related factors over the 4 years were investigated.ResultsBody mass indices (BMI), blood pressures (BPs), liver function test (LFT) results, and total cholesterol (TC) levels were significantly worsened during the training period. The increases were the highest in the early training years, between the 2nd and 1st AHC. The working hours of the fourth-year residents were the shortest and showed low smoking and drinking rates and high regular exercise rates. On comparing by department, surgical residents showed the highest increases in BMI, diastolic BP, and fasting blood glucose (FBG), LFT enzyme, and TC levels during the training period, compared to residents from the medical and clinical support departments. Residents who were working ≥ 80 hours showed significantly higher FBG and LFT enzyme levels than those working < 80 hours.ConclusionThis study is meaningful as it is the first study in Korea to investigate the changes in the health of residents through objective health indicators. The possibility of the 4-year training period adversely affecting the health of residents was confirmed. Health indicators were significantly worsened, especially in the early training period, in surgical residents, and in residents who worked for long hours. Efforts are needed to restrict long working hours and distribute workload during the 4-year training period.

Health Promotion, Functional Abilities, and Quality of Life Before and During COVID-19 in People With Multiple Sclerosis.

Because multiple sclerosis (MS) is an autoimmune disease and many individuals with MS take disease-modifying drugs that suppress immune response, serious concerns have been expressed about the potential effect of COVID-19 on those with this chronic condition. The purpose of this research was to utilize the most recent 5 years of data from an ongoing longitudinal study of health promotion and quality of life (QoL) among people with long-standing MS to investigate changes across time in functional limitations, health promotion, and health-related QoL. Participants are mailed an annual survey to complete about their health promotion, depressive symptoms, health status, social support, MS-related functional limitations, and QoL. Differences across time were analyzed with repeated measures of analysis of variances and planned contrasts. In 2021, the 141 participants had a mean age of 69 years and had been diagnosed with MS for 34 years, on average. Most had attended college, were married/partnered women, and reported adequate economic resources. Thirty-seven percent reported they were in poor to fair health. Physical activity and health responsibility scores decreased significantly during 2020-2021 compared with 2017-2019. Significant changes in depressive symptoms, social support, and functional limitation scores followed a different pattern, with the largest changes occurring between 2018 and 2019. QoL and other health promotion scores did not change significantly across time. The relatively small changes in health indicators revealed here suggest that older people with long-standing MS may have generally been able to maintain their health promotion, functional abilities, and QoL from before to during the COVID-19 pandemic. However, nurses and other providers should support them to resume their physical activity and regular provider contact as COVID-19 restrictions are eased. The patterns observed here demonstrate the importance of examining changes across an extended period, rather than simply looking at 1 year before and 1 year after a major event, such as COVID-19. These findings can help nurses understand how to help their patients with chronic health conditions maximize their health as they move forward.

Changes in Health Indicators of Welfare in Group-Housed Shelter Cats.

The aim of this study was to detect changes in health-oriented welfare indicators of shelter cats housed in a shelter by means of long-term monitoring of health indicators of welfare in a population of group-housed cats in a private, no-kill shelter in the Czech Republic. The cat population housed in a large group was monitored for 1 year. The data recording took place at 2-week intervals. A total of 220 cats were evaluated using a protocol containing eight health-oriented welfare indicators: body condition, third eye visibility, eye discharge, eye irritation, nose discharge, the presence of pathologically induced respiratory sounds, coat condition, and lameness and abnormal posture. The assessment was performed based on the observation by two trained evaluators. The cats' condition was rated on a 5-point scale for each indicator, where the optimal condition was represented by the score of 1 and a severe deterioration by the score of 5 for the given indicator, except for the body condition indicator, where the optimal condition was represented by the score of 3. A deterioration in the score in at least one of the indicators during the stay in the shelter was recorded in 52 (41.6%) of 125 cats that were assessed at least twice. The effect of the LOS, sex and age on the scores for each health indicator was examined via a linear mixed model analysis, as this method allows for handling of dependencies in the data of repeated measurements. The effect of predictors on the third eye visibility scores was not found. The age of cats predicted the coat condition and body condition scores. The LOS predicted scores of the abnormal posture and lameness indicator and scores of a composite index composed of indicators related to upper respiratory tract disease. The results suggest that despite the fact that some improvement of health was documented during the cats' stay in the shelter, there were a non-negligible number of animals experiencing a permanent or long-term deterioration in health. Efforts to minimize the undesirable factors contributing to the deterioration of well-being of cats during their stay in a shelter should be made.

Continuous unobtrusive assessment of meaningful change in older adults with cancer: The Pacific Aging &amp; Cancer Study Collaborative—PACS collaborative.

1569 Background: Knowledge of changes in health that precede a cancer diagnosis is challenging because of a lack of longitudinal, objective measurement techniques. Current approaches rely on periodic assessment via self-report which may miss when and how health changes, particularly when changes may appear subtly over time. Remote-monitoring technologies provide a mechanism to continuously, passively, and unobtrusively monitor changes in health so that trajectories of change in relation to a life event (i.e., cancer diagnosis, treatment) can be detected and described. We examined the changes in digital indicators of health and life events 1 year before and after a self-reported cancer diagnosis in community-dwelling adults aged 65 and older. Methods: This is a secondary, retrospective data analysis of older adults who self-reported a new cancer diagnosis in the Oregon Center for Aging &amp; Technology (ORCATECH) cohort. Ten older adults (age = 71.8±4.9 years, 30% women) were included with various cancer types (esophageal, prostate, uterine, pancreatic, b-cell follicular lymphoma, multiple myeloma, basal cell melanoma, basal and/or squamous cell carcinoma). Daily physical activity was measured using step counts derived from an actigraph watch. Weekly health and life events (pain severity, loneliness, hospitalization/emergency room (ER) visits, days away from home overnight) were self-reported from weekly online surveys. Results: A total of 3,624 days of actigraphy data (210 ± 88 days pre-cancer; 153 ± 81 days post-cancer) and 750 weeks of self-reported online survey data (36 ± 12 weeks pre-cancer; 39 ± 14 weeks post-cancer) were collected. Longitudinal linear mixed-effects models revealed that the trajectory of step counts was different pre- and post-cancer (β = -1.52, p &lt;.001), with a gradual decrease in step counts before a cancer diagnosis. The trajectory of pain severity was different pre- and post-cancer (β = 0.01, p &lt;.001), with a gradual increase in pain severity before a cancer diagnosis. There was a gradual increase in the occurrence of hospitalization/ER visits (OR = 1.07, p = 0.02) and days away from home overnight (OR = 1.04, p = 0.01) before a cancer diagnosis. Feelings of loneliness increased over time, regardless of pre- or post-cancer (OR = 1.04, p &lt;.001). Conclusions: Changes in health and life events 1-year before a cancer diagnosis in older adults with varying cancer types and severity were unobtrusively observed. This study suggests that a remote-monitoring technology platform deployed in homes can detect meaningful intra-individual changes before and after a cancer diagnosis. Future studies can employ this technology as a pathway for improving the timeliness of detection and more effective therapeutic follow-up for older adults.

Be careful with ecological associations.

Ecological studies are observational studies commonly used in public health research. The main characteristic of this study design is that the statistical analysis is based on pooled (i.e., aggregated) rather than on individual data. Thus, patient-level information such as age, gender, income and disease condition are not considered as individual characteristics but as mean values or frequencies, calculated at country or community level. Ecological studies can be used to compare the aggregated prevalence and incidence data of a given condition across different geographical areas, to assess time-related trends of the frequency of a pre-defined disease/condition, to identify factors explaining changes in health indicators over time in specific populations, to discriminate genetic from environmental causes of geographical variation in disease, or to investigate the relationship between a population-level exposure and a specific disease or condition. The major pitfall in ecological studies is the ecological fallacy, a bias which occurs when conclusions about individuals are erroneously deduced from results about the group to which those individuals belong. In this paper, by using a series of examples, we provide a general explanation of the ecological studies and provide some useful elements to recognize or suspect ecological fallacy in this type of studies.

Adaptation of an exercise intervention for pregnant women to community-based delivery: a study protocol.

IntroductionDespite well-established guidelines and benefits to exercise, the majority of pregnant women in the USA fail to meet recommended activity levels. Studies need to determine feasible ways to translate clinical interventions to community settings by engaging pregnant women in widely accessible locations to ensure benefits to more women. The aim of this study is to adapt and determine feasibility, acceptability and fidelity of the research clinic-based Expecting intervention (NCT02125149) with pregnant women with obesity in community settings.Methods and analysisWe will use the Replicating Effective Programs (REP) to guide the adaptation and implementation of the research clinic-based intervention into the community. REP provides a four-phase process for implementing evidence-based interventions including collection of feedback from community stakeholders, iterative piloting of the intervention in the community and a process for standardising the intervention across community settings. Following adaptation, the updated intervention will be piloted. The pilot study will include 60 expecting women. We will randomise half to receive the community-adapted Expecting intervention (intervention, N=30) and half to receive standard of care (control, N=30). Feasibility and Acceptability of Intervention Measures are primary outcomes as key indicators of feasibility. Secondary outcomes will include the number of intervention sessions completed, the change in the number of minutes of physical activity as measured by accelerometer, as well as change in health indicators from enrolment to time of delivery and 6 months post-delivery (ie, body mass index, blood pressure and total cholesterol).Ethics and disseminationThis study has been approved by the Institutional Review Board (#260132). Findings will be shared with study participants and stakeholder advisors through written summaries and in-person presentations; results will also be shared through presentations at scientific conferences and publications in peer-reviewed journals.Trial registration numberNCT04298125; Pre-results.