Community-based Settings Research Articles

Forging new paths in the development of community mental health interventions for people with mental illness at risk of criminal legal system contact

BackgroundIndividuals with serious mental illness (SMI) have disproportionately high rates of criminal legal system involvement. For many, this becomes a repeated cycle of arrest and incarceration. Treatments that address symptoms of mental illness are a critical component of the continuum of services for people with SMI in the legal system; yet on their own, psychiatric treatments have not been successful at reducing criminal legal system involvement for this population. Research suggests that criminogenic risk factors, the major drivers of criminal legal system involvement, are disproportionately prevalent among individuals with SMI. However, promising criminogenic-focused interventions have only just begun to be adapted for individuals with SMI. The proposed study will examine the capacity of Forging New Paths (FNP), a novel criminogenic-focused group intervention developed for individuals with SMI, to engage its primary and secondary outcomes when delivered in community mental health settings.MethodsThe proposed pilot study will engage a small-scale clinical trial comprising three cycles of FNP delivered in a community mental health center in a Southeastern state in the U.S. The anticipated total sample size is N = 72 and will consist of community-dwelling adults with SMI who have a moderate or higher criminogenic risk level and a history of criminal legal system contact. This study will examine the extent to which FNP is able to engage its primary (aggression and community tenure) and secondary (criminal attitudes and impulsivity) treatment outcomes.DiscussionFNP provides an important new service for community-based mental health settings to reduce criminal legal system involvement (and recidivism) among the individuals they serve with SMI.Clinical Trial RegistrationNCT06290648.

Empowering lives: How deinstitutionalization and community living improve the quality of life of individuals with intellectual and developmental disabilities.

The number of people with intellectual and developmental disabilities (IDD) living in residential settings has not changed substantially in recent years in Spain. To change this situation the project "My House: A Life in the Community" aims to promote the transition of individuals with IDD and high support needs into community settings. This paper deepens the understanding of the underlying mechanisms responsible for the changes observed in the process of deinstitutionalization. A longitudinal study was designed to evaluate the quality of life of individuals with IDD (n = 90) across different environments at two distinct time points: when they were living in an institution and nine months after transitioning to a community-based setting. A comparison group (n = 72) consisting of individuals who remained institutionalized was included to carry out intergroup comparisons. T-tests were used to estimate mean differences both between and within groups. Longitudinal path models were used to investigate the processes underlying the relationships between variables. After transition, movers obtained significantly higher mean scores on all variables with large or very large effect sizes. However, simply moving to a different place was not the factor responsible for the observed improvements: positive changes in quality of life require the constant availability of opportunities to support decision making. deinstitutionalization will only lead to improvements in quality of life if it favors people's control over their lives. Community living should therefore be understood not as an autonomous life but as a chosen one.

Revitalizing Parenthood Among Chinese Parents with Major Depressive Disorder: A Qualitative Study in Hong Kong

Studies on parental depression predominantly use quantitative designs and are based in Western cultural contexts. Research on the lived experiences of Chinese parents with major depressive disorder (MDD) in Hong Kong society is scant. In this study, we aim to address this research gap using a qualitative design, exploring Chinese parents’ subjective experiences. From December 2022 to April 2023, 12 parents, purposively sampled from a community-based setting, participated in semi-structured, rigorous interviews exploring how they responded to MDD. Using thematic analysis, an overarching theme of “revitalizing parenthood” was identified, under which five subthemes, namely “rejecting fatalism of parental depression,” “regulating proximity with children,” “retaining parenthood,” “redefining suffering,” and “untapped resources in the dyad,” were generated. The findings provide suggestions for social workers to engage with parents with MDD, who are perceived as active players in the journey of recovery and revitalizing parenthood. Mental health professionals and researchers should consider departing from a deficit-based landscape to a resilience-oriented perspective to identify the potential of the parents, which may contribute to the well-being of the whole family.

DEPLOYING TELEWELLNESS PROGRAMS IN THE COMMUNITY: BARRIERS, FACILITATORS, AND POTENTIAL

Abstract ‘Telewellness’ programs use technology (e.g., video conferencing software) to facilitate remote participation in exercise classes. These programs hold great potential to expand access to physical and mental health benefits of group exercise classes for older adults, especially those with mobility disabilities. We translated the Tai Chi for Health Institute’s in-person, evidence-based tai chi program, Tai Chi for Arthritis, to be a virtual experience (via Zoom) that is both socially engaging and inclusive of people with a mobility disabilities. The ‘Tele Tai Chi’ clinical trial (NCT04696887) explored to what extent this program may increase social interaction and positive health behaviors among older adults with long-term mobility disabilities; data analysis is in progress. The next phase of this project is focused on delivering our Tele Tai Chi program in real world, community-based settings (e.g., senior centers, senior living communities). This session will present findings from interviews with subject matter experts (e.g., senior center coordinators, administrators from Area Agencies on Aging, tai chi instructors) on perceived barriers to delivering Telewellness classes (e.g., safety, staffing, demands, technical support), as well as potential facilitators to address them. We will also discuss the need for different models of Telewellness (e.g., hybrid classes with attendees both in-person and online) that align with the community’s unique characteristics, preferences, and support needs.

TRANSLATABLE EXERCISE INTERVENTIONS TO REACH OLDER ADULTS WITH PHYSICAL AND COGNITIVE FRAILTY

Abstract Mobility limitations, falls and dementia are leading causes of disability, institutionalization, and mortality among U.S older adults. Considering that the population of adults aged ≥ 65 years is projected to surpass 80 million by 2040, more effective and scalable intervention strategies to maintain mobility, reduce falls or offset cognitive decline are necessary to help older Americans to continue to live independently. This presentation will discuss the rationale, design and implementation of several innovative exercise intervention strategies for older adults with mobility limitations, elevated fall risk, and for older adults at high risk for developing dementia. The session will specifically describe how large-scale clinical trial evidence for the benefits of exercise can be translated to reach more vulnerable older adults in real-world community-based settings. The session will also describe how a digitally delivered multicomponent fall prevention exercise program can be tailored to reach at-risk older adults in their own homes. Overall, it is posited that these innovative interventions hold significant potential as highly scalable approaches for maintaining mobility, preventing falls, and mitigating cognitive decline among rapidly expanding populations of older adults.

HEALTH SYSTEM ADOPTION OF COMMUNITY-BASED EXERCISE FOR OLDER ADULTS TO ADDRESS LONELINESS AND SOCIAL ISOLATION

Abstract Transitioning the delivery of evidence-based programs (EBPs) for older adults from research to community-based settings potentially alters programs’ reach. We compared the demographics of our research participants to our referred community participants after the program’s adoption by Cedars-Sinai, Community Health Improvement (CHI). Research participants enrolled in Falls Prevention EBPs reported decreased levels of loneliness and social isolation and were referred by physicians, social workers, and pharmacists using an order in the electronic medical record (EMR). Clinicians referred 1355 in-person participants (July 2017-March 2020) and 283 virtual (April 2020- May 2021). Enrolled research participants (in-person (n=382) /virtual (n=214)) had an average age of 76.6 / 76.5 years; were 83.4% / 82.5 % female; and non-Hispanic white 42 % / 70.4%; and non-Hispanic Black 43.5% / 8.2%. CHI retained the relationship with the non-profit partner who ran the study’s EBPs and the EMR order remained active and received 391 referrals (July 2021 – March 2024). Referred patients had an average age of 79.5 years, 79.3% female, 59.5% non-Hispanic white, 21.5% Black, 8.2% Hispanic, 5.9% Asian, 3.1% Other; 68.5% had Medicare and 31.7% Medicare Advantage. Referral orders were associated with diagnoses for preventative visits (18.7%), falls (15.6%), and cognitive changes (13.6%). Compared to research participants, community referrals included those with cognitive impairment, were older, more male, and more racially diverse than virtual study participants. Community implementation of EBPs may reach a more diverse population than research participants and successful transition of programs can be facilitated through preserving prior community partnerships and referral pathways.

Loneliness and living: The trigger effect of living arrangements and self-reported health in adults 45+ – a LASI cross-sectional study

ABSTRACT Loneliness, a distressing emotion resulting from unmet social needs, is a growing public health issue. This study analyzes data from the 2017–2018 LASI Wave-1 to examine the impact of socio-demographic and lifestyle factors on loneliness among Indians aged 45 and older. Key variables include age, sex, marital status, residence, living arrangement, physical activity, tobacco and alcohol use, and self-reported health. The findings reveal that living alone significantly increases the likelihood of loneliness, with individuals 4.35 times more at risk compared to those living with spouses and children. Those living with others are 2.33 times more prone to loneliness. Poor health is linked to a 1.53 times higher risk, while physical inactivity increases loneliness risk (OR = 1.19). Interestingly, alcohol consumption appears to slightly reduce loneliness (OR = 0.94). The study highlights the critical role of family support and perceived health in mitigating loneliness in community-based settings.

Nonfatal Strangulation Injuries: Improving Physician Knowledge and Attitudes

In the emergency department, physicians evaluate patients who have experienced nonfatal strangulation resulting from sexual assault or intimate partner violence. Given the prevalence and potential consequences of nonfatal strangulation injuries, physicians need confidence in their decision-making for these patients. Previous educational interventions effectively improved physician knowledge of sexual assault and intimate partner violence patients; however, no studies have been conducted with the goal of improving physician knowledge about nonfatal strangulation injuries in this population. Pre- and post-intervention surveys were administered to physicians from four different south-central Indiana emergency departments. These surveys assessed comfort and knowledge regarding the treatment of survivors of sexual assault, intimate partner violence, and nonfatal strangulation. Additionally, six vignette-style questions designed to evaluate knowledge in clinical scenarios were also administered. A 15-min, interactive, educational presentation was delivered prior to the post-survey. Post-intervention participants tended to rate awareness of imaging recommendations and resources, decision-making, history taking, and use of trauma-informed care higher than pre-intervention participants. The post-intervention group ( n = 12) answered more clinical vignette questions correctly with an average of 92% correct compared with the pre-intervention group ( n = 22), which had an average of 76% correct. Based on these results a 15-min educational intervention was effective in improving physician knowledge, confidence, and comfort in treating patients who have experienced nonfatal strangulation in small community-based emergency department settings. In the future, similar interventions may be implemented in other emergency departments to increase awareness about the evaluation and treatment of nonfatal strangulation injuries.

Preliminary evidence that self-incentives uniquely promote smoking cessation in incarcerated populations: A pilot randomized controlled trial.

Smoking prevalence rates in prison are typically four times higher than the rates found within community-based settings, increasing premature mortality. Encouraging smokers to self-administer incentives contingent on abstinence (i.e., self-incentivize) are effective in community-based settings and have the potential to work in an incarcerated population. The present study aims to: gauge the feasibility of- and assess possible effects associated with- encouraging smokers to self-incentivize to increase smoking abstinence. The study recruited 25 smokers from a UK prison who were attending the prison-based stop smoking service. Participants were randomized to one of three conditions, either: (a) an active control, asked to form a plan to quit smoking (n = 5); or to self-incentivize if they had not smoked at all by the end of (b) the week (n = 7); or (c) the month (n = 13). The study gave no specific options to participants in choosing a self-incentive for a number of reasons (e.g., to enable choice of a self-incentive of sufficient rewarding value within a restrictive setting). Participant eligibility included: (a) aged 18 years or over, (b) able to understand written English, (c) competent to provide informed consent, and (d) were tobacco smokers, smoking on a daily basis. Acceptance and completion assessed feasibility. Chi-square analysis assessed possible effect of the intervention. Twenty five out of 27 smokers who were approached, welcomed the opportunity of further support and completed the baseline questionnaire. At 3-month follow-up, no participants (0/5) in the control condition abstained from smoking. In contrast, three (out of seven, d = 1.12) participants who self-incentivized on a weekly basis abstained, and five (out of 13, d = 0.83) participants who self-incentivized on a monthly basis abstained at the 3-month follow-up time point. Abstaining is defined as no cigarette smoked within at least the last 28-days via self-report and supported by biochemical verification from a sub-sample of participants (68 %; 17/25). Use of self-incentives alongside behavioral support and cessation medication is feasible and can be delivered at low-cost. Furthermore, the promise seen in this trial suggests a fully powered randomized controlled trial has the potential to increase smoking abstinence in an incarcerated population.

Young men's everyday life experiences with contraception and unintended pregnancy in Papua New Guinea.

Unintended adolescent pregnancy is a public health priority in Papua New Guinea (PNG), where national policies specify need for easier access to reliable modern contraceptives. To reduce young people's experiences of unintended pregnancy in PNG, improved understandings of use of modern and other forms of contraception within young people's relationships is required to support the development of new sexual and reproductive health (SRH) programs and policies. The aim of this paper is to understand young men's use of modern and other contraceptives. This qualitative study involved semi-structured interviews with 35 sexually active young men aged 15-24 years, who were sampled purposively from the general population within community-based settings. Data were analysed using inductive thematic analysis techniques. Our analysis of young men's everyday experiences of using condoms and other contraceptives highlights clear drivers of unintended adolescent pregnancies. Across three settings, these included non-use of any modern method at first sex or during early sexual experiences; inconsistent use of condoms, often only after first pregnancy experiences; difficulties accessing condoms from health service providers, pharmacies and stores; a lack of understanding of other modern contraceptive strategies; inconsistent use of the withdrawal method; and inconsistent and incorrect use of calendar approaches due to misunderstandings about women's fertile period. Ten young men had never used any form of contraception. These occurred largely because young men's sexual agency is constrained within sexual and peer relationships, and community, school and health service settings, in ways that inhibit pregnancy prevention. It is important to engage meaningfully with young men to build sexual and reproductive health policies and programs that pay honest, respectful attention to young people's everyday sexual and social lives. Young men's everyday stories provide a unique lens through which we can identify mechanisms of change required to address the health and social inequities associated with unintended pregnancy among young men and young women in PNG and beyond.

Association between alcohol consumption and sleep difficulty in a nationwide Korean survey

Abstract Background: The data on the association between alcohol intake and sleep quality in a community-based setting are lacking. This study examined overall sleep difficulty according to alcohol habits among Korean adults. Materials and Methods: We analyzed data from 4937 adults who responded to questions about sleep difficulty and drinking habits from the 2019 Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for substantial sleep difficulty based on the frequency or amount of alcohol consumption in total and age- and sex-stratified subgroup analyses. Results: Approximately 8.5% of the study population had substantial sleep difficulty. Individuals who drank <1 per week (frequency) or 1–2 cups per time (amount) had the lowest prevalence of substantial sleep difficulty, even compared with nondrinkers. Among drinkers, the association between alcohol use and sleep difficulty was significant in a dose-dependent manner (P for trend: 0.003 in frequency and < 0.001 in amount). Subgroup analysis revealed that significant linear relationships were robust for adults aged <50 years ([ORs] 1.20 [95% CIs 1.03–1.40] for frequency and 1.25 [1.10–1.42] for amount) and females (1.26 [1.10–1.44] for amount). Conclusion: Alcohol consumption is associated with increased sleep difficulties, especially in younger adults and women, underscoring the need for targeted interventions and in-depth research on the effects of alcohol on sleep.

Effects of Heart Rate Fluctuation on Aerobic Training Outcomes in Patients With Stable Coronary Artery Disease: A Prospective Study.

This study aimed to evaluate the effects of different heart rate fluctuation ranges during aerobic training on outcomes in patients with stable coronary artery disease (CAD). Ninety-seven patients diagnosed with stable CAD were enrolled between March 2017 and December 2019. Participants were randomly assigned to three groups: the control (CON) group, the medium-intensity heart rate small range (MIS) group, and the medium-intensity heart rate large range (MIL) group. The CON group received standard care and patient education, while the MIS and MIL groups underwent personalized rehabilitation training with specific heart rate fluctuation targeted ranges, in addition to standard care. Cardiopulmonary function and exercise performances were assessed using resting heart rate (RHR), maximum heart rate (HRmax), heart rate recovery (HRR), and a 6-min walk test (6MWT) at the baseline and after 16 weeks of training. The MIS group demonstrated a significant reduction in RHR compared to the CON and MIL groups. While both exercise rehabilitation groups exhibited improvement in HRR, only the MIS group achieved a statistically significant improvement compared to the CON group. Post-training HRmax and 6MWT performance increased in both MIS and MIL groups, with only the MIL group presenting statistical significance compared to the CON group. Exercise rehabilitation with different training regimens can enhance cardiac function in patients with CAD. Different heart rate modulation strategies yielded distinct effects on cardiopulmonary function. Maintenance of a narrower heart rate fluctuation during exercise was observed to significantly enhance the effectiveness of rehabilitation, which could lead to new treatment protocols or optimization of existing strategies for patients with cardiovascular conditions. The combination of 6MWT and power bicycle training may offer an effective method for improving cardiac function in community-based rehabilitation settings.

Head & neck surgical oncology: Success in private practice.

Due to its complexity and multimodality treatment needs, traditional delivery of head and neck cancer care often occurs in a multidisciplinary cancer center, frequently in a university-based program in an urban setting. Fellowship training opportunities for subspecialty-focused head and neck surgeons have increased over recent years. There is a persistent concern that the number of newly minted Head & Neck Surgeons graduating each year outpaces the number of university-based employment opportunities, and that the workforce does not match the job opportunities. Recent publications examine this potential mismatch to better understand career choices, with a 2021 survey revealing that nearly 90% of fellowship graduates were employed by a university or academic institution and only 10% reported being in "private practice". However, it should not be an automatic assumption that academic practice is somehow superior to private practice. Moreover, not every patient can access university-based care, creating a societal mismatch between disease incidence, resources, and access to high quality care. The well-trained Head & Neck Surgeon may be able to deliver excellent care in a satisfying practice setting without an academic affiliation. Two Head & Neck Surgeons who have practiced in both Academic and Community-based ("private") subspecialty settings offer practical and actionable tips to provide high level evidence-based head and neck surgical care without the trappings of a university, and with a focus on patient-centered care as well as career satisfaction. Further, since graduates of comprehensive otolaryngology training programs receive a robust amount of head and neck surgery training in residency, understanding these practical tips will potentially assist the Comprehensive Otolaryngologist in private practice to expand head and neck services within their practice. 1) Review recently published survey-based reports of practice patterns and career satisfaction of recent HNS fellowship graduates, recognizing self-reported rates of practice settings, academic versus non-university-based ("private practice"). 2) Analyze and report practice structure of HNS graduates over the years 2015 to 2021 to determine rates of practice structure change from academic to private or vice versa, using Public Use Files combined with Google search. 3) Outline tips and pearls for a successful Head & Neck Surgery practice in a non-university-based setting, with 11 practical and actionable items that will allow high level subspecialty care without the traditional attributes of academic employment. Graduates of head & neck surgery fellowships in recent years may perceive a paucity of academic job opportunities. This article reviews practice patterns of recent graduates, and presents practical tips to achieve a satisfying Head & Neck Surgery career in a private practice setting.

Real-world diagnostic, referral, and treatment patterns in early Alzheimer's disease among community-based practices in the United States.

Over 90% of individuals with mild cognitive impairment (MCI) may not receive a timely diagnosis. Understanding community-based practice patterns, where most individuals are seen, is critical to improving patient care. To understand how patients with MCI and mild dementia due to Alzheimer's disease (AD) are diagnosed and managed in community-based settings, including the use of clinical and cognitive assessments, referrals to dementia-related specialties, and receipt of treatment. This observational study recruited community-based primary care physicians (PCPs) (N = 177) and neurologists (N = 147) in August-September 2023, through a verified physician panel with broad geographic representation across the US. Physicians abstracted medical chart data from patients diagnosed with MCI or mild AD within the previous two years. Data collected included use of neurocognitive assessments, biomarker and structural imagine tests, referrals, and treatments. Descriptive statistics were used. Medical records for 817 MCI and 467 mild AD patients were abstracted. The mean age was 70.2 years, 56.4% were female, and 67.2% were White. Symptoms were commonly reported by a family member (67.2%). Nearly 1 in 6 patients did not receive any neurocognitive assessments (16.1%), and nearly 1 in 4 did not receive a structural imaging or AD-specific biomarker test (23.7%). AD-specific biomarker tests were more common among patients aged ≥65 (87.1% versus 75.3%; p < 0.05). Less than 1 in 4 patients were referred for cognitive/behavioral concerns. As the diagnostic and treatment landscape changes, education on symptom recognition, and physician training on new technologies may facilitate timely diagnoses and improve patient outcomes.

Prevalence of steatotic liver disease, advanced fibrosis and cirrhosis among community-dwelling overweight and obese individuals in the USA

BackgroundThere are limited prospective data among overweight and obese individuals on the prevalence of advanced fibrosis, and cirrhosis using advanced MRI-based methods in the USA. The aim of this study...

Acceptability and utility of a broad test battery to evaluate physical functioning and frailty in community-based settings for people experiencing homelessness and addiction–Findings from the LEAP trials

BackgroundPhysical function deficits and frailty are commonly reported in people experiencing homelessness and addiction. Typically, geriatric, or general physical performance measures are employed to evaluate these constructs. Objectives and settingWe aimed to investigate the feasibility of a broad test battery to evaluate physical functioning and frailty in a non-geriatric community-based population of people experiencing homelessness and addiction. Design and methodsPhysical function and the presence of frailty was evaluated using combined data from two linked low-threshold exercise pre-post intervention studies (LEAP-I and II). ParticipantsSeventy-four participants attending an open-access day-service centre (18 to 65 years) were evaluated. Participants with acute confusion or behavioural issues, or major medical conditions precluding safe participation were excluded. InterventionA broad test battery was performed which evaluated physical functioning and frailty. Main outcome measuresOutcome measures included were the Short Physical Performance Battery, Single Leg Stance, Chair Stand Test, 10mWT and 2 Minute Walk Tests, limb circumference, dynamometry, Clinical Frailty Scale, SHARE-Frailty Instrument, Numerical Pain Rating Scale and Short Form-12. ResultsTest completion was 100% for all outcomes except pain rating (81% and 79% for LEAP-I and II, respectively), and balance and walking tests (95% and 93% in LEAP-II). A ceiling effect was detected for the Short Physical Performance Battery. ConclusionHigh feasibility of the test batteries was demonstrated. An optimised test battery was proposed based on findings. This has important implications for clinicians working in inclusion health settings. Clinical Trial Registration NumberClinical Trials.gov: NCT05700305. Contribution of the Paper•This paper proposes a suitable test battery to enable clinicians to evaluate physical functioning and frailty in people experiencing homelessness and addiction challenges in community settings.•There is a paucity of research evaluating outcome measures for this population and no core outcome set has been reported.•This test battery would allow the effect of treatment and targeted interventions to be evaluated in this marginalised population.

Interventions to improve access to cancer care in underserved populations in high income countries: a systematic review.

Underserved populations both globally and in Canada face serious cancer inequities that result from systemic economic, environmental, and social conditions. These pose barriers in access to cancer care and lead to suboptimal cancer care experiences and outcomes. Knowledge of effective interventions to improve access to cancer care is needed to inform the design of tailored interventions for these populations. To identify interventions and programs to improve access to cancer care for underserved populations in high income countries with universal health coverage (UHC) and the United States (US) throughout the cancer care continuum. We conducted a systematic review following the PRISMA standards. We searched Medline, EMBASE, PsycINFO, CINAHL, Scopus, and the Cochrane Library. Inclusion criteria: quantitative and qualitative studies published in English in the last 10years (2013-2023), describing interventions/programs to improve access to cancer care for underserved populations (18years and over). We included studies in the US given the body of scholarship on equity in cancer care in that country. Screening, data extraction and analysis were undertaken by two independent reviewers. Our search yielded 7,549 articles, and 74 met the inclusion criteria. Of these, 56 were conducted in the US, 8 in Australia, 6 in Canada, and 4 in the United Kingdom. Most (90.5%) were quantitative studies and 47.3% were published between 2020-2023. Seven types of interventions were identified: patient navigation, education and counselling, virtual health, service redesign, financial support, improving geographical accessibility and multicomponent interventions. Interventions were mainly designed to mitigate language, distance, financial, lack of knowledge and cultural barriers. Most interventions focused on access to cancer screening, targeted rural populations, racialized groups and people with low socioeconomic status, and were conducted in community-based settings. The majority of interventions or programs significantly improved access to cancer care. Our systematic review findings suggest that interventions designed to remove specific barriers faced by underserved populations can improve access to cancer care. Few studies came from countries with UHC. Research is required to understand tailored interventions for underserved populations in countries with UHC.

Detecting muscle fatigue among community-dwelling senior adults with shape features of the probability density function of sEMG

BackgroundPhysical exercise is an important method for both the physical and mental health of the senior population. However, excessive exertion can lead to increased risks of falls, severe injuries, and diminished quality of life. Therefore, simple and effective methods for fatigue monitoring during exercise are highly desirable, particularly in community settings. The purpose of this study was to explore the possibility of real-time detection of exercise-induced fatigue using surface Electromyogram (sEMG) features, including the kurtosis and skewness of the Probability Density Function (PDF) in the community settings to solve the issues of low sensitivity and high computational complexity of commonly used sEMG features.MethodssEMG signals from six forearm muscles were recorded during hand grip tasks at 20% maximal voluntary contraction (MVC) task-to-failure contractions from 30 healthy community-dwelling elders at their respective community centers. PDF shape features of the sEMG, namely kurtosis and skewness, were computed from 25 s of non-fatigue stable phase and 25 s of fatigue data for comparison. Statistical tests were conducted to compare and test for the significance of these features. We further proposed a novel fatigue indicator, Temporal-Mean-Kurtosis (TMK) of channel-averaged kurtosis, to detect fatigue with relatively low computational complexity and adequate sensitivity in community settings. ANOVA and post-hoc analyses were performed to examine the performance of TMK.ResultsStatistically significant differences were found between the non-fatigue period and the fatigue period for both kurtosis and skewness, with increasing values when approaching fatigue. TMK was shown to be sensitive in detecting fatigue with respect to time with lower computational complexity than the Sample Entropy.ConclusionThis study investigated PDF shape features of sEMG signals during a handgrip exercise to identify muscle fatigue in older adults in community experiments. Results revealed significant changes in kurtosis upon fatigue, indicating that PDF shape features were suitable convenient detectors of muscle fatigue in community experiments. The proposed indicator, TMK, showed potential sensitivity in tracking muscle fatigue over time in community-based settings with limited computational complexity, highlighting the promise of sEMG’s PDF features in detecting muscle fatigue among the elderly.

A Community-Based Trial of Commercially Available Compression Tights in Patients With Postural Orthostatic Tachycardia Syndrome.

Compression garments reduce heart rate and symptoms in patients with postural orthostatic tachycardia syndrome in an acute laboratory setting. Patients taking medications controlling heart rate have less benefit from compression than those not on medications. The effectiveness of commercially available garments in a community-based setting, with and without medication use, is not known. The authors sought to evaluate commercially available compression tights in a community-based setting both with, and without, medications modulating heart rate, using a clinical trial with 2 before-after protocols conducted in a randomized crossover fashion. Participants (N=26) held medications during protocol #1 and took medications as normal during protocol #2. For each, participants completed 4, 10-minute active stand tests in the morning (AM) and afternoon (PM) with the garments on (ON) and off (OFF) (AM-OFF, AM-ON, PM-ON, and PM-OFF). Heart rate (Holter monitor) and symptoms (Vanderbilt Orthostatic Symptom Score [VOSS]) were measured for each standing test. Protocol #1: Standing heart rate was reduced (105 [99-116] beats/min vs 119 [105-130] beats/min; P< 0.001) and symptoms improved (P< 0.001), during AM-ON vs AM-OFF. Standing heart rate (P=0.04) and symptoms (P=0.004) increased when compression was removed after several hours. Protocol #2: Standing heart rate was reduced (84 [77-90] beats/min vs 89 [84-100] beats/min; P< 0.001), and symptoms improved (P=0.03), during AM-ON vs AM-OFF. Standing heart rate (P=0.02) and symptoms (P< 0.001) increased when compression was removed after several hours. Commercially available compression tights reduced heart rate and symptoms both acutely and after several hours of use. This additional benefit persisted whether concomitant medications were used. (Compression Garments in the Community With POTS [COM-COM-POTS]; NCT04881318).

The performance of a point-of-care test for the diagnosis of Neurocysticercosis in a resource-poor community setting in Zambia – a diagnostic accuracy study

Neurocysticercosis (NCC) is the main cause of epilepsy in Taenia solium endemic rural communities. NCC diagnosis is difficult due to unavailability and unaffordability of serologic assays and neuroimaging. This study aimed to assess the performance of a cheap, novel T.solium lateral-flow point-of-care (TS POC) test for the diagnosis of NCC in a community setting. A diagnostic accuracy study with prospective data collection, using a two-stage design was conducted in Sinda district of the Eastern province of Zambia between December 2017 and June 2019. Eligible participants were tested with the TS POC test. Thereafter, participants with a TS POC CC+ result and a subset of participants with a TS POC CC- result were subjected to serological testing for reference assays, and cerebral computed tomography (CT) for the reference diagnosis of NCC. A total of 1249 participants were tested with the TS POC of which 177 (14%) were positive. Of the 151TS POC CC+ and 82TS POC CC- participants with cerebral CT examination, 35TS POC CC+ and 10TS POC CC-, respectively, had NCC. The sensitivity of the TS POC CC strip was 26% (uncertainty interval [UI] 15-41) for any type of NCC, which was similar to that estimated for the rT24H-EITB (23%, UI 8-48) and the serum antigen ELISA (30%, UI 11-58). The specificity was 88% (UI 85-90) for the TS POC, 89% (UI 79-94) for the rT24H-EITB, and 82% (UI71-89) for the antigen ELISA. For NCC with active stage lesions, sensitivity was >99% (UI 58->99) for the TS POC, 76% (UI 40-94) for the rT24H-EITB and 76% (UI 39-94) for the antigen ELISA. The TS POC CC had a promising sensitivity for diagnosis of participants with active NCC lesions within a community-based setting. Accuracy for NCC at any stage was limited for all tests (TS POC, rT24H-EITB and antigen ELISA). With further development the TS POC CC may enable a better detection and faster referral of NCC patients who may benefit from antiparasitic treatment. European and Developing Countries Clinical Trials Partnership (EDCTP) and the German Federal Ministry of Education and Research (BMBF).