Long-term Maintenance Effects Research Articles

Telerehabilitation in Chronic Obstructive Pulmonary Disease (COPD) Management: Exploring Experiences and Effectiveness

Telerehabilitation has emerged as a promising approach to address the challenges posed by chronic obstructive pulmonary disease (COPD) management. This article provides a comprehensive review of telerehabilitation’s characteristics,components, efficacy, patient experiences, and the implications for COPD patients. Telerehabilitation involves the use of telecommunication technologies to remotely deliver rehabilitation services, including exercise training, education, and monitoring, to individuals with COPD. It addresses barriers such as geographical distance and limited access to specialized facilities, making rehabilitation accessible from home. Telerehabilitation encompasses various approaches, including telemonitoring, teleconsultation, and tele-education. Several studies have indicated positive outcomes in exercise capacity, dyspnea, and quality of life when comparing telerehabilitation interventions to standard care or traditional rehabilitation programs. However, challenges related to technology access, digital literacy, and privacy need to be addressed for equitable implementation. Interdisciplinary collaboration among healthcare professionals is essential for the successful delivery of telerehabilitation. Future research should focus on refining the interventions, standardizing the protocols, and evaluating the long-term maintenance effects. By integrating patient-centered approaches and leveraging advancements in digital technologies, telerehabilitation can revolutionize COPD management strategies, enhancing patient outcomes in the modern healthcare landscape.

Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis

BackgroundIn recent years, accelerated transcranial magnetic stimulation (aTMS) has been developed, which has a shortened treatment period. The aim of this study was to evaluate the efficacy and long-term maintenance effects of aTMS in patients with major depressive disorder (MDD).MethodsWe systematically searched online databases for aTMS studies in patients with MDD published before February 2023 and performed a meta-analysis on the extracted data.ResultsFour randomized controlled trials (RCTs) and 10 before-and-after controlled studies were included. The findings showed that depression scores significantly decreased following the intervention (SMD = 1.80, 95% CI (1.31, 2.30), p < 0.00001). There was no significant difference in antidepressant effectiveness between aTMS and standard TMS (SMD = -0.67, 95% CI (-1.62, 0.27), p = 0.16). Depression scores at follow-up were lower than those directly after the intervention based on the depression rating scale (SMD = 0.22, 95% CI (0.06, 0.37), p = 0.006), suggesting a potential long-term maintenance effect of aTMS. Subgroup meta-analysis results indicated that different modes of aTMS may have diverse long-term effects. At the end of treatment with the accelerated repetitive transcranial magnetic stimulation (arTMS) mode, depressive symptoms may continue to improve (SMD = 0.29, 95% CI (0.10, 0.49), I2 = 22%, p = 0.003), while the accelerated intermittent theta burst stimulation (aiTBS) mode only maintains posttreatment effects (SMD = 0.01, 95% CI (-0.45, 0.47), I2 = 66%, p = 0.98).ConclusionsCompared with standard TMS, aTMS can rapidly improve depressive symptoms, but there is no significant difference in efficacy. aTMS may also have long-term maintenance effects, but longer follow-up periods are needed to assess this possibility.Trial registrationThis article is original and not under simultaneous consideration for publication. The study was registered on PROSPERO (https://www.crd.york.ac.uk/prospero/) (number: CRD42023406590).

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

BackgroundTongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults.ObjectiveThe purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults.MethodsWe developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention.ResultsOf the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed.ConclusionsSwallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted.International Registered Report Identifier (IRRID)RR2-10.2196/19585

Ten-year Medicare budget impact of increased coverage for anti-obesity intervention

Aims: To estimate the long-term budget impact of expanding Medicare coverage of anti-obesity interventions among adults aged 65 and older in the US.Materials and methods: This study analyzed a representative sample of Medicare beneficiaries from the combined 2008–2016 National Health and Nutrition Examination Surveys. Population characteristics, cost and effectiveness of anti-obesity interventions, and the sustainability of weight loss in real-life were modeled to project the budgetary impact on gross Medicare outlay over 10 years. Hypothetical scenarios of 50% and 67% increases in intervention participation above base case were used to model moderate and extensive Medicare coverage expansion of intensive behavior therapy and pharmacotherapy.Results: For each Medicare beneficiary receiving anti-obesity treatment, we estimate Medicare savings of $6,842 and $7,155 over 10 years under moderate and extensive coverage utilization assumptions, respectively. The average cost of intervention is $1,798 and $1,886 per treated participant. Taking the entire Medicare population (treated and untreated) into consideration, the estimated 10-year budget savings per beneficiary are $308 and $339 under moderate and extensive assumptions, respectively. Sensitivity analysis of drug adherence rate and weight-loss efficacy indicated a potential variation of budget savings within 7% and 22% of the base case, respectively. Most of the projected cost savings come from lower utilization of ambulatory services and prescription drugs.Limitations: Due to the scarcity of studies on the efficacy of pharmacotherapy among older adults with obesity, the simulated weight loss and long-term maintenance effects were derived from clinical trial outcomes, in which older adults were mostly excluded from participation. The model did not include potential side-effects from anti-obesity medications and associated costs.Conclusions: This analysis suggests that expanding coverage of anti-obesity interventions to eligible individuals could generate $20–$23 billion budgetary savings to Medicare over 10 years.

Rice Dwarf Viruses with Dysfunctional Genomes Generated in Plants Are Filtered Out in Vector Insects: Implications for the Origin of the Virus

Rice dwarf virus (RDV), with 12 double-stranded RNA (dsRNA) genome segments (S1 to S12), replicates in and is transmitted by vector insects. The RDV-plant host-vector insect system allows us to examine the evolution, adaptation, and population genetics of a plant virus. We compared the effects of long-term maintenance of RDV on population structures in its two hosts. The maintenance of RDV in rice plants for several years resulted in gradual accumulation of nonsense mutations in S2 and S10, absence of expression of the encoded proteins, and complete loss of transmissibility. RDV maintained in cultured insect cells for 6 years retained an intact protein-encoding genome. Thus, the structural P2 protein encoded by S2 and the nonstructural Pns10 protein encoded by S10 of RDV are subject to different selective pressures in the two hosts, and mutations accumulating in the host plant are detrimental in vector insects. However, one round of propagation in insect cells or individuals purged the populations of RDV that had accumulated deleterious mutations in host plants, with exclusive survival of fully competent RDV. Our results suggest that during the course of evolution, an ancestral form of RDV, of insect virus origin, might have acquired the ability to replicate in a host plant, given its reproducible mutations in the host plant that abolish vector transmissibility and viability in nature.

Maintenance of effects of the CATCH physical education program: results from the CATCH-ON study.

Long-term maintenance effects of physical education (PE) curriculum and staff development programs have not been studied. The authors assessed the sustainability of the Child and Adolescent Trial for Cardiovascular Health (CATCH) PE intervention using direct observations of 1,904 PE lessons in former intervention and control schools in four U.S. states 5-years postintervention. Student physical activity levels, lesson contexts, and level of CATCH PE training of teachers were analyzed. Student energy expenditure levels and proportion of PE time in moderate-to-vigorous physical activity in intervention schools were maintained 5 years later, but vigorous activity declined sharply. Meanwhile, postintervention gains in former control schools, influenced by delayed program implementation and secular trends, resulted in a convergence of activity levels in intervention and control schools. Use of CATCH PE curricula was associated with increased levels of teacher training and school support for PE in both former intervention and control schools.

The effects of selenium on trichocyst quantity in the ciliate Pseudomicrothorax dubius. Clonal segregation of secretory phenotypes

Summary Variations in the quantity of secretory organelles (trichocysts) within clonal populations is investigated, with particular emphasis on the effects of long-term maintenance with or without 63 nM selenium (Se) in the growth medium. The principal results concern clones that produce many trichocysts when continuously grown with Se, and in which no cells are observed without trichocysts. When grown without Se, no cells produce trichocysts. When clones are grown for various durations of up to 4 years without Se, and again placed in growth medium with Se to allow trichocyst production, they show clonal segregation in the quantity of trichocysts produced: cells without trichocysts, or with few trichocysts, are observed among the cells with many trichocysts. Subcloning reveals that some of the cells without trichocysts are pure non-secreters, since they do not regain ejectable trichocysts even following growth with Se for 5 years, whereas cells with many trichocysts continue to be strong secreters if maintained with Se. To explain these observations, and to provide a working hypothesis for future study, a secretion factor (SF) is proposed to be implicated in processing of trichocyst precursors to final secretory products. Se is postulated to be necessary for SF gene expression and/or replication, which become irreversibly blocked during long-term Se deficiency.

Evaluation of a social interaction coaching program in an integrated day-care setting.

We used a multiple baseline design across teachers (with a reversal phase for 1 teacher) to evaluate the direct and indirect effects of a structured coaching procedure on the teaching behaviors of 3 day-care teachers. Structured coaching preceding daily caregiver routines resulted in (a) substantial increases in adult delivery of behavioral support of social interaction during group activities with 2- and 4-year-old children and (b) marked collateral increases in positive interactions of socially withdrawn children. Long-term maintenance effects were demonstrated by both the teachers and target children, and social validity measures indicated that the teachers rated coaching very positively on several dimensions. The results are discussed in relation to in-service training of day-care staff, the concept of coaching as a setting event, and the dissemination of teaching technology related to social interaction of young children.