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Background: The community mobility and engagement of older people is an important aspect of health and quality of life. Population studies and clinical trials are important for understanding ageing-related experiences, needs, and impacts of interventions. Passive collection of data through sensors could help to build the understanding of community lives, potentially without adding to participant burden or requiring an accurate recall. There are assumptions that technology-based data collection may not be feasible or acceptable for older people with cognitive impairment. Technology development and evaluation needs to engage with the direct perspectives of users with cognitive impairment to build an understanding of usability, acceptability, and ethical considerations. Objective: To explore the feasibility, user experiences, and processes needed to support the smartphone-based collection of older people with cognitive impairment. Method: An exploratory study, embedded within a longitudinal observational study, invited older adults to collect geolocation data for one week using smartphones and Bluetooth beacons. A process to support consent, transparency of data collection, and accessibility eredeveloped. Experiences and reflections on data collection were gathered via audio-recorded semi-structured interviews and field notes. Inductive content analysis was conducted. Results: Eighteen older adults (15 with mild cognitive impairment, 3 with probable dementia; age M=86.7 years; 8 men) collected geolocation data. Most completed a week of data collection and considered it a positive experience. On average 161.5 hours (SD 31.7) of geolocation data were collected over a week. Reported user experiences included technical issues, consent and concerns, acceptability, and accessibility. Some support and reassurance were required, along with time to gain familiarity. Participants reportedly enjoyed engaging with their collected lifespace data. Conclusion: Older adults with cognitive impairment were able to collect geolocation data following an accessible and ethical process. Future work may increase usability and engagement between participants and their data to build insights. [ABSTRACT FROM AUTHOR]

Introduction: Mobile smoking cessation (mCessation) apps have the potential to complement and enhance existing interventions, but many are of low quality. Exploring app reviews can provide a broader understanding of user experiences and engagement, to enhance the quality, acceptability, and effectiveness of future developments.Methods: Publicly available user reviews and ratings of smoking cessation apps were mined from Google Play and the App Store via a targeted two-stage search strategy. English language smoking cessation apps with at least 20 consumer reviews between 2011 and 2020 were included. User reviews were thematically analyzed using Braun and Clarke's framework. Apps were independently scored using the Mobile Apps Rating Scale (MARS) and compared to average user star ratings.Results: Forty-eight versions of 42 apps, encompassing 1414 associated reviews, met eligibility criteria. Inductive coding of reviews produced 1084 coding references including reviews coded across multiple nodes. Themes generated included: (1) supportive characteristics/tools; (2) useability; (3) influence on smoking behavior; (4) benefits of quitting; and (5) role as a supplementary tool for quitting. The mean MARS score of 36 free and accessible apps was 3.10 (SD 0.71) with mean scores ranging from 2.00 to 4.47. An inverse relationship between MARS scores and average user star ratings was observed.Conclusions: App personalization, relationality, functionality, and credibility were important to users, and should be considered as key design components for future apps. Differences between user star ratings and MARS scores may illustrate competing priorities of consumers and researchers, and the importance of a codesign development method.Implications: This is the first study to use unsolicited user reviews from a large population to understand the general mCessation user experience in relation to making a quit attempt. Our findings highlight specific features favored and disliked by users, including their influence on engagement, and supports previous findings that mCessation applications need to be highly tailorable, functional, credible, and supportive. We recommend a consumer-driven, co-design approach for future mCessation app developments to optimize user acceptability and engagement. [ABSTRACT FROM AUTHOR]

Objective: Lifespace, the physical area in which someone conducts life activities, indicates lived community mobility. This study explored the feasibility of technology‐based lifespace measurement for older people with dementia and mild cognitive impairment (MCI), including the generation of a range of lifespace metrics, and investigation of relationships with health and mobility status. Methods: An exploratory study was conducted within a longitudinal observational study. Eighteen older adults (mean age 86.7 years (SD: 3.2); 8 men; 15 MCI), participated. Lifespace metrics were generated from geolocation data (GPS and Bluetooth beacon) collected through a smartphone application for one week (2015–2016). Cognitive and mobility‐related outcomes were compared from study data sets at baseline (2005–2007) and 6‐year follow‐up (2011–2014). Results: Lifespace data could be collected from all participants, and metrics were generated including percentage of time at home, maximum distance from home, episodes of travel in a week, days in a week participants left home, lifespace area (daily, weekly and total), indoor lifespace (regions in the home/hour), and a developed lifespace score that combined time, frequency of travel, distance and area. Results indicated a large range of lifespace areas (0.1 – 97.88 km2; median 6.77 km2) with similar patterns across lifespace metrics. Significant relationships were found between lifespace metrics and concurrent driving status and anteceding scores on the sit‐to‐stand test (at baseline and follow‐up). Conclusions: Further longitudinal exploration of lifespace is required to develop an understanding of the nature of lifespace of older community‐dwelling people, and its relationship with health, mobility and well‐being outcomes. [ABSTRACT FROM AUTHOR]

Objective: To support informed decision-making about reanalysis of clinical genomic data for risk of preventable conditions ('additional findings') by developing a chatbot (electronic genetic resource, 'eDNA').Methods: Interactions in pre-test genetic counseling sessions (13.5 h) about additional findings were characterized using proponent, thematic and semantic analyses of transcripts. We then wrote interfaces to draw supplementary data from external genetics applications. To create Edna, this content was programmed using a chatbot framework which interacts with patients via speech-to-text.Results: Conditions, terms, explanations of concepts, and key factors to consider in decision making were all encoded into chatbot conversations emulating counseling session flows. Patient agency can be enhanced by prompted consideration of the personal and familial implications of testing. Similarly, health literacy can be broadened through explanation of genetic conditions and terminology. Novel aspects include sentiment analysis and collection of family history. Medical advice and the impact of existing genetic conditions were deemed inappropriate for inclusion.Conclusion: Edna's successful development represents a movement towards accessible, acceptable and well-supported digital health processes for patients to make informed decisions for additional findings.Practice Implications: Edna complements genetic counseling by collecting and providing genomic information before or after pre-test consultations. [ABSTRACT FROM AUTHOR]

Objective: Neuroimaging research has revealed that structural brain alterations are common across broad diagnostic families of disorders rather than specific to a single psychiatric disorder. Such overlap in the structural brain correlates of mental disorders mirrors already well-documented phenotypic comorbidity of psychiatric symptoms and diagnoses, which can be indexed by a general psychopathology or p factor. The authors hypothesized that if general psychopathology drives the convergence of structural alterations common across disorders, then 1) there should be few associations unique to any one diagnostic family of disorders, and 2) associations with the p factor should overlap with those for the broader diagnostic families.Methods: Analyses were conducted on structural MRI and psychopathology data collected from 861 members of the population-representative Dunedin Multidisciplinary Health and Development Study at age 45.Results: Study members with high scores across three broad diagnostic families of disorders (externalizing, internalizing, thought disorder) exhibited highly overlapping patterns of reduced global and widely distributed parcel-wise neocortical thickness. Study members with high p factor scores exhibited patterns of reduced global and parcel-wise neocortical thickness nearly identical to those associated with the three broad diagnostic families.Conclusions: A pattern of pervasively reduced neocortical thickness appears to be common across all forms of mental disorders and may represent a transdiagnostic feature of general psychopathology. As has been documented with regard to symptoms and diagnoses, the underlying brain structural correlates of mental disorders may not exhibit specificity, and the continued pursuit of such specific correlates may limit progress toward more effective strategies for etiological understanding, prevention, and intervention. [ABSTRACT FROM AUTHOR]

Importance: Childhood lead exposure has been linked to disrupted brain development, but long-term consequences for structural brain integrity are unknown.Objective: To test the hypothesis that childhood lead exposure is associated with magnetic resonance imaging (MRI) measurements of lower structural integrity of the brain in midlife.Design, Setting, and Participants: The Dunedin Study followed a population-representative 1972-1973 birth cohort in New Zealand (N = 564 analytic sample) to age 45 years (until April 2019).Exposures: Childhood blood lead levels measured at age 11 years.Main Outcomes and Measures: Structural brain integrity at age 45 years assessed via MRI (primary outcomes): gray matter (cortical thickness, surface area, hippocampal volume), white matter (white matter hyperintensities, fractional anisotropy [theoretical range, 0 {diffusion is perfectly isotropic} to 100 {diffusion is perfectly anisotropic}]), and the Brain Age Gap Estimation (BrainAGE), a composite index of the gap between chronological age and a machine learning algorithm-estimated brain age (0 indicates a brain age equivalent to chronological age; positive and negative values represent an older and younger brain age, respectively). Cognitive function at age 45 years was assessed objectively via the Wechsler Adult Intelligence Scale IV (IQ range, 40-160, standardized to a mean of 100 [SD, 15]) and subjectively via informant and self-reports (z-score units; scale mean, 0 [SD, 1]).Results: Of 1037 original participants, 997 were alive at age 45 years, of whom 564 (57%) had received lead testing at age 11 years (302 [54%] male) (median follow-up, 34 [interquartile range, 33.7-34.7] years). Mean blood lead level at age 11 years was 10.99 (SD, 4.63) μg/dL. After adjusting for covariates, each 5-μg/dL higher childhood blood lead level was significantly associated with 1.19-cm2 smaller cortical surface area (95% CI, -2.35 to -0.02 cm2; P = .05), 0.10-cm3 smaller hippocampal volume (95% CI, -0.17 to -0.03 cm3; P = .006), lower global fractional anisotropy (b = -0.12; 95% CI, -0.24 to -0.01; P = .04), and a BrainAGE index 0.77 years older (95% CI, 0.02-1.51 years; P = .05) at age 45 years. There were no statistically significant associations between blood lead level and log-transformed white matter hyperintensity volume (b = 0.05 log mm3; 95% CI, -0.02 to 0.13 log mm3; P = .17) or mean cortical thickness (b = -0.004 mm; 95% CI, -0.012 to 0.004 mm; P = .39). Each 5-μg/dL higher childhood blood lead level was significantly associated with a 2.07-point lower IQ score at age 45 years (95% CI, -3.39 to -0.74; P = .002) and a 0.12-point higher score on informant-rated cognitive problems (95% CI, 0.01-0.23; P = .03). There was no statistically significant association between childhood blood lead levels and self-reported cognitive problems (b = -0.02 points; 95% CI, -0.10 to 0.07; P = .68).Conclusions and Relevance: In this longitudinal cohort study with a median 34-year follow-up, higher childhood blood lead level was associated with differences in some MRI measures of brain structure that suggested lower structural brain integrity in midlife. Because of the large number of statistical comparisons, some findings may represent type I error. [ABSTRACT FROM AUTHOR]

OBJECTIVE. This study examined the parallel-forms reliability of a web application (app) of the Activity Card Sort Australia for adults ages 18--64 and assessed its clinical utility. METHOD. Forty-eight participants completed the app and card versions of the tool within a 2- to 3-wk interval and provided feedback via a purpose-designed survey. Intraclass correlation analysis tested parallelforms reliability. RESULTS. The app demonstrated acceptable parallel-forms reliability for overall retained activity level (r5 .75, p < .001), the daily life domain (r 5 .77, p < .001), and the recreation and relaxation domain (r 5 .74, p < .001), but not for the physical activity domain (r 5 .59, p < .001). Clinical utility responses suggested good acceptance of both versions. CONCLUSION. The results suggest that further studies are required before the app version can be used for research or in clinical settings. [ABSTRACT FROM AUTHOR]