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Objectives, Purposes, and Aims: Principles of behavioral economics are now being used across fields in changing human behavior toward perceived benefit. We studied the effectiveness of simple, cost-effective design cues based on these principles, in encouraging use of a neglected outdoor space in a hospital. Background: Benefits of access to nature and green spaces are established in healthcare; however, we found utilization of an outdoor space to be suboptimal. Presenting choices in different ways is known to influence user choice. Methods: We designed four design interventions based to nudge relative-caregivers waiting outside the operation theater toward utilizing an adjoining outdoor balcony. These included making the terrace prominent, reducing indoor sensory stimulation, adding stereotypical elements, and improving usability. We measured usage via video camera data and satisfaction using questionnaires. Results: The number of users and average time per person spent on the balcony increased over the consecutive intervention periods as compared to baseline (trend p <.01 for both), mainly driven by the addition of stereotypical elements. There were no adverse events in the balcony. There was no difference in the satisfaction related outcomes on questionnaire; a larger percentage of positive comments tended to be related to the balcony in the final intervention. Conclusions: Cost-effective design cues nudged patient-caregivers toward spending more time with nature, thus changing behavior toward that with perceived benefits. [ABSTRACT FROM AUTHOR]

Personalized medicine refers to using individual patient characteristics including phenotype and genotype, to tailor the therapeutic strategy. This approach seeks to challenge the "one-size-fits-all" method to patient management. In the bargain, it reduces adverse drug reactions, improves compliance, and reduces the economic burden of disease management. Traditionally, as extrapolated from usage in oncology, the term applied to using genomic, metabolomic, and epigenomic data in selecting medications; however, even simpler data such as clinical phenotype can aid therapeutic decision making. Autoimmune diseases provide many such data points, owing to the multi-organ nature of clinical manifestations as well as the availability of a wide variety of tests for antibodies as well as cytokines. Rheumatologists already use personalization intuitively, based on various factors such as organ involvement, comorbidities, fertility concerns, and costs. However, in a literature search, few studies look at tailoring treatment regimens to individual characteristics. Building coherent databases can help in better analysis of data and answering locally relevant questions in the future. [ABSTRACT FROM AUTHOR]

Background: Dietary vitamin B12 (B12) deficiency is common in Indians. Long-term compliance to tablet supplementation is poor in asymptomatic individuals. Objective: To study efficacy of B12 fortified nutrient bar and yogurt in improving plasma B12 concentrations in children and adults. Methods: Two double-blind, placebo-controlled directly observed therapy randomized controlled trials were conducted for 120 days: (1) Healthy children (10-13 years) were fed nutrient bar fortified with B12 (2 μg), multiple micronutrients B12 (1.8 μg) or placebo. (2) Healthy adults (18-50 years) were fed yogurt fortified with B12 (2 μg) or Propionibacterium (1 × 108 cfu/g) or placebo. B12, folate, homocysteine, and hemoglobin concentrations were measured before and post intervention. Results: We randomized 164 children and 118 adults; adherence was 96% and 82%, respectively. In children, B12 fortified bars increased B12 concentrations significantly above baseline (B12 alone +91 pmol/L, B12+ multiple micronutrients +82 pmol/L) compared to placebo. In adults, B12 fortified yogurt increased B12 significantly (+38 pmol/L) but Propionibacterium and placebo did not. In both trials, homocysteine fell significantly with B12 supplementation. Rise of B12 and fall of homocysteine were influenced by dose of B12 and folic acid. There was no significant difference in change of anthropometry and hemoglobin between groups. Conclusions: B12 fortified foods are effective in improving B12 status in Indian children and adults. They could be used to improve B12 status in the national programs for children, adolescents, and women of reproductive age. They could also be used as over-the-counter products. [ABSTRACT FROM AUTHOR]

Assistive devices (ADs) refer to external devices adapted to improve tasks and function. The common types of ADs include those improving mobility such as wheelchairs and walkers, positioning devices such as standing frames, custom-made devices (orthotics) such as fitted shoes and braces, and daily living devices. In inflammatory myositis, ADs are of utility in combating weakness, improving mobility, preventing and treating contractures, preventing falls, and assisting in daily chores. This narrative review looks at the evidence for the use of ADs in myositis and disorders with a similar pattern of muscle weakness (e.g., muscular dystrophy) subsequent to a literature search. A range of devices, from ankle orthoses to robotic exoskeletons, has been used in children with these diseases, and is part of the rehabilitation process. Evidence for their use in inflammatory myositis comes mainly from inclusion body myositis where progression is usual, and distal movement loss additionally affects functionality. In these patients, gait ADs and lower limb orthoses have been shown to be useful. Patient acceptability of these interventions is paramount in choosing the correct device and fit. An interaction of the treating rheumatologist with the physiatrist, the physical therapist, the occupational therapist, and the patient is paramount in ensuring compliance and benefit. [ABSTRACT FROM AUTHOR]