Search

Background: Sleep care is crucial for the health and development of infants, with proper sleep patterns reducing the risk of sudden infant death syndrome (SIDS) and other sleep-related incidents. Educational interventions targeting caregivers are essential in promoting safe sleep practices. Methods: This systematic review adhered to PRISMA guidelines, searching databases such as PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria focused on studies involving home-based interventions for infants aged 0–12 months, including parental education and behavioral interventions. Exclusion criteria included studies in clinical settings and non-peer-reviewed articles. Data extraction and synthesis were performed by two independent reviewers, using a narrative approach to categorize interventions and outcomes. Results: Twenty-three studies met the inclusion criteria. Key findings indicate that home-based educational interventions, including hospital-based programs, home visits, and mobile health technologies, significantly improve parental knowledge and adherence to safe sleep practices. These interventions also enhance parental satisfaction and contribute positively to infant health outcomes. Conclusions: Educational interventions have demonstrated effectiveness in promoting safe sleep practices among caregivers, particularly in home settings. These interventions, including hospital-based programs, home visits, and digital tools, improve parental knowledge, adherence to guidelines, and overall satisfaction. The impact is evident in the reduction of unsafe sleep behaviors and enhanced infant health outcomes. However, variability in the intervention methods and delivery, cultural contexts, and geographic focus suggest a need for more tailored, long-term, and comprehensive studies. Future research should standardize outcome measures and assess the sustained impact of these educational strategies on infant sleep patterns and caregiver practices over time. This will provide deeper insights into the trends and long-term effectiveness of educational patterns and methods in diverse home environments. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of multidisciplinary home-based interventions delivered by multidisciplinary teams to prevent adverse events (mortality, emergency visits, and hospital readmissions) and improve quality of life (QoL) among frail older adults. Methods: A systematic search of PubMed/MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature was conducted until November 2023. The Risk of bias of the randomized controlled trials was assessed via the Cochrane risk of bias tool (RoB 2.0), and the synthesis and quality of evidence for each outcome were assessed via the Grading of Recommendation, Assessment, Development and Evaluation (GRADE). The effect size (ES), pooled OR (p-OR), and 95 % confidence intervals (95 % CIs) were calculated for QoL and adverse events. Subgroup analyses and meta-regressions were conducted. Results: Twenty-seven studies were included in the systematic review. The p-OR for the effect of home-based interventions on mortality was 0.88 (95 % CI: 0.75 to 1.02; I2 = 27.6 %), that for visits to the emergency department was 0.88 (95 % CI: 0.78 to 1.00; I2 = 56.4 %), that for hospital admissions in days was 0.85 (95 % CI: 0.52 to 1.37; I2 = 85.2 %), and that for hospital admissions was 0.90 (95 % CI: 0.79 to 1.01; I2 = 52.0 %). In addition, the pooled ES for the effect of home-based interventions on QoL was 0.08 (95 % CI: 0.02 to 0.17; I2 = 60.7 %). The type of intervention, type of control, evaluation of the risk of bias, duration of the intervention, mean age of the intervention group, and percentage of women in the intervention group did not modify the effect of MHBIs to prevent adverse events or to improve quality of life (QoL) among frail older adults. Conclusions: Multidisciplinary home-based interventions do not appear to reduce adverse events (mortality, visits to the emergency department, or hospital admissions/readmissions) in older people defined and/or considered frail. In addition, these interventions do not improve QoL in older people, or the evidence is unclear.

Background: Sleep care is crucial for the health and development of infants, with proper sleep patterns reducing the risk of sudden infant death syndrome (SIDS) and other sleep-related incidents. Educational interventions targeting caregivers are essential in promoting safe sleep practices. Methods: This systematic review adhered to PRISMA guidelines, searching databases such as PubMed, MEDLINE, Scopus, and the Cochrane Library. Inclusion criteria focused on studies involving home-based interventions for infants aged 0–12 months, including parental education and behavioral interventions. Exclusion criteria included studies in clinical settings and non-peer-reviewed articles. Data extraction and synthesis were performed by two independent reviewers, using a narrative approach to categorize interventions and outcomes. Results: Twenty-three studies met the inclusion criteria. Key findings indicate that home-based educational interventions, including hospital-based programs, home visits, and mobile health technologies, significantly improve parental knowledge and adherence to safe sleep practices. These interventions also enhance parental satisfaction and contribute positively to infant health outcomes. Conclusions: Educational interventions have demonstrated effectiveness in promoting safe sleep practices among caregivers, particularly in home settings. These interventions, including hospital-based programs, home visits, and digital tools, improve parental knowledge, adherence to guidelines, and overall satisfaction. The impact is evident in the reduction of unsafe sleep behaviors and enhanced infant health outcomes. However, variability in the intervention methods and delivery, cultural contexts, and geographic focus suggest a need for more tailored, long-term, and comprehensive studies. Future research should standardize outcome measures and assess the sustained impact of these educational strategies on infant sleep patterns and caregiver practices over time. This will provide deeper insights into the trends and long-term effectiveness of educational patterns and methods in diverse home environments.

Cognitive difficulties are common in people with mental health issues, including psychotic disorders, although this population may have difficulty accessing treatments due to various challenges, including transportation, remembering appointments, or discomfort in crowded or unfamiliar places. Home-based services can be crucial and effective for reaching populations with accessibility issues; one home-based intervention technique is individual cognitive stimulation (iCS), which has been shown to be an effective strategy to target and improve cognitive functioning in various samples. Using a previously established Portuguese iCS protocol, based on an initial brief cognitive assessment and the subsequent administration of cognitive stimulation materials and reflection exercises, the current randomized controlled trial explored the effectiveness of the iCS intervention on participants in Portugal with psychotic disorders. Outcome tools included measures of cognition, depression, quality of life, and functional abilities at baseline, the completion of the intervention, and post-intervention follow-up. With two well-matched groups at baseline, the results revealed significant improvements in the intervention group on cognitive functioning, depression, quality of life, and, more modestly, functional activities. These results offer an important contribution to the field of iCS protocols, in an effort to enhance the lives and well-being of various clinical populations, including those with psychotic disorders. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of multidisciplinary home-based interventions delivered by multidisciplinary teams to prevent adverse events (mortality, emergency visits, and hospital readmissions) and improve quality of life (QoL) among frail older adults., Methods: A systematic search of PubMed/MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature was conducted until November 2023. The Risk of bias of the randomized controlled trials was assessed via the Cochrane risk of bias tool (RoB 2.0), and the synthesis and quality of evidence for each outcome were assessed via the Grading of Recommendation, Assessment, Development and Evaluation (GRADE). The effect size (ES), pooled OR (p-OR), and 95 % confidence intervals (95 % CIs) were calculated for QoL and adverse events. Subgroup analyses and meta-regressions were conducted., Results: Twenty-seven studies were included in the systematic review. The p-OR for the effect of home-based interventions on mortality was 0.88 (95 % CI: 0.75 to 1.02; I2 = 27.6 %), that for visits to the emergency department was 0.88 (95 % CI: 0.78 to 1.00; I2 = 56.4 %), that for hospital admissions in days was 0.85 (95 % CI: 0.52 to 1.37; I2 = 85.2 %), and that for hospital admissions was 0.90 (95 % CI: 0.79 to 1.01; I2 = 52.0 %). In addition, the pooled ES for the effect of home-based interventions on QoL was 0.08 (95 % CI: 0.02 to 0.17; I2 = 60.7 %). The type of intervention, type of control, evaluation of the risk of bias, duration of the intervention, mean age of the intervention group, and percentage of women in the intervention group did not modify the effect of MHBIs to prevent adverse events or to improve quality of life (QoL) among frail older adults., Conclusions: Multidisciplinary home-based interventions do not appear to reduce adverse events (mortality, visits to the emergency department, or hospital admissions/readmissions) in older people defined and/or considered frail. In addition, these interventions do not improve QoL in older people, or the evidence is unclear., Competing Interests: The authors of this manuscript declare no conflict of interest., (© 2024 The Authors.)

Background: Home-based training is an alternative option to provide intensive rehabilitation without costly supervised therapy. Though several studies support the effectiveness of home-based rehabilitation in improving hemiparetic upper limb function in stroke survivors, a collective evaluation of the evidence remains scarce. Objectives: This study aims to determine the effects of home-based upper limb rehabilitation for hemiparetic upper limb recovery in stroke survivors. Methods: The databases of the Cochrane Library, MEDLINE, CINAHL, and Web of Science were systematically searched from January 2000 to September 2020. Only randomized, controlled, and cross-over trials that evaluated the effects of home-based upper limb interventions were selected. The Pedro scale was used to assess the methodological quality of the studies. A meta-analysis of the upper limb function outcomes was performed by calculating the mean difference/standardized mean difference using a fixed/random effect model. Results: An initial search yielded 1,049 articles. Twenty-six articles were included in the review. The pooled evidence of the meta-analysis showed that home-based upper limb intervention was more effective in improving upper limb function [SMD: 0.28, 95% CI (0.12, 0.44), I² = 0%, p < 0.001, fixed effect model] than conventional therapy. When comparing two types of home-based interventions, subgroup analysis revealed that home-based technology treatment--electrical stimulation--provided more significant improvement in upper limb function than treatment without the use of technology (SMD: 0.64, 95% CI (0.21, 1.07), I² = 0%, p = 0.003, random effect model). Conclusion: The beneficial effects of home-based upper limb interventions were superior to conventional therapy in improving function and perceived use of the hemiparetic upper limb in daily activities. Among the home-based interventions, home-based electrical stimulation seemed to provide the most optimal benefits. [ABSTRACT FROM AUTHOR]

Occupational therapy-based interventions may help people with advanced cancer to live actively despite their illness. However, there is limited evidence concerning what kinds of content intervention should encompass, and how this should be done. To describe the development and content of an occupational therapy-based intervention programme for people with advanced cancer living at home. In the development of the intervention, an evidence synthesis was performed based on a systematic literature search, data from a cross-sectional study, and experiences from an expert panel. The programme contains six components: 1) An initial interview to select which of the other five components to address, based on the participants' individual needs. The interview addressed problems and needs of participants in relation to prioritized activities, in order to tailor the following components: 2) prioritisation of resources, energy and everyday activities; 3) adaptation of activities; 4) adaptation of posture and seating; 5) provision of assistive technology; and, 6) modification of the physical home environment. An occupational therapy-based intervention programme for people with advanced cancer living at home has been developed. The study generates knowledge and insights relevant to improving the treatment of this patient group. [ABSTRACT FROM AUTHOR]

Cognitive difficulties are common in people with mental health issues, including psychotic disorders, although this population may have difficulty accessing treatments due to various challenges, including transportation, remembering appointments, or discomfort in crowded or unfamiliar places. Home-based services can be crucial and effective for reaching populations with accessibility issues; one home-based intervention technique is individual cognitive stimulation (iCS), which has been shown to be an effective strategy to target and improve cognitive functioning in various samples. Using a previously established Portuguese iCS protocol, based on an initial brief cognitive assessment and the subsequent administration of cognitive stimulation materials and reflection exercises, the current randomized controlled trial explored the effectiveness of the iCS intervention on participants in Portugal with psychotic disorders. Outcome tools included measures of cognition, depression, quality of life, and functional abilities at baseline, the completion of the intervention, and post-intervention follow-up. With two well-matched groups at baseline, the results revealed significant improvements in the intervention group on cognitive functioning, depression, quality of life, and, more modestly, functional activities. These results offer an important contribution to the field of iCS protocols, in an effort to enhance the lives and well-being of various clinical populations, including those with psychotic disorders.

Emerging literature suggests that wearable devices offer a promising option for self-directed home-based upper limb training for persons with stroke. However, little research is available to explore integrating smartphone applications with wearable devices to provide upper limb telerehabilitation to stroke survivors at home. This study examined the feasibility and potential therapeutic effects of a wearable device integrated with a smartphone-based telerehabilitation system to provide upper limb rehabilitation to stroke survivors at home.Twelve stroke survivors from community support groups participated in a treatment consisting of 4-week telerehabilitation using a wearable device and 4-week conventional therapy successively in a single-blind, randomised crossover study. A 3-week washout period was administered between the two 4-week treatments. The primary outcome measures were the Fugl Meyer Assessment, the Action Research Arm Test, and the active range of motion (ROM) of the upper limb. Secondary outcome measures included the Motor Activity Log and exercise adherence.Results showed that the active ROM of participants’ hemiplegic shoulder improved more significantly after 4 weeks of telerehabilitation with the wearable device than with conventional therapy. No significant differences were found in other outcome measures.A 4-week telerehabilitation programme using a wearable device improves the hemiplegic upper limb in community-dwelling stroke survivors and may be feasible as an effective intervention for self-directed upper limb rehabilitation at home. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relative importance of different home support attributes from the perspective of carers of people with later-stage dementia. Method: Preferences from 100 carers, recruited through carers' organisations, were assessed with a Discrete Choice Experiment (DCE) survey, administered online and by paper questionnaire. Attributes were informed by an evidence synthesis and lay consultations. A conditional logit model was used to estimate preference weights for the attributes within a home support 'package'. Results: The most preferred attributes were 'respite care, available regularly to fit your needs' (coefficient 1.29, p = < 0.001) and 'home care provided regularly for as long as needed' (coefficient 0.93, p = < 0.001). Cost had a significant effect with lower cost packages preferred. Findings were similar regardless of the method of administration, with respite care considered to be the most important attribute for all carers. Carers reported that completing the DCE had been a positive experience; however, feedback was mixed overall. Conclusions: These carer preferences concur with emerging evidence on home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers' preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support. [ABSTRACT FROM AUTHOR]

Objectives:To examine people with dementia and carer preferences for home support attributes in early-stage dementia, building on the paucity of evidence in this area. Method:Preferences from 44 people with dementia and 103 carers, recruited through memory clinics and an online questionnaire, were assessed with a Discrete Choice Experiment survey, with attributes informed by an evidence synthesis and lay consultation. A conditional logit model was used to estimate preference weights for the attributes within a home support ‘package’. Results:The most preferred attributes were support with personal feelings and concerns, provided by a trained counsellor at home (coefficient 0.67,p= <0.001) and information on coping with dementia, provided by an experienced worker at home (coefficient 0.59,p= <0.001). However, for people with dementia, opportunities for social and recreational activities were considered the most important (coefficient 0.48,p= <0.001). Conclusions:These preferences concur with emerging evidence on psychosocial interventions in dementia. Support with personal feelings, information and social engagement are important components. Additionally, knowledge of preferences of people with dementia and their carers can identify other attributes that may be important to effectiveness in ‘living well’ but for which there remains limited evidence. [ABSTRACT FROM AUTHOR]

Objectives:The prevalence of asthma is highest in minority children living in urban areas. Pediatric asthma research has focused on self-management education and trigger remediation using a multi-trigger, multi-component educational intervention approach. The purpose of this systematic review was to identify common educational parameters of these proposed interventions. The review also sought to identify which clinical outcomes improved with multi-trigger, multi-component educational interventions.Data Sources:PubMed, SCOPUS and ProQuest Dissertations were searched between 2000 to 2014 using the following terms: asthma; urban population or poverty area; environmental remediation; health education; allergens or dust mites or cockroaches or mold or mice or rats.Study Selections:Studies were included if they met the following criteria: 1) participants were minority children identified as underserved; 2) there was a multi-trigger and multi-component intervention; 3) asthma severity was classified as persistent; and 4) asthma control was classified as not well controlled.Results:A total of 531 articles were retrieved of which 17 met the inclusion criteria. The interventions lacked consistency in their explanation. Most studies were vague in reporting pedagogical methods and educational content. Few studies reported a theoretical framework to guide their approach. Over half the studies did not report a learning assessment nor health literacy of the caregiver or the child with asthma. Yet all of the findings demonstrated statistically significant results in some or all of their primary outcomes.Conclusion:Overall, the research lacked clarity in the approach to impact asthma outcomes and reduces the opportunity to substantiate the findings through replication. [ABSTRACT FROM AUTHOR]

African American women report high rates of physical inactivity and related health disparities. In our previous formative research, we conducted a series of qualitative assessments to examine physical activity barriers and intervention preferences among African American women in the Deep South. These data were used to inform a 12-month Home-based, Individually-tailored Physical activity Print (HIPP) intervention, which is currently being evaluated against a wellness contact control condition among 84 post-menopausal African American women residing in the metropolitan area of Birmingham, Alabama. This paper reports the rationale, design and baseline findings of the HIPP trial. The accrued participants had an average age of 57 (SD = 4.7), a BMI of 32.1 kg/m 2 (SD = 5.16) with more than half (55%) having a college education and an annual household income under $50,000 (53.6%). At baseline, participants reported an average of 41.5 min/week (SD = 49.7) of moderate intensity physical activity, and 94.1% were in the contemplation or preparation stages of readiness for physical activity. While social support for exercise from friends and family was low, baseline levels of self-efficacy, cognitive and behavioral processes of change, decisional balance, outcome expectations, and enjoyment appeared promising. Baseline data indicated high rates of obesity and low levels of physical activity, providing strong evidence of need for intervention. Moreover, scores on psychosocial measures suggested that such efforts may be well received. This line of research in technology-based approaches for promoting physical activity in African American women in the Deep South has great potential to address health disparities and impact public health. [ABSTRACT FROM AUTHOR]

The article reviews practical experiences and theoretical reflections from the Dutch child and youth care sector on the provision of care for families with multiple problems. Emphasis is laid upon the complex relations between socioeconomic and psychosocial problems, and subsequent issues that may arise in arranging child and youth care. Furthermore, the current state of discussion in program development for the target group in the Netherlands is introduced. The originally English concept of families with multiple problems has been used only modestly in German-speaking countries. This is remarkable from an international perspective, especially considering the re-emerging prominence of social policies that define families as a site of social work practice in English-speaking countries. We conclude that the themes, as derived from our review open up possibilities for further international comparisons, and can provide valuable reference for the transnational discourse about child and youth care services for families with multiple problems. [ABSTRACT FROM AUTHOR]

Background: The use of wearable technology offers a promising home-based self-directed option for upper limb training. Although product usability is a crucial aspect of users' acceptance of a wearable device, usability studies in wearable devices are rare, with most studies focusing primarily on clinical validity., Objective: This study aimed to explore the usability of a wristwatch device called "Smart reminder" for home-based upper limb telerehabilitation for persons with stroke., Methods: Eleven stroke participants used the proposed wristwatch for at least two weeks and underwent a home-based telerehabilitation program. A mixed-methods design was used to explore the usability of the wristwatch. Quantitative data were collected through the System Usability Scale (SUS) questionnaire, and the participants' rate of therapy compliance (gathered from the device) was reported descriptively. In addition, qualitative data were collected through semi-structured interviews with the participants and were analyzed using thematic analysis., Results: The results demonstrated that the usability of the proposed wristwatch and telerehabilitation system was rated highly by the participants, with a high SUS mean score of 84.3 (12.3) and high therapy compliance rate (mean  =  91%). Qualitatively, all participants reported positive experiences with the wristwatch and indicated keenness to use it again. Participants reported physical improvements and felt motivated to exercise after using the wristwatch. They found the device easy and convenient and appreciated the remote monitoring function. Meanwhile, they highlighted critical considerations for the design of the device and program, including technical support, a wearable design of the device, graded exercise content according to ability, and flexibility in exercise schedules. Finally, they suggested that an interim review with the therapist on their progress might help them continue using the wristwatch., Conclusions: This study's results supported the proposed wearable device's usability and showed strong acceptance by the participants for using it as a home-based upper limb telerehabilitation intervention., Competing Interests: This research received the grant from Caspar Health Limited (No. ZDBD). I had full access to all of the data in this study and I take complete responsibility for the integrity of the data and the accuracy of the data analysis., (© The Author(s) 2023.)

Background: The rates of overweight and obesity are high among United States Veterans, necessitating the development of accessible weight reduction interventions. Purpose: This observational study evaluated the efficacy of a novel home-based telehealth weight loss intervention (TeleMOVE) for Veterans with obesity. Methods: We obtained weight measures of 171 patients before and after one and two 90-day cycles of TeleMOVE. Results: Enrollment in the first 90-day cycle of TeleMOVE was associated with significant weight loss (M = 8.62 lbs, SD = 9.85). Those who subsequently enrolled in the second, identical, cycle lost significantly more weight overall (M = 11.68 lbs, SD = 12.53) than those who only enrolled in the first cycle (M = 5.55 lbs, SD = 8.23). However, this difference was due to two-cycle participants losing significantly more weight during the first cycle alone (M = 10.52, SD = 10.32). Conclusions: TeleMOVE is a promising intervention, warranting a further investigation of its efficacy. [ABSTRACT FROM AUTHOR]

Background The success of adherence to combination antiretroviral therapy (cART) in sub-Saharan Africa is hampered by factors that are unique to this setting. Home based interventions have been identified as possible strategies for decentralizing ART care and improving access and adherence to cART. There is need for evidence at individual- or community-level of the benefits of home-based interventions in improving HIV suppression in African patients receiving cART. Methods We conducted a systematic review and meta-analysis of the literature to assess the effect of home-based interventions on virologic outcomes in adults receiving cART in Africa. Results A total of 260 publications were identified by the search strategy, 249 were excluded on initial screening and 11 on full review, leaving 5 publications for analysis. The overall OR of virologic suppression at 12 months after starting cART of home-based interventions to standard of care was 1.13 (95% CI: 0.51-2.52). Conclusions There was insufficient data to know whether there is a difference in HIV suppression at 12 months in the home-based arm compared with the standard of care arm in adults receiving cART in Africa. Given the few trials conducted from Africa, there is need for further research that measures the effects of home-based models on HIV suppression in African populations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To develop a home-based intervention for parents of 2–5year old children to promote household routines to prevent overweight/obesity. Methods: We recruited 121 children from health centers in Boston between 2011 and 2012 and randomized 62 to intervention and 59 to the control condition. The 6-month intervention included 1) motivational coaching at home and by phone with a health educator, 2) mailed educational materials, and 3) weekly text messages. The intervention promoted three household routines: eating meals as a family, obtaining adequate sleep, and limiting screen time. Results: Of the 121 children, mean (SD) age was 4.0 (1.1) years; 52% were Hispanic, 34% Black, and 14% White/Other. Nearly 60% of the sample had annual household incomes≤$20,000. Approximately 64% of families reported eating together≥7 times per week, however, many meals were eaten in front of a TV. Over half of the children slept less than the recommended 11h/night and 78% viewed≥2h/day of screen time. Conclusions: Household routines that increase obesity risk were prevalent among low-income families in this study. If proven to be effective, promotion of household routines related to family meals, sleep, and screen time may prevent young children from becoming overweight/obese. Clinical Trials Registration Number: NCT01565161. [Copyright &y& Elsevier]

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In recent years, there has been much discussion of the efficacy of mental health interventions for children as well as the transportation of empirically-supported treatments (ESTs) to field settings. A logical initial step in this line of research is to examine whether the efficacy of ESTs can be demonstrated in community settings such as in the home environment. The purpose of the study was to examine the efficacy of an in-home Parent-Child Interaction Therapy (PCIT) program using a single-subject, A/B design across five subjects with staggered baselines. Decreases in caregiver use of negative behavior and caregiver-reported child behavior problems were observed for the three families that completed treatment. In addition, completers demonstrated increases in child compliance, caregiver use of positive behavior, and contingent praise. Data regarding caregivers' reported parenting stress and caregiver proportion of direct commands were less convincing. All three dyads completing treatment reported satisfaction with the intervention. Clinical implications regarding the possible benefits of PCIT for improving the effectiveness of home visiting programs are discussed as well as directions for future research. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF), the most common chronic cardiac dysrhythmia, is an important cause of cardiovascular morbidity and mortality. However, there is a paucity of studies examining the potential benefits of optimizing the postdischarge management of patients with chronic AF Research objective: To examine the effects of a nurse-led, multidisciplinary, home-based intervention (HBI) on the pattern of recurrent hospitaltzation and mortality in patients with chronic AF in the presence and absence of chronic heart failure (HF). Patient cohort and methods: Health outcomes in a total of 152 hospitalized patients (53% male) with a mean age of 73.9 years and a diagnosis of chronic AF who were randomly allocated to either HBI (n = 68) or usual postdischarge care (UC: n = 84) were examined. Specifically, the pattern of unplanned hospitalization and all-cause mortality during 5-year follow-up were compared on the basis of the presence (n = 87) and absence (n = 65) of HF at baseline. Results'. Patients with concurrent HF exposed to HBI (n = 37) had fewer readmissions (2.9 vs 3.4/patient), days of associated hospital stay (22.7 vs 30.5: P= NS) and fatal events (51 % vs 66%) relative to UC (n = 50): P= NS for all comparisons. In the absence of HF, morbidity and mortality rates were significantly lower but still substantial during 5-year follow-up. In these patients, HBI was associated with a trend towards prolonged event-free survival (adjusted RR = 0.70; P= .12) and fewer fatal events (29% vs 53%, adjusted RR = 0.49; P= .08). HBI patients (n = 31) also had fewer readmissions (2.1 vs 2.6/patient) and days of associated hospital stay (16.3 vs 20.3/patient), although this did not reach statistical significance. On the basis of these data, it was calculated that a randomized study of an AF-specific HBI would require 250 patients followed for a median of 3 years to detect a 25% variation in recurrent hospital stay relative to UC. Conclusions: These unique data provide sufficient preliminary evidence to support the hypothesis that the benefits of HBI in relation to the management of HF may extend to "high risk" patients with chronic AF in whom morbidity and mortality rates are also unacceptably high. Further, appropriately powered studies are required to confirm these benefits. [ABSTRACT FROM AUTHOR]

Regular physical activity (PA) is of central importance for healthy aging and has a well-known impact on helping older adults maintain their cognitive and physical health. Thus, we aimed to compare the effectiveness of two physical activity interventions primarily conducted at home (print-based or web-based vs. web-based plus the use of an activity tracker) on cognitive and physical health parameters in older adults. Data of participants ( n = 551, 60-80 years) were analyzed after being randomly allocated to a waitlist control group (CG), a web-based or print-based intervention group (IG) or a web-based intervention group that also included the use of an activity tracker (AG). Measured parameters were grip strength, endurance (two-minute step test), gait speed (four-meter walk test), cognition (Simon task; balanced integration score (BIS), reaction time and accuracy) and physical self-concept (Physical Self-Description Questionnaire (PSDQ)). We found the highest effect sizes in all measured dimensions for AG (grip strength, endurance, gait speed, reaction time, physical self-concept), followed by IG (endurance, gait speed, reaction time, physical self-concept) and CG (endurance, gait speed, BIS). Findings suggest that a combined web-based and activity tracker intervention may improve physical functions, physical self-concept, and cognition in community-dwelling older adults.

Introduction: Pharmacological interventions to address behavioural and psychological symptoms of dementia (BPSD) can have undesirable side effects, therefore non-pharmacological approaches to managing symptoms may be preferable. Past studies show that music therapy can reduce BPSD, and other studies have explored how formal caregivers use music in their caring roles. However, no randomised study has examined the effects on BPSD of music interventions delivered by informal caregivers (CGs) in the home setting. Our project aims to address the need for improved informal care by training cohabiting family CGs to implement music interventions that target BPSD, and the quality of life (QoL) and well-being of people with dementia (PwD) and CGs., Methods and Analysis: A large international three-arm parallel-group randomised controlled trial will recruit a sample of 495 dyads from Australia, Germany, UK, Poland and Norway. Dyads will be randomised equally to standard care (SC), a home-based music programme plus SC, or a home-based reading programme plus SC for 12 weeks. The primary outcome is BPSD of PwD (measured using the Neuropsychiatric Inventory-Questionnaire). Secondary outcomes will examine relationship quality between CG and PwD, depression, resilience, competence, QoL for CG and QoL for PwD. Outcomes will be collected at baseline, at the end of the 12-week intervention and at 6 months post randomisation. Resource Utilisation in Dementia will be used to collect economic data across the life of the intervention and at 6-month follow-up. We hypothesise that the music programme plus SC will generate better results than SC alone (primary comparison) and the reading programme plus SC (secondary comparison)., Ethics and Dissemination: Ethical approval has been obtained for all countries. Results will be presented at national and international conferences and published in scientific journals and disseminated to consumer and caregiver representatives and the community., Trial Registration Numbers: ACTRN12618001799246p; NCT03907748., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)