Search Results (375)

Background and Objectives: Thirty-day hospital readmissions are a major clinical and economic challenge, particularly among frail older patients. Integrated protected discharge models, coordinated by nurse case managers and including multidimensional hospital-to-community interventions, may improve continuity of care and reduce inappropriate readmissions. Materials and Methods: We conducted a retrospective observational study on 200 consecutive patients aged ≥65 years, discharged between January and December 2024 from a public hospital in Italy. Frailty was assessed using BRASS scores (≥11), ADL, and IADL. The primary outcome was 30-day hospital readmission. Logistic regression models evaluated the impact of individual interventions (Model 1) and combined interventions (Model 2), defined as the simultaneous presence of four components: nurse case manager involvement, telephone follow-up, activation of home care (ADI) within 24 h, and social worker support. Results: Overall, 65 patients (32.5%) were readmitted within 30 days. In the multivariate analysis, nurse case manager involvement was associated with lower odds of readmission (OR = 0.023; 95% CI 0.008–0.064; p < 0.001). Early ADI activation was not associated with readmission in the bivariate analysis (p = 0.195) but showed higher odds of readmission in the multivariable model (OR = 3.475; 95% CI 1.384–8.725; p = 0.008). The combined interventions variable was significantly associated with readmission in Model 2. Patients who did not receive combined interventions had higher odds of 30-day hospital readmission compared with those who did (OR = 26.1; 95% CI 10.1–67.5; p < 0.001). Conclusions: An integrated protected discharge model coordinated by a nurse case manager and including combined interventions was associated with lower odds of 30-day hospital readmission among frail older patients. These findings suggest that the potential benefit of transitional care may lie not in isolated interventions but in the multidimensional integration and coordination of clinical, functional, and social support strategies, highlighting the central role of nurse case managers in transitional care pathways. Full article

Background/Objectives: Maintaining healthy blood pressure (BP) is essential in the frailty phenotype to prevent cardiovascular events. This study examined the effects of a 6-month educational program on BP in community-dwelling pre-frail or frail older adults. Methods: In this multicenter randomized controlled trial, 210 community-dwelling older adults (145 women; 74 ± 6 years) meeting at least one of Fried’s frailty criteria were assigned to a control group (usual care; n = 95) or an intervention group (educational program; n = 115). The 6-month intervention consisted of an educational program that provided recommendations on physical activity, nutrition, cognition, and psychosocial well-being, delivered through four group sessions and six telephone calls. Systolic BP and diastolic BP were measured at baseline and after 6 months, and categorized as normal, high-normal, or hypertensive (systolic: <130, 130–139, ≥140 mmHg; diastolic: <85, 85–89, ≥90 mmHg, respectively). Results: A significant reduction in systolic BP was observed within the intervention group (Z = −2.84, p < 0.01, r = 0.27), increasing the proportion of participants with normal systolic BP by 16% and reducing the proportion of participants with high-normal and hypertensive systolic BP by 8% each (χ² (3) = 9.21, p = 0.03). No significant changes were observed in the control group (p > 0.05), nor were there significant effects for diastolic BP in any study group (p > 0.05). Conclusions: These findings suggest that this educational program may be a feasible complementary non-pharmacological strategy to improve systolic BP, a key cardiovascular risk factor, in community-dwelling pre-frail and frail older adults. Full article

This study assessed perceptions of the food environment and its association with the availability of unprocessed, minimally processed, and ultra-processed foods in the households of Brazilian schoolchildren during the COVID-19 pandemic. A cross-sectional telephone survey (n = 475) was conducted between March, April and May 2021 with a representative sample of households with public school students from two Brazilian municipalities. Household food availability was assessed using a frequency questionnaire referring to the 30 days prior to the survey. Perception of the food environment was assessed using questions that measured perceived availability, price, and quality of fruits and vegetables (FV) and ultra-processed foods (UPF) sold in the neighbourhood. To analyse the association between perceived food environment and food availability, univariate and multivariate logistic regression analyses were performed, with 95% CI. The results indicate that high availability of unprocessed or minimally processed foods was found in 7.4% of households and high availability of UPF in 92.6%. Positive perception of UPF variety in the neighbourhood was more prevalent in households with greater availability of these foods (p < 0.05). After adjustment for sociodemographic characteristics, a positive perception of FV variety was associated with lower odds of high household UPF availability (OR = 0.54; 95%CI: 0.30–0.97). Perception of the food environment is an important factor associated with household UPF availability. Policy interventions should consider promoting healthier food environments by expanding the distribution of fresh foods alongside measures that ensure economic access to these foods. Full article

Background: Although physical activity (PA) offers substantial physical and psychosocial benefits, engagement remains suboptimal among cancer survivors. A theory-informed understanding of survivors’ perceived barriers, facilitators, and recommendations is needed to inform patient-centered PA about survivorship interventions. Objective: This study aimed to explore perceived barriers, facilitators, and recommendations for PA engagement among adult cancer survivors using the Theoretical Domains Framework (TDF). Methods: A phenomenological qualitative design was used. Eighteen cancer survivors from Nebraska participated in semi-structured interviews via Zoom or telephone. Semi-structured interviews (guided by open-ended questions with flexibility for probing) were transcribed verbatim, imported into MAXQDA 2024, and analyzed using TDF to identify themes and subthemes. Results: Three overarching themes emerged: barriers, facilitators, and recommendations related to PA engagement. Barriers included individual factors (low motivation and self-efficacy, limited awareness of PA guidelines, time constraints, and physical limitations due to treatment and comorbidities), social factors (limited support from family, friends), clinical factors (limited PA guidance from healthcare providers), and environmental factors (restricted access to resources and unfavorable weather). Facilitators included individual factors (PA knowledge, motivation, goals, and health benefits), social factors (support from family, friends), and clinical factors (encouragement from healthcare providers), and environmental factors (favorable weather and available community PA resources). Recommendations emphasized the need for tailored education, supportive counseling, and structured PA programs within survivorship care. Conclusions: Cancer survivors described multilevel determinants of PA engagement across individual, social, and environmental contexts. Findings highlight the importance of theory-informed, patient-centered strategies that enhance PA guideline awareness, strengthen social and clinical support, and improve access to community resources to promote sustained PA during cancer survivorship. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDP) increase the risk of cardiovascular disease (CVD), but few studies have explored the efficacy of lifestyle interventions to improve CVD risk post-HDP. This study compared the 6 month (6M) and 12 month (12M) dietary and physical activity outcomes of women post-HDP participating in one of three lifestyle interventions. Methods: This sub-study of the Blood Pressure Postpartum (BP²) randomised controlled trial included participants from six hospitals across Sydney, Australia, randomly assigned to one of three groups: Group 1 (usual care) received general postpartum health information; Group 2 (brief education) received usual care plus an individualised cardiovascular risk assessment and lifestyle counselling; Group 3 (extended lifestyle) received all Group 2 components plus enrolment in a six-month telephone coaching programme. Baseline and post-intervention data were collected at 6M and 12M, respectively. Diet and physical activity were assessed using the NSW Population Health Survey, alongside cardiometabolic measures. Results: Overall, 405 women provided complete 6M and 12M data (Group 1 n = 129, Group 2 n = 137, Group 3 n = 139). From 6M to 12M, Group 3 increased their vegetable serves/day (3.0 vs. 2.0, p = 0.001). No significant changes in fruit intake and physical activity levels were observed among groups. Groups 2 and 3 reported that nutritional information had a greater influence on their food choices at 12M (p = 0.010 and p < 0.001, respectively). At 12M, higher vegetable and fruit intake correlated with lower body mass index (BMI) (p = 0.006, p = 0.003) and waist circumference (p = 0.035, p = 0.014), and increased vigorous and strength exercise correlated with lower BMI (p = 0.005, p = 0.003) and waist circumference (p < 0.001, p < 0.001). Conclusions: Intensive lifestyle interventions improved vegetable intake and nutrition awareness in post-HDP women at 12M, holding promise for long-term cardiometabolic health benefits. Full article

Student engagement is a key predictor of academic achievement and retention in higher education. This study investigated the impact of personalised behavioural nudges, delivered through structured phone calls and supported by personalised email/Microsoft Teams messaging, on student engagement with a Learning Management System (LMS) and academic outcomes among 192 at-risk STEM undergraduates identified by initial low LMS activity. Students received up to five phone call nudges from an academic buddy, weekly, over an eight-week period, coupled with personalised email/MS Teams follow-ups, designed to provide informational and relational support. Results showed a significant improvement in LMS engagement (p < 0.01) among students who responded to at least one phone call nudge compared to non-responders. Although LMS engagement was not significantly associated with module outcomes within the sample, academic outcomes, measured by module results, improved for students who engaged with the nudges; improvements were statistically significant for those who responded to two, three, and five phone call nudges (p < 0.05) compared to non-responders, with the highest gains observed in the five (highest nr. nudges) response group. Content analysis of student feedback highlighted four themes: Valuing Supportive Journeying with an Academic Buddy, Improved Academic Engagement, Motivation Triggered by Intervention, and wider Challenges. Findings suggest that while an initial personalised telephone call can enhance student engagement with their studies, achieving measurable academic success requires sustained intervention. This study underscores the value of relationally grounded nudges in promoting success among at-risk students. Full article

Background: Conservative treatment of chronic musculoskeletal pain includes exercise, manual therapy, medications, physical agents/modalities, and Therapeutic Patient Education (TPE). Research on TPE has predominantly focused on spinal pain, so we do not know the extent and scope of clinical research in other areas, particularly lower extremities. This review aimed to map current research on this topic. Methods: We searched PubMed, PEDro, CINAHL, PsycINFO, and Cochrane Library up to 1 April 2024. We included RCTs on adults with chronic lower limb musculoskeletal pain, written in English, French, Spanish, or Italian. Results: Fifty-two records concerning knee osteoarthritis (n.33), hip and knee osteoarthritis (n.8), hip osteoarthritis (n.3), chronic knee pain (n.3), patellofemoral pain (n.3), and gluteal tendinopathy (n.2) were included. TPE was delivered through self-management, disease-specific information, pain education, and the management of physical activity, load, diet, stress, and sleep. Interventions were both individual- and group-based; delivery methods included in-person intervention, telephone/video calls, and web tools/apps. TPE combined with exercise seemed to be more effective than exercise alone, information/little education, or usual care. The effects of TPE as a stand-alone intervention appeared uncertain. Conclusions: There is considerable variability in TPE in terms of teaching topics, providers, administration methods, and dosage of interventions. Future studies should investigate the effects of TPE in young adult populations and in ankle conditions. They should also investigate the effects of TPE on pain intensity versus pain interference with activities, by deepening TPE effects on disability and quality of life. Full article

Objectives. To integrate clinical and economic evidence on the main non-pharmacological interventions aimed to reduce the burden of caregivers of people with dementia, with specific attention to stated preference measures (SPM), Willingness-to-Pay (WTP) and Willingness-to-Accept (WTA), alongside other cost-effectiveness indicators (ICER, QALY). Methods. A systematic review was conducted on randomized and quasi-experimental evaluations, economic models, and preference studies concerning psychoeducational/coping interventions, activity-centered/occupational programs (TAP), technological solutions and tele-support, and goal-oriented cognitive rehabilitation (CR). For each study, the following indexes were extracted: design, sample size, psychological outcomes (anxiety/depression, burden, engagement), utility per QALY, costs per perspective (the health–social and the broader societal perspectives), ICER, WTP/WTA, and sensitivity results. Results. Psychoeducational programs and CR show consistent benefits on distress, anxiety/depression, and caregiver quality of life; TAP reduces caregiver burden and patient behavioral problems, with favorable signs of cost–effectiveness; results on the effects of technologies are heterogeneous, but online modules with telephone support improve psychological morbidity. QALY improvement is generally modest, but the probability of cost-effectiveness remains high when costs do not differ significantly from treatment as usual, or when, from a societal perspective, the unpaid caregiving time of the caregiver is valued. Preference studies indicate positive WTP for additional hours of home care, health–social integration, and facilitated groups; evidence on WTA is scarcer and methodologically variable. Conclusions. Short, structured interventions with a human support component offer good value-for-money; the adoption of societal perspectives and the systematic use of WTP/WTA can better capture the value perceived by caregivers. Heterogeneity issues persist. Full article

Background/Objectives: Loneliness is a significant public health issue among older adults, especially in rural and socioeconomically vulnerable groups. Telephone-based interventions have become a scalable, cost-effective way to reduce social isolation, although evidence of their long-term effects on various health outcomes remains limited. This study aimed to assess how effective HELPeN, a structured telephone program delivered by trained nursing students, is in decreasing loneliness and enhancing psychosocial and cognitive health in community-living older adults. Methods: A randomized controlled trial was conducted with 119 older adults (≥65 years) residing in the community. Participants were allocated to either an intervention group (n = 65), which received weekly structured telephone calls over 9 months, or a control group (n = 54), which received standard care. Outcomes were evaluated at baseline (M0), mid-intervention (M1–M3), and 3 months after the intervention (M4). The primary outcomes measured included loneliness and perceived social support. Secondary outcomes comprised functional status, comorbidities, depressive symptoms, quality of life, sleep quality, and cognitive function. The data were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction. Results: Significant group interactions over time were identified for loneliness (F = 5.92, p = 0.001, η² = 0.067), social support (F = 3.39, p = 0.023, η² = 0.043), depressive symptoms (F = 3.87, p = 0.019, η² = 0.046), and cognitive status (F = 5.35, p = 0.002, η² = 0.063). No significant differences were found for functional status, comorbidity, sleep quality, or quality of life. Conclusions: The HELPeN program demonstrated significant effectiveness in reducing loneliness and social isolation, and in improving emotional, cognitive, and sleep-related outcomes in older adults. As a low-cost and scalable model, this intervention strengthens the role of nursing students in addressing social determinants of health and may be integrated into community and public health strategies targeting vulnerable aging populations. Full article

Designing and communicating physical activity guidelines takes considerable resources; thus, understanding the awareness and adoption of such guidelines by different population groups is important. A national cross-sectional survey (N = 972; aged 19+ years living in Wales) was delivered as part of a population panel using a multi-method approach (online, telephone and face-to-face). The survey measured the awareness and adoption of the 2019 UK physical activity guidelines and recommendations and socio-demographics, including age, sex, residential deprivation and disability status. Around a fifth (21.7%) of participants had heard of the physical activity guidelines. Almost a third (30.7%) reported knowing the moderate physical activity recommendation, with 13.3% knowing the vigorous physical activity recommendation and 13.4% knowing the muscle-strengthening recommendation. There were no significant socio-demographic differences in knowing the moderate recommendation (p > 0.05); however, females were less likely than males to report knowing the vigorous recommendation (p = 0.009), and participants with a disability were less likely than those without a disability to report knowing the muscle-strengthening recommendation (p = 0.026). Having heard of the physical activity guidelines increased the likelihood of knowing each of the three recommendations (all p < 0.001). Additionally, for both moderate-to-vigorous physical activity and muscle-strengthening recommendations, a positive relationship was found between knowing the recommendation and reporting meeting the recommendation (p = 0.008 and p = 0.002, respectively). The awareness of both the physical activity guidelines and their recommendations was low. The development of communication strategies to aid knowledge mobilisation should be considered. Socio-demographic differences in awareness should be considered when designing interventions in line with proportionate universalism principles. Full article

Background: Referrals to the Stroke prevention clinic with incomplete preliminary investigations decrease clinic capacity due to additional workload and the need for multiple follow-ups. We aimed to improve the efficacy of the initial visit by increasing the completion rate of vascular imaging in a quality improvement (QI) project. Methods: This is a quasi-experimental study with three phases: Phase 1: Surveillance; Phase 2: Stakeholder feedback-informed intervention development (physicians and clinic staff); and Phase 3: Intervention. Interventions included a new standardized specific physician triage form listing required investigations (brain imaging, vascular imaging, cardiac tracing), and a nurse-led pre-visit via telephone. The primary outcome measure was the completion of vascular imaging by the time of visit, assessed using multivariable logistic regression adjusted for age (in years), sex, and triage category. Results: The study’s inclusion criteria were met by 397 patients, with a mean age of 67.7 ± 13.2 years; 47.8% were female, and 62.9% (250) were diagnosed with vascular events. An increase in vascular imaging before the initial visit was observed in Phase 3 (148/199, 75.5%) compared to Phase 1 (121/198, 61.1%), with an adjusted Odds ratio of 1.77 (95% CI 1.2–2.8; p = 0.01). A trend toward fewer follow-up visits was observed in Phase 3 (23.1%) compared with Phase 1 (31.8%; p = 0.052). Conclusions: Implementing a standardized triage process and a nurse-led pre-visit may improve completion of vascular imaging before patients visit the stroke prevention clinic. Further QI studies are required to improve the completion rate of rhythm monitoring in this patient group to enable early detection and management of atrial fibrillation. Full article

Background/Objectives: Hispanic caregivers report higher levels of burden and poorer mental health compared to non-Hispanic caregivers. While problem-solving interventions have shown promise in improving stroke caregiver and patient well-being, they have not been specifically tailored or tested with Hispanic stroke caregivers. This study aimed to evaluate the effectiveness of a telephone- and online-based problem-solving intervention that was culturally adapted for Spanish-speaking Hispanics on caregiver burden. Methods: A two-arm parallel randomized clinical trial (NCT03142841) with repeated measures was conducted with 210 Hispanic caregivers of veterans who had experienced a stroke within the past year. Participants were recruited from three VA medical centers. The intervention consisted of 8-telephone sessions using online materials conducted by a trained interventionist. Participants in the standard group received usual VA resources they would have received as part of routine care such as stroke-related information. Chi-square tests and regression analyses were used to assess outcomes at 9 and 21 weeks. Results: Most participants were female (88%), college-educated (49%), and spouses or partners of a veteran (46%). Caregivers in the intervention group showed significantly greater reductions in caregiver burden (p = 0.011; p < 0.001) compared to the standard care group. Conclusions: Similarly to others reporting positive findings with non-Hispanic caregivers, these findings suggest that the problem-solving intervention can potentially alleviate Hispanic Spanish-speaking stroke caregivers’ burden by improving coping skills, problem-solving, and social support. Further research is needed to address gaps in effective interventions and promote equitable care for this population. Full article

Background: Commissioning of ‘joint care’ across teenage and young adult (TYA) principal treatment centres (PTC) and regional designated hospitals was introduced to enable cancer care closer to home, while providing support through the TYA multidisciplinary team. We aimed to explore the processes being used to enable inter-organisational collaboration under joint care models through rapid ethnography. Methods: Healthcare professionals in TYA PTCs in England and Wales between June 2022 and December 2023 were identified by the TYA lead in each PTC as delivering TYA cancer care. Semi-structured interviews were conducted virtually or by telephone based on the structuration model of collaboration proposed by D’Amour. Data were analysed against the model through framework analysis. Results: Our study highlighted variation across the different dimensions of inter-organisational collaboration. We found that healthcare professionals delivering TYA cancer care were working toward a shared goal but this was not always achieved. Social interaction between professionals was required to develop relationships and trust, but opportunities for social interaction were not regularly available. Processes for sharing information were not streamlined, so there were instances when information could not be shared between organisations. Interventions to achieve coordinated care, such as an outreach team, supported the delivery of joint care but these were not available in every region. While there were some levels of leadership within aspects of services, there were limited examples nationally or across geographical regions, which hindered the development of coordinated care. Conclusions: Coordination of care is mostly developing; however, the shared vision and goals dimension did achieve full active collaboration. The implementation of a service specification will address regional leadership requirements, but resources are required to extend the delivery of interventions to support coordination and collaboration, allowing the commissioned model of care to be delivered safely. Full article

Background: Antiretroviral adherence for incarcerated individuals living with HIV/AIDS in correctional service facilities remains a challenge. This study examined the experiences of professional nurses related to this issue in Limpopo Province, South Africa. Method: A qualitative, exploratory, descriptive, and contextual approach was employed in the Correctional Services Department facilities within the Vhembe District. The professional nurses were purportedly sampled. Data were collected through semi-structured telephone interviews and analysed thematically. Results: Three themes emerged: (1) professional nurses’ experiences with incarcerated individuals from foreign countries; (2) manipulative behaviours; and (3) misuse of antiretroviral therapy (ART) medication by incarcerated individuals. Conclusion: For public policy, the findings require the development of standardised guidelines for the management of foreign national incarcerated individuals and the implementation of anti-diversion strategies to prevent misuse of medications. For nursing practice, the results emphasise the importance of specialised training programmes that equip nurses to manage manipulative behaviours, enhanced supervision systems addressing moral distress, and structured adherence monitoring, including direct observed therapy for high-risk incarcerated individuals. These evidence-based interventions are essential to improve the outcomes of ART adherence, reduce treatment failure and drug resistance, and decrease HIV-related mortality in correctional settings while protecting general public health. Full article

There are limited empirically supported interventions that target three outcomes—behavior of children with ASD (instead of using adjectives such as “disruptive,” “interfering,” “problem,” or “challenging” behavior, we use “behavior” to avoid ableist language), parent stress, and parenting sense of competence. To help address this need, we tested a hybrid telehealth adaptation of COMPASS for Hope (C-HOPE), an 8-week parent-mediated program originally offered via face-to-face or synchronous telehealth delivery. The present study incorporated asynchronous group discussion board sessions hosted on a learning-management platform together with synchronous individual coaching sessions by telephone. Using a pre-post design, 10 caregivers completed the intervention. Effect sizes were calculated for three treatment outcomes of child behavior, parent stress, and parenting sense of competence. There was a statistically significant difference in the scores for child behavior, with a large effect size (d = 0.73) and a statistically significant difference in parent stress, with a medium effect size (d = 0.50). No difference was observed for parenting sense of competence. Treatment adherence and caregiver satisfaction for the intervention were acceptable. Findings support the feasibility and promise of combining asynchronous and synchronous telehealth elements to increase access to evidence-based parent-mediated interventions for ASD. Full article