A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. OBJECTIVE: The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. METHODS: This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. RESULTS: Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (ß=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (ß=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (ß=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (ß=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (ß=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (ß=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. CONCLUSIONS: This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.

The Impact of Assisted Living Organizational Structure and Process Characteristics on Staff Absence During COVID-19.

Quality of care in assisted living communities (ALCs) is important to consumers. The coronavirus disease of 2019 (COVID-19) pandemic and associated emergency policies have posed major challenges on staff recruitment and retention. This study aimed to examine the relationship between organizational characteristics of ALCs in Florida and challenges with staff absence during COVID-19 (N = 129 ALCs). Results indicated that structures (provision of memory care services), processes of care (challenges hiring new staff, staff sent home to comply with precautions, and staff anxiety), and local COVID-19 positivity rate were significantly associated with staff absence due to fear of infection, sickness, or family responsibilities. ALC providers and state regulatory agencies should develop policies and procedures that take these issues into consideration to prepare for future emergencies and disasters. Infection control policies should reflect whether an ALC provides memory care services and inform ways to overcome potential challenges with protocols. Efforts to reduce staff anxiety and disaster-related concerns should also be considered to ensure quality of care during emergencies.

ALCs who provided memory care services had significantly greater challenges with staff absence due to fear of infection during the COVID-19 pandemic.The administrative action of sending staff home to comply with COVID-19 precautions, difficulty hiring new staff, and staff anxiety were process characteristics of ALCs associated with greater challenges with staff absence.Policymakers should consider whether an ALC provides memory care services, faces potential challenges with infection control protocols, and addresses the mental health of staff when creating and implementing infection control policies.

Feasibility of the Palliative Care Education in Assisted Living Intervention for Dementia Care Providers: A Cluster Randomized Trial.

BACKGROUND AND OBJECTIVES: Alzheimer's disease and related dementia (ADRD) is a major cause of death in the United States. While effective interventions have been developed to deliver palliative care to nursing home residents with ADRD, little work has identified effective interventions to reach assisted living (AL) residents with dementia. RESEARCH DESIGN AND METHODS: One hundred and eighteen AL residents with dementia from 10 different ALs in Florida participated. A pilot study using a cluster randomized trial was conducted, with 6 sites randomized to receive a palliative care educational intervention for staff (N = 23) to deliver care to residents; 4 sites were usual care. The feasibility of the intervention was assessed by examining recruitment, retention, and treatment fidelity at 6 months. Cohen's d statistic was used to calculate facility-level treatment effect sizes on key outcomes (documentation of advance care planning [ACP] discussions, hospice admission, and documentation of pain screening). RESULTS: The intervention proved feasible with high ratings of treatment fidelity. The intervention also demonstrated preliminary evidence for efficacy of the intervention, with effect sizes for the treatment group over 0.80 for increases in documentation of ACP discussions compared to the control group. Hospice admissions had a smaller effect size (0.16) and documentation of pain screenings had no effect. DISCUSSION AND IMPLICATIONS: The pilot results suggest that the intervention shows promise as a resource for educating and empowering AL staff on implementing person-centered palliative care delivery to persons with dementia in AL. A larger, fully powered randomized trial is needed to test for its efficacy.

Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Longitudinal Analysis.

OBJECTIVES: The objective of this study was to examine associations between music engagement and episodic memory for more than 12 years in a nationally representative sample of middle- and older-aged adults in the United States. METHODS: This study is based on a secondary analysis of data from a sample (N = 5,021) of cognitively normal adults from the Health and Retirement Study (2006-2018). Episodic memory was measured by immediate and delayed recall tasks. Music engagement was classified as none, passive (i.e., listening to music), active (i.e., singing and/or playing an instrument), or both (i.e., listening to music and singing or playing an instrument). RESULTS: Compared with those with no music engagement, respondents who reported both passive and active engagement performed 0.258 points better at baseline on episodic memory tasks. This group also performed better across time with scores that declined by 0.043 points fewer per study visit. Additionally, compared to those with no music engagement, participants with passive music engagement had scores that declined by 0.023 points fewer per visit. There were no significant differences in performance at baseline for those with passive or active music engagement, or across time for those with active engagement. DISCUSSION: The results of this study suggest that engaging in both passive and active music engagement may be superior to engaging with music only passively or actively and that engaging in music both ways may be able to protect against age-related declines in episodic memory. Future research should examine whether community-based music engagement interventions can affect this trajectory of decline.

Risk Factors for Vision Loss among Nursing Home Residents: A Cross-Sectional Analysis.

OBJECTIVE: Approximately 2% of older adults currently live in nursing homes. It is important that the risks for vision loss be characterized to ensure appropriate vision care is provided for nursing home patients. Our objective was to evaluate the association of age-related eye diseases (AREDs) and multimorbidities with vision loss. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: This is a cross-sectional analysis of comprehensive eye examination records for 7753 residents of 74 North Carolina nursing homes who were ≥65 years of age at time of the initial patient visit. METHODS: Complete data on vision and associated factors were included from the standardized Centers for Medicare and Medicaid Services eye examination. We defined vision impairment and blindness respectively as best-corrected visual acuity between 20/40 and 20/200, and 20/200 or worse. Clinical diagnoses of AREDs were defined by the attending clinician. Data were extracted from electronic health records, and all analyses were conducted in SAS v 9.4. We used descriptive statistics to summarize the resident characteristics and AREDs and logistic regression analysis to examine independent risk factors for vision impairment. RESULTS: A total of 7753 initial eye examination records with complete data were included in the analysis. Overall, 34% of the residents had normal vision, 43% had vision impairment, and 23% were blind. Among participants with various AREDs, the prevalence of vision impaired/blind ranged from 63% to 76%, while blindness ranged from 23% to 53%. We found correction of refractive error alone served to reduce vision impairment or blindness. CONCLUSIONS AND IMPLICATIONS: Comprehensive eye examinations showed vision impairment and blindness affected 66% of nursing home residents, overall. This study substantiates the positive impact of comprehensive eye examinations to promote visual, systemic, and cognitive health and well-being and the need that eye care service be used to inform policy and practice to improve patient functioning and independence.

Effects of music interventions on sleep in people with dementia: A systematic review.

Poor sleep health is a risk factor for and a common symptom of dementia. Music has been shown to improve sleep across a wide range of clinical and community populations. However, it is unclear whether and to what extent music interventions may also help alleviate sleep problems in people with dementia. This systematic review is the first review examining the effects of music on sleep outcomes among people with dementia. In accordance with PRISMA guidelines, we extracted 187 articles from nine databases (Academic Search Premier, Ageline, APA PsycArticles, PsycINFO, CINAHL, Embase, PubMed, Scopus, and Web of Science). Eight studies were eligible for this systematic review (Range sample sizes: 1-59 people with dementia). Results revealed that assessments of sleep in the current literature were limited and mainly focused on sleep duration, subjective sleep quality, or nighttime sleep disturbances. Intervention delivery, music selection, and findings varied. Positive effects of music on sleep outcomes were observed in six out of the eight studies (75%), specifically there were decreases in nighttime sleep disturbances, increases in daytime alertness, and improvements in sleep quality. The remaining two studies found no statistically significant change in sleep outcomes (i.e., daytime sleepiness and quality). Study limitations included small sample sizes and the use of proxy reporters (e.g., caregiver, researcher, blinded clinician) which may reduce the accuracy of the sleep measures. Future research may want to incorporate objectively measured sleep to better understand the role of sleep in dementia care. More research is needed to determine whether music interventions are effective in improving sleep in people with dementia and whether improvements in sleep can slow the progression of dementia.

Perceived and unmet needs for health and social services among families coping with dementia in China: A descriptive study.

OBJECTIVES: To describe the perceived and unmet needs for health and social services and their relative importance among families coping with dementia in urban China. METHODS: We used data from a cross-sectional survey conducted between 2018 and 2019 in two cities in eastern China. Trained staff conducted structured interviews of family caregivers of people living with dementia at home to obtain individual characteristics as well as types of service needs of families coping with dementia. Service needs and utilization in 24 types of services across five domains (daily living, medical/nursing, rehabilitation, mental health, and other) were examined. Descriptive statistics were used to describe characteristics of the dyads and the ranking of services based on the percentage of respondents with perceived/unmet needs. RESULTS: A total of 170 (87.6%) family caregivers completed the interviews. The mean age of the care recipient was 77.2 years (range: 60-102) and 65.3% were female. The mean age of family caregivers was 58.4 years (range: 28-90), and 57.1% were female. The top five services used by the care recipients were: primary care, medication management, housekeeping, activities of daily living assistance, and adult day service. The five services with the most unmet needs were: legal assistance (42.7%), hospice care (44.7%), respiratory secretion management (expectoration) (57.6%), life enrichment activities (65.4%), and companion care (67.0%). Except for transportation and dressing/grooming, working and nonworking caregivers reported similar relative importance of service needs. CONCLUSIONS: The findings suggest that people living with dementia and their family require a wide range of services and supports to live in the community. Future research and policy efforts should target the unmet needs of families to improve dementia care in the community and promote aging-in-place.

Translational Genomic Research: The Association between Genetic Profiles and Cognitive Functioning or Cardiac Function Among Breast Cancer Survivors Completing Chemotherapy.

Introduction: Emerging evidence suggests that Chemotherapy (CT) treated breast cancer survivors (BCS) who have "risk variants" in genes may be more susceptible to cognitive impairment (CI) and/or poor cardiac phenotypes. The objective of this preliminary study was to examine whether there is a relationship between genetic variants and objective/subjective cognitive or cardiac phenotypes. Methods and Analysis: BCS were recruited from Moffitt Cancer Center, Morsani College of Medicine, AdventHealth Tampa and Sarasota Memorial Hospital. Genomic DNA were collected at baseline for genotyping analysis. A total of 16 single nucleotide polymorphisms (SNPs) from 14 genes involved in cognitive or cardiac function were evaluated. Three genetic models (additive, dominant, and recessive) were used to test correlation coefficients between genetic variants and objective/subjective measures of cognitive functioning and cardiac outcomes (heart rate, diastolic blood pressure, systolic blood pressure, respiration rate, and oxygen saturation). Results: BCS (207 participants) with a mean age of 56 enrolled in this study. The majority were non-Hispanic white (73.7%), married (63.1%), and received both CT and radiation treatment (77.3%). Three SNPs in genes related to cognitive functioning (rs429358 in APOE, rs1800497 in ANKK1, rs10119 in TOMM40) emerged with the most consistent significant relationship with cognitive outcomes. Among five candidate SNPs related to cardiac functioning, rs8055236 in CDH13 and rs1801133 in MTHER emerged with potential significant relationships with cardiac phenotype. Conclusions: These preliminary results provide initial targets to further examine whether BCS with specific genetic profiles may preferentially benefit from interventions designed to improve cognitive and cardiac functioning following CT.

Feasibility and Acceptability of a Group Music Intervention in Memory Care Communities.

Music-based interventions have been shown to reduce behavioral expressions among persons with dementia. The goal of this study was to examine the feasibility and acceptability of a group music intervention to reduce agitation. Two memory care communities were recruited to participate in this single-arm mixed-methods study. The group music intervention program included a total of 12 sessions delivered over 4 weeks. Agitation was assessed quantitatively at weeks 0, 2, and 4. Qualitative interviews of memory care staff were conducted post-intervention. Data were analyzed using linear mixed-effects models and qualitative content analysis. The study sample (N = 19) had a mean age of 82.74, and 73.7% were female. The great majority of participants completed the intervention and 63.2% experienced a reduction in agitation, suggesting that the intervention is feasible and acceptable in memory care and may be efficacious. Future research should evaluate the efficacy of the intervention in a randomized controlled trial.

Association Between Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Cross-Sectional Analysis.

OBJECTIVES: To determine whether music engagement influences middle-aged and older adults' performance on episodic memory tasks. METHOD: Secondary data analysis of a sample (N = 4,592) of cognitively healthy adults from the 2016 Health and Retirement Study was used for this study. Multivariable regression models were used to analyze the cross-sectional differences in performance on tasks of episodic memory between participants who listened to music (n = 3,659) or sang or played an instrument (n = 989). RESULTS: On average, participants recalled 10.3 words out of a possible 20. Regression analyses showed that both listening to music and singing or playing an instrument were independently associated with significantly better episodic memory. DISCUSSION: The findings provide the first population-based evidence that music engagement is associated with better episodic memory among middle-aged and older adults. Future studies should examine whether the relationship between music engagement and episodic memory can be replicated in other populations and that the association persists in longitudinal studies.

Factors Associated With Assisted Living Facility Closure.

BACKGROUND AND OBJECTIVES: Assisted living facilities (ALFs) have experienced rapid growth in the past few decades. The expansion in the number of ALFs may cause markets to become oversaturated, and a greater risk of unprofitable ALFs to close. However, no studies have investigated ALF closure. This study adapted a model developed for the nursing home market for the ALF market to examine the organizational, internal, and external factors associated with closure. RESEARCH DESIGN AND METHODS: Data on 1,939 ALFs operating in 2013 from Florida were used to estimate a logistic regression to examine the organizational, internal, and external factors that were associated with closure between 2013 and 2015. RESULTS: During the 2-year study period, 141 ALFs (7.3%) closed. Significant factors associated with increased odds of closure included fewer beds, not accepting Medicaid, and more deficiencies. Two factors (market concentration and population density) were marginally significant. DISCUSSION AND IMPLICATIONS: The results of this study confirm the usefulness of a model that includes organizational, internal, and external factors to predict ALF closure. These outcomes highlight the concerns that closure can affect access to community-based long-term care, especially for rural older adults, and indicate an expansion of Medicaid acceptance in ALFs could be protective against closure.

Factors associated with self-medication in children and the decomposition of rural-urban disparities in China.

BACKGROUND: Self-medication in children is one of the greatest threats to children health in China. OBJECTIVES: The purpose of this study was to examine the potential factors associated with self-medication in children and explore rural-urban disparities. METHODS: A total of 2798 children enrolled in the study. Informed consent was obtained from each primary caregiver following a detail explanation about the purpose of the study. Multivariable logistic regression analysis and Oaxaca-Blinder decomposition analysis were used. RESULTS: The results showed that 38.2% primary caregivers of rural areas self-medicated their children, compared to 18.7% of those in urban areas. The urban primary caregivers with college or above education were more likely to self-medicate their children, while rural primary caregivers with college or above education were less likely to self-medicate their children. Children having unhealthy eating habits were more likely to have been self-medicated by their primary caregivers in urban and rural areas. Urban primary caregivers who spend more than 10 min from home to the nearest medical institution were more likely to self-medicate their children. In rural areas, children aged 3-6 years old, primary caregivers with monthly household income per capita of 1001-3000 Yuan, and children with chronic diseases are another set of enabling factors which impacted on self-medication. Unhealthy eating habits of children were the largest contributor to the rural-urban self-medication gap. CONCLUSIONS: Children's factors explained the largest portion of the rural-urban difference in self-medication among children. The evidence presented in this study suggests that public health policies addressing rural-urban differences in children' s factors could serve as an effective method for reducing rural-urban disparities in self-medication among children.

Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Cardiac Arrest in Adult Patients in the United States.

Background Factors associated with poor prognosis following receipt of extracorporeal membrane oxygenation (ECMO) in adults with cardiac arrest remain unclear. We aimed to identify predictors of mortality in adults with cardiac arrest receiving ECMO in a nationally representative sample. Methods and Results The US Healthcare Cost and Utilization Project's National Inpatient Sample was used to identify 782 adults hospitalized with cardiac arrest who received ECMO between 2006 and 2014. The primary outcome of interest was all-cause in-hospital mortality. Factors associated with mortality were analyzed using multivariable logistic regression. The overall in-hospital mortality rate was 60.4% (n=472). Patients who died were older and more often men, of non-White race, and with lower household income than those surviving to discharge. In the risk-adjusted analysis, independent predictors of mortality included older age, male sex, lower annual income, absence of ventricular arrhythmia, absence of percutaneous coronary intervention, and presence of therapeutic hypothermia. Conclusions Demographic and therapeutic factors are independently associated with mortality in patients with cardiac arrest receiving ECMO. Identification of which patients with cardiac arrest may receive the utmost benefit from ECMO may aid with decision-making regarding its implementation. Larger-scale studies are warranted to assess the appropriate candidates for ECMO in cardiac arrest.

The Influence of Health Literacy and Social Support on Loneliness Among Patients With Severe Mental Illness in Rural Southwest China.

Loneliness is an important risk factor for poor health outcomes among adults, especially among those with severe mental illnesses (SMIs). Existing research has shown that adults with SMIs often lack health literacy, which contributes to more restricted social networks and low levels of social support. The objective of this cross-sectional study was to examine the influence of health literacy and social support on the loneliness of patients with SMI in rural Southwest China. We recruited 300 patients with SMI in rural Southwest China between December, 2017 to May, 2018 via a multi-stage stratified random sampling approach. We used structural equation modeling (SEM) test the hypothesized relationships among the variables of the 270 patients who completed the survey. Results of the SEM showed that health literacy was both directly and indirectly associated with loneliness, with social support playing a mediating role. These findings suggest psychoeducation for SMI patients, and their informal caregivers, may offer beneficial effects toward reducing loneliness in this vulnerable population. Further, social support is another potential target for intervention development for improving patient outcomes.

Enhancing care transitions intervention with peer support to improve outcomes among older adults with co-occurring clinical depression: a pilot study.

The Care Transitions Intervention (CTI) is an evidence-based intervention aimed at supporting the transition from hospital back to the community for patients to ultimately reduce preventable re-hospitalization. In a pilot randomized controlled trial, we examined the preliminary effectiveness of an Enhanced Care Transitions Intervention (ECTI), CTI with the addition of peer support, for a racially/ethnically diverse sample of older adults (age 60+) with co-morbid major depression. We observed a significant decline in health-related quality of life (HRQOL) after being discharged from the hospital among those who received CTI. Additionally, those who received ECTI either maintained HRQOL scores, or, saw improvement in HRQOL scores. Findings suggest the Enhanced Care Transitions Intervention can maintain or improve HRQOL and reduce disparities for older participants from diverse racial/ethnic backgrounds with clinical depression.

A tailored telehealth group tobacco cessation treatment program for people with HIV: Study protocol for a randomized controlled trial.

BACKGROUND: Smoking-related illnesses are the leading cause of death among people with HIV (PWH). Yet, there are few effective evidence-based interventions that help PWH quit smoking. The group-based program Positively Smoke Free is a biobehavioral cessation intervention for PWH with a growing evidence base. This study builds on prior work of Positively Smoke Free and addresses numerous weaknesses of prior trials for this population. We describe the Positively Quit Trial, a randomized controlled trial comparing a videoconferencing delivered Positively Smoke Free intervention to an attention-matched condition, assessing cessation over a 1-year period. METHODS: This attention-matched, randomized (1:1) controlled trial compares Positively Smoke Free Video-Groups to an updated version of Healthy Relationship Video-Groups. Participants are PWH, aged 18 years and older, who smoke at least one cigarette per day. All are offered nicotine replacement therapy patches and given brief advice to quit. Participants are enrolled in 12 group sessions focusing on either smoking cessation for PWH or broader topics regarding living healthy with HIV; in both conditions, Social Cognitive Theory is the guiding theoretical framework. Participants complete assessments at baseline, days 42, 90, 180, and 360; self-reported abstinence is verified with a video-observed cheek swab sent to a lab and tested for cotinine. PRIMARY OUTCOMES: Biochemically confirmed 7-day point prevalence smoking abstinence at day 360 is the primary outcome. Cost per quit, sustained abstinence at various timepoints, and biochemical confirmed abstinence at three and six months are secondary outcomes. Effects of smoking cessation on CD4 and virologic suppression are also explored.

Movement-based mind-body practices and cognitive function in middle-aged and older adults: Findings from the Midlife in the United States (MIDUS) study.

OBJECTIVES: Cognitive function is a key component of healthy aging. While conventional physical activities (walking, jogging, etc.) have been shown to support physical and cognitive health in late-life, it remains unclear whether traditional Eastern movement-based mind-body practices (MBP) have long-term cognitive benefits above and beyond conventional leisure physical activities. This study examines the relationship between movement-based MBP and cognitive function in middle-aged and older adults during a 10-year follow-up period. METHODS: We used data from Waves 2 (2004-05) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. MIDUS initially surveyed a national probability sample of community-living adults aged 24-75 years in 1995 (Wave 1). Tests of cognitive functioning measuring executive function and episodic memory were added in Wave 2 and repeated in Wave 3. We estimated multivariable linear regression models to examine the effect of MBP (Wave 2) on the episodic memory and executive function (Wave 3) while controlling for covariates (sociodemographic factors, health, and cognitive function at Wave 2). RESULTS: A total of 2097 individuals aged 42-92 years (M = 64 ±â€¯11, 56 % women) were included. After controlling for sociodemographic factors, health and functional status, and prior levels of cognitive function, engaging in MBP was independently associated with a smaller decline in episodic memory (b = 0.11, p = .03), but not executive function (b=0.03, p = .34). DISCUSSION: The findings provide the first large population-based evidence supporting the cognitive benefits of MBP over a 10-year period among middle-aged and older adults. Future research should examine whether MBP are effective non-pharmacological intervention to attenuate age-related cognitive decline.

Health Literacy Mediates the Association Between Socioeconomic Status and Productive Aging Among Elderly Chinese Adults in a Newly Urbanized Community.

Productive aging, or older adults engaging in paid or unpaid activities that produce socially valued goods or services, has been suggested to have the beneficial impact on older adults' health and well-being. We performed a cross-sectional study to examine the influence of health literacy on the relationship between socioeconomic status (SES) and productive aging among older Chinese adults in a newly urbanized community. Data was collected from 995 older adults from a newly urbanized community between June and August 2013 in Chengdu, China. We used structural equation modeling (SEM) to test the hypothesized relationship among SES, health literacy and productive aging. Results showed that education attainment and income had a direct positive effect on health literacy (ß = 0.47and ß = 0.15, respectively). Education had a partial indirect effect on productive aging through health literacy (ß = 0.27). And health literacy was an important factor in improving the productive aging of the elderly. Interventions targeting health education and health promotion should be taken to improve health literacy of older adults under the background of urbanization, especially for those with lower SES.

Social support and quality of life among rural family caregivers of persons with severe mental illness in Sichuan Province, China: mediating roles of care burden and loneliness.

OBJECTIVE: To explore the relationship between social support and quality of life (QoL) among family caregivers of persons with severe mental illness (SMI) and examine the mediating roles of care burden and loneliness. METHODS: A cross-sectional study was carried out between December 2017 and May 2018. A random sample of 256 family caregivers of persons with SMI in rural areas of Sichuan Province, China was recruited for participation. Survey data on socio-demographics, social support, care burden, loneliness, and QoL were collected via in-person interviews. Multiple linear regression analysis and structural equation modeling (SEM) were used to test the hypothesized relationships. RESULTS: The majority (72.7%) of family caregivers of persons with SMI in this study reported having low QoL. Social support was positively associated with QoL and negatively associated with care burden and loneliness. The findings suggested the mediating roles of care burden and loneliness on the association between social support and QoL. CONCLUSION: The hypothesized model was found to be a suitable model for predicting QoL among family caregivers of persons with SMI. The findings can help inform the design of future interventions aimed at enhancing social support, reducing care burden and loneliness, which may be helpful to improve caregivers' QoL. Future study is required to find a causal path to promote QoL among family caregivers of persons with SMI.

Efficiency of an mHealth App and Chest-Wearable Remote Exercise Monitoring Intervention in Patients With Type 2 Diabetes: A Prospective, Multicenter Randomized Controlled Trial.

BACKGROUND: Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible. OBJECTIVE: We aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise. METHODS: Patients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program. RESULTS: Of the 101 participants who were enrolled, the majority of them (85/101, 84.2%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71%) than in the intervention group (18/44, 41%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference -2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference -1.8% vs -0.8%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group. CONCLUSIONS: This was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080.